hirshsprung or CF -

[ArchivalUser]

guest

a neonate develops bile-stained vomiting and progressive abdominal distention,and does not pass meconium over the first two days of life.The anus is patent,and the bowel loops are palpable.Plain radiograph shows bubbly meconium in the right lower quadrant.No localized areas of constriction or other abnormalities are noted.Which of the following is most likely etiologically related to this infants condition?
a.cystic fibrosis
b.hirschsprung's disease
c.merkel's diverticulum
d.omhalocele
e.polycystic kidney disease
would appreciate answer with explanation.

[ArchivalUser]

docespy - docespy

B

[ArchivalUser]

katty

CF.
Note AXRlain radiograph shows bubbly meconium in the right lower quadrant.No localized areas of constriction or other abnormalities are noted.Which of the following is most likely etiologically related to this infants.

Unabl to pass meconium is CF until proven otherwise.

In Hirschsprung you would expect area of dilatation above the aganglionic segment on plain AXR.

[ArchivalUser]

mash

CF
meconium ileus
meconium not passed during 1st 2 days

[ArchivalUser]

Aron - aronhk_md@comcast.net

Hirschsprung and CF are definitely the two hot answers here, and both are possible given most of what is described in the case.

Most testing questions on CF seem to focus on children over 1 yr old that are exhibiting signs/symptoms like recurrent pulmonary infxns, fat soluble vitamin def., etc.

In this case they are being tricky I think. Both can cause the vomiting, and both can have bile in it......as long as the bile canaliculi are not ALSO blocked by thickened secretions in CF.

The key here I think is that they actually say there is no constriction "...or other abnormalities noted." While in the real world there may be cases where narrowing of the affected segment and dilation of the proximal segment are not seen......this is the testing world. Aside from not passing meconium and a biopsy of the segment, the narrowing and dilation are part of every question I've read on congenital megacolon.

CF, on the other hand, is asked in multitudes of ways.....perhaps because it manifests in so many ways.

I too would have to go with CF.

Aron

[ArchivalUser]

tima

Hi,

does anybody know if quinidine is associated with type III hypersens or type III ( in autoimmune hemolitic anemia)

[ArchivalUser]

Lim

het guest do you have the answer?

[ArchivalUser]

amb

cystic fibrosis

[ArchivalUser]

guest

the answer is CF.The bubbly meconium is the give away here though both are causes of constipation.In hirchsprung's disease the rectum is affected in most cases and dilation of the segment proximal to it.If meconium was to been seen I should think that it would be in the left.
thanks