bilious vomiting in neonates Flashcards
which condition is duodenal atresia assoc with
Downs syndrome
presentation of duodenal atresia
bilious vomiting a few hours after birth
diagnosis of duodenal atresia
AXR = double bubble sign
contrast study may confirm
management of duodenal atresia
duodenoduodenostomy
malrotation with volvulus cause
usually caused by incomplete rotation during embryogenesis
malrotation with volvulus presentation
bilious vomiting 3-7days after birth
volvulus with compromised circuation –> peritoneal signs + haemodynamic stability
malrotation with volvulus investigation
upper GI contrast - DJ flexure is more medially placed
USS - abnormal orientation of SMA + SMV
malrotation with volvulus management
Ladd’s procedure
condition assoc with meconium ileus
cystic fibrosis !
20% with meconium ileus have CF
meconium ileus presentation
in 1st **24-48hrs **of life with abdominal distension + bilious vomiting
meconium ileus investigation
air-fluid levels on AXR
sweat test –> to confirm CF
management of meconium ileus
surgical decompression
- serosal damage may require segmental resection
necrotising enterocolitis risk factors
prematurity
intercurrent illness
necrotising enterocolitis presentation
feeding intolerance
abdominal distension
bloody stools
abdo discolouration
perforation -> peritonitis
necrotising enterocolitis investigation
abdo xray
- dilated bowel loops, bowel wall oedema
- penumatosis intestinalis (intramural gas)
- portal venous air
- pneumoperitoneaum - from perforation
Riglers sign = air both in + outside bowel wall
management of necrotising enterocolitis
non-perforated = conservative + supportive
perforation/clinical deterioration = laparotomy + resection
meconium aspiration syndrome
respiratory distress in newborn as a result of meconium in trachea
- occur in immediate neonatal period
commoner inpost term deliveries (42wks+)
RF - maternal hypertension, preeclmapsia, chorioamnionitis, smoking or substance use
