Bilious Vomiting in Neonates

Question 1

what conditions can lead to bilious vomiting in neonates?

Answer 1

• duodenal atresia
• malrotation with volvulus
• jejunal/ileal atresia
• meconium ileus
• necrotising entercolitis

Question 2

at what age does duodenal atresia typically present?

Answer 2

few hours after birth

Question 3

what does AXR show in duodenal atresia?

Answer 3

double bubble sign

Question 4

what is the treatment for duodenal atresia?

Answer 4

duodenoduodenostomy

Question 5

what is malrotation with volvulus typically caused by?

Answer 5

incomplete rotation during embryogenesis

Question 6

at what age does malrotation with volvulus typically present?

Answer 6

3-7 days after birth

Question 7

how does malrotation with volvulus present?

Answer 7

• biliouos vomiting
• soft abdomen –> strangulation of the gut (firm abdomen)

Question 8

what is seen on upper GI contrast study in malrotation with volvulus?

Answer 8

DJ flexure is more medially placed

Question 9

what is seen on USS in malrotation with volvulus?

Answer 9

abnormal orientation of SMA and SMV

Question 10

what is the treatment for malrotation with volvulus?

Answer 10

ladd’s procedure

Question 11

what is the cause of jejunal/ileal atresia?

Answer 11

vascular insufficiency in utero

Question 12

at what age does jejunal/ileal atresia typically occur?

Answer 12

within 24 hours of birth

Question 13

what will AXR show in jejunal/ileal atresia?

Answer 13

air-fluid levels

Question 14

what is the treatment of jejunal/ileal atresia?

Answer 14

laparotomy with primary resection and anastomosis

Question 15

what condition is meconium ileus associated with?

Answer 15

cystic fibrosis

Question 16

at what age does meconium ileus present?

Answer 16

first 24-48 hours of life

Question 17

how does meconium ileus present?

Answer 17

• bilious vomiting
• abdominal distension

Question 18

what is seen on AXR meconium ileus?

Answer 18

air-fluid levels

Question 19

what is the treatment for meconium ileus?

Answer 19

surgical decompression

Question 20

what are the risk factors for necrotising enterocolitis?

Answer 20

• prematurity
• inter-current illness

Question 21

at what age does necrotising enterocolitis typically present?

Answer 21

usually 2nd week of life

Question 22

what is seen on AXR in necrotising enterocolitis?

Answer 22

dilated bowel loops

Question 23

what is the management of necrotising enterocolitis?

Answer 23

• non-perforated = supportive
• perforation = laparotomy and resection