Bilious Vomiting in Neonates Flashcards
what conditions can lead to bilious vomiting in neonates?
- duodenal atresia
- malrotation with volvulus
- jejunal/ileal atresia
- meconium ileus
- necrotising entercolitis
at what age does duodenal atresia typically present?
few hours after birth
what does AXR show in duodenal atresia?
double bubble sign
what is the treatment for duodenal atresia?
duodenoduodenostomy
what is malrotation with volvulus typically caused by?
incomplete rotation during embryogenesis
at what age does malrotation with volvulus typically present?
3-7 days after birth
how does malrotation with volvulus present?
- biliouos vomiting
- soft abdomen –> strangulation of the gut (firm abdomen)
what is seen on upper GI contrast study in malrotation with volvulus?
DJ flexure is more medially placed
what is seen on USS in malrotation with volvulus?
abnormal orientation of SMA and SMV
what is the treatment for malrotation with volvulus?
ladd’s procedure
what is the cause of jejunal/ileal atresia?
vascular insufficiency in utero
at what age does jejunal/ileal atresia typically occur?
within 24 hours of birth
what will AXR show in jejunal/ileal atresia?
air-fluid levels
what is the treatment of jejunal/ileal atresia?
laparotomy with primary resection and anastomosis
what condition is meconium ileus associated with?
cystic fibrosis
at what age does meconium ileus present?
first 24-48 hours of life
how does meconium ileus present?
- bilious vomiting
- abdominal distension
what is seen on AXR meconium ileus?
air-fluid levels
what is the treatment for meconium ileus?
surgical decompression
what are the risk factors for necrotising enterocolitis?
- prematurity
- inter-current illness
at what age does necrotising enterocolitis typically present?
usually 2nd week of life
what is seen on AXR in necrotising enterocolitis?
dilated bowel loops
what is the management of necrotising enterocolitis?
- non-perforated = supportive
- perforation = laparotomy and resection
