2: Surgical problems in newborns Flashcards
Surgical problems in newborns often affect which system?
Gastrointestinal system
What are the two main causes of surgical GI problems in newborns?
Pre-term birth
Congenital malformations
What is pneumoperitoneum?
Free gas within the peritoneal cavity
What event precedes most cases of pneumoperitoneum?
Bowel perforation
Apart from bowel perforation, what are some other causes of pneumoperitoneum?
Mechanical ventilation
Pneumothorax, pneumomediastinum
Post-operative free air
Oral sex
What disease most commonly causes bowel perforation in pre-term babies?
Necrotising enterocolitis (NEC)
In which population is necrotising enterocolitis most commonly encountered?
Pre-term babies
What is the pathophysiology of NEC?
Idiopathic inflammation, ischaemia and perforation of the bowels
What are the symptoms of NEC in a pre-term baby?
Poor feeding
Bile-stained vomiting
Abdominal distension
Bloody stools
Diarrhoea
What are the signs of NEC on an abdominal X-ray?
Dilated bowel loops
Pneumoperitoneum
What are the three general types of bowel obstruction?
1. Intralumenal obstruction
2. Obstruction caused by the bowel wall itself
3. Compression of bowel from outside structures
What area of the small bowel is characteristically affected in Crohn’s disease?
Distal ileum
What is meconium?
What does it look like?
First stool passed by a foetus
Usually dark, black and thick in appearance
Which disease causes abnormally thickened secretions?
Cystic fibrosis
In cystic fibrosis, a baby’s meconium will be (thicker / thinner) than usual.
thicker
If a baby has cystic fibrosis, their meconium may be thicker than usual.
Where can it become stuck?
Which kind of obstruction does this cause?
Distal ileum - meconium ileus
Intralumenal obstruction
What are the signs and symptoms of meconium ileus?
Bile-stained vomiting
Abdominal distension
Failure to pass first stool by 2 days post-birth
Which investigation can be used to diagnose meconium ileus?
Abdominal X-ray with contrast enema
What is the appearance of meconium ileus on an abdominal X-ray with contrast enema?
Dense from rectum to distal ileum
Bubbly, patchy lucent appearance from there on - indicates meconium build-up
Which type of contrast is used in the diagnosis of meconium ileus?
Water-soluble contrast
How meconium ileus treated?
Water-soluble contrast enema usually clears the blockage out
Otherwise surgery
What congenital bowel wall problem may cause bowel obstruction in newborns?
Atresia
Duodenal, jejunal, ileal, colonic…
What is atresia?
Incomplete formation of a structure
In this case the bowel wall, causing incomplete or complete blockage if the tube is blind-ended
What problem, in which an organ protrudes somewhere it shouldn’t, can cause bowel obstruction?
Herniation
inguinal/femoral bowel herniation, leading to compression, ischaemia and perforation
Which condition must you exclude in any newborn with bile-stained vomiting?
Malrotation / Volvulus
Why must malrotation or volvulus be excluded in any newborn with bile-stained vomiting?
Ischaemia –> Necrosis –> Loss of huge length of small bowel
Which investigation can identify malrotation?
X-ray with contrast swallow
If you want a contrast swallow for a baby with suspected malrotation, what should you ask the radiographers for specifically?
Abdominal X-ray with water-soluble contrast swallow AND follow through
What surgical emergency should you suspect if a baby’s stool is “jelly-like”or“hard and sausage-shaped”?
Intussusception
telescoping of the bowel, causing ischaemia and necrosis
