Anal malformation

Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. WHat is the next step? # NEET SS 22 

a) Cross table X ray

b) Invertogram

c) Anoplasty

d) Sigmoid colostomy

Ans a) Cross table X ray

1st step in such cases Rule out congenital abnormalities of spine, sacrum , kidney heart etc

2nd step Cross table x ray  If it shows Perineal fistula do ANoplasty, If x ray shows rectal gas below coccyx do PSA RP with or without colostomy, If it shows gas above coccyx with associated defects do colostomy

Table 67.14 Sabiston 

 

Steroid Refractory Ulcerative colitis

Q) Not used in steroid refractory severe Ulcerative Colitis ( AIIMS 2020 Nov) 

a) Infliximab
b) Azathioprine
c) Cyclosporine
d) Surgery

Ans b- Azathioprine

Cyclosporine is  immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response

Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.

The use of various anti–tumor necrosis factor-α  (TNF-α) monoclonal antibodies ( infliximab)  is well supported in the case of
severe ulcerative colitis refractory to steroids. 

Rectal Intussusception

Q) Pick the true statement about rectal intussusception

a) It is a rare finding in defecography

b) When found, it is found to be a common cause of refractory constipation

c) Biofeedback therapy and fibre intake is the mainstream treatment of choice

d) Rectopexy has had good long term results