Baby problems Flashcards
What does intussusception look like?
This child is demonstrating symptoms suggestive of intussusception, which commonly presents with nausea, bilious vomiting, and intermittent crampy abdominal pain. This occurs with telescoping of a bowel segment into itself and may lead to edema, arterial occlusion, gut necrosis, and death. It is the most common cause of bowel obstruction in the first 2 years of life. Ileocecal intussusception is the most common type. A sausage-shaped abdominal mass is often palpable upon examination. Children who are too young to communicate may present with crying and are often noted to lie in positions where their knees are drawn up to their chest to minimize discomfort. The question stem may also mention “currant jelly” stools. Abdominal ultrasound is generally part of the initial workup; however, air contrast or water-soluble enema is both diagnostic and therapeutic. Following reduction via enema, treat with supportive care.
Meckel Diverticulum is what? What do we do?
Meckel diverticulum is the most common malformation of the intestinal tract, occurring in up to 2% of the population. The single most common presenting symptom is painless rectal bleeding in the form of melena, followed by intestinal obstruction from volvulus or intussusception. Occasionally the patient may suffer from painful diverticulitis mimicking appendicitis. Meckel diverticulum is located in the distal ileum, usually within about 60 to 100 cm (about 2 feet) of the ileocecal valve.
The rule of 2s should be remembered when making the diagnosis: 2% (of the population), 2 feet (from the ileocecal valve), 2 inches (in length), 2% are symptomatic, 2 types of common ectopic tissue (gastric and pancreatic), 2 years is the most common age of presentation, and males are 2 times as likely to be affected as females. Treatment is with surgical resection.
