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Year 4 Repro and paeds > Billious vomiting > Flashcards

Billious vomiting Flashcards

1
Q

what colour is bile stained vomit?

A

green

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2
Q

what colour is bile?

A

yellow

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3
Q

what is billious vomit suggestive of?

A

intestinal obstruction - distal to ampulla of vater

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4
Q

cause of duodenal atresia

A

failure of recanalisation of fetal duodenum

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5
Q

duodenal atresia incidence

A

1 in 5000

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6
Q

duodenal atresia diagnosis

A

antenatal USS
polyhydramnios
double bubble sign

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7
Q

presentation of duodenal atresia

A

billious vomiting in first hours of life
scaphoid abdomen
double bubble sign xray

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8
Q

duodenal atresia initial management

A

NG tube insertion

IV resus

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9
Q

duodenal atresia definitive management

A

laparotomy

diamond shaped duodeno-duodenostomy = kimura

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10
Q

duodenal atresia associations

A

50% congenital abnormalities
trisomy 21 - 30%
CHD, VACTERL, renal anomalies, malrotation

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11
Q

VACTERL

A 
vertebral 
anal atresia
cardiac defects
Tracheooesophageal fistula
renal anomalies 
limb abnormalities
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12
Q

normal rotation during development of the gut

A

midgut herniate into extra-embryonic coelom
270 counter clockwise turn around sup.mesen.artery
DJ flexure in LUQ

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13
Q

where does the DJ junction lie in malrotation?

A

right of the midline

caecum abnormally located

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14
Q

malrotation - caecum

A

fixed to right lateral abdominal wall by ladds bands

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15
Q

volvulus

A

bowel mesentery prone to twisting around itself

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16
Q

what can volvulus lead to?

A

high intestinal obstruction
midgut ischaemia
infarction
death

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17
Q

malrotation incidence

A

1 in 6000
75% <1months
90% <1 year

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18
Q

malrotation presentation

A

billious vomiting

rapid deterioration with abdominal pain and distention

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19
Q

late signs of malrotation/volvulus

A 
metabolic acidosis
hypovolaemia
abdominal wall erythema
haematemesis
malaena
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20
Q

infant with billious vomiting has what until proven otherwise?

A

malrotation

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21
Q

diagnosis of malrotation

A

upper GI contrast study
abnormal DJ flexure
corkscrewing of duodenum - volvulus

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22
Q

malrotation treatment

A

fluid resus
broad spectrum abx
exploration with ladds procedure

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23
Q

ladds procedure

A 
counter clockwise detorsion of bowel 
divide ladds bands
broaden mesentery
incidental appendicectomy
reposition small bowel
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24
Q

cause of jejuno-illeal atresia

A

ischaemic insult late in utero

reabsorption of affected segment

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25
Q

jejuno-illeal atresia presentation

A

abdominal distention

billious vomiting

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26
Q

jejuno-illeal atresia AXR

A

triple bubble sign
dilated SB loops
no distal gas

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27
Q

jejuno-illeal atresia contrast enema

A

disused micro-colon

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28
Q

jejuno-illeal atresia treatment

A

resection of affected atretic gut

primary anastamosis

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29
Q

meconium ileus association

A

CF

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30
Q

meconium in CF

A

low water content
high protein waste
thick, hard - intestinal obstruction

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31
Q

CF gene mutation

A

delta F508 - CFTR

32
Q

meconium ileus antenatal

A

hyperechogenic bowel

non-visualisation gallbladder

33
Q

presentation of simple ileus

A

abdominal distention and billious vomiting 1-2 days PN

34
Q

meconium ileus examination

A

empty rectum

meconium filled loops palpable in abdomen

35
Q

what can complicated ileus result in?

A 
intrauterine volvulus 
atresia 
perforation 
meconium peritonitis 
pseudocyst
36
Q

meconium ileus AXR

A

soap bubble sign

swallowe airm mixed with meconium

37
Q

meconium ileus treatment

A

contrast enema

38
Q

other meconium ileus treatments

A

N-acetylcysteine PR and via NG tube

laparotomy

39
Q

Hirschprung’s disease

A

absent intestinal ganglionic cells

40
Q

Hirschprung’s disease incidence

A

1 in 5000

90% neonatal period

41
Q

Hirschprung’s disease presentation

A

fail to pass meconium at 48hrs, billious vomiting and abdo distention

42
Q

Hirschprung’s disease types

A

75% short segment - male

25% long segment - equal

43
Q

Hirschprung’s disease AXR

A

grossly dilated bowel proximal to affected segment

44
Q

Hirschprung’s disease rectal exam

A

rapid propulsion of stool

45
Q

Hirschprung’s disease gold standard diagnosis

A

suction rectal biopsy

46
Q

Hirschprung’s disease suction rectal biopsy

A

absent ganglion cells

increased uptake of Acetylcholinesterase in hypertrophied nerve trunks

47
Q

Hirschprung’s disease treatment

A

regular rectal washouts

surgery - resect affected bowel and pull through of normal ganglionated bowel with anastamosis

48
Q

Hirschprung’s disease contrast enema

A

collapsed distal rectum with dilated proximal bowel

49
Q

low vs high anorectal malformation

A 
low = opening on perineum
high = fistula between bowel/urinary tract
50
Q

anorectal malformation - what do all require?

A

abdo/spinal XR, ECHO, renal/spinal USS, pass NGT

51
Q

treating low ARM

A

anal cutback

52
Q

treating high ARM

A

defunctioning stoma

staged PSARP - posterior saggital anorectoplasty

53
Q

low ARM association post op

A

constipation

54
Q

high ARM association

A

long term incontinence

55
Q

NEC

A

ischaemia and infection of bowel wall

56
Q

NEC untreated

A

perforation, sepsis and death

57
Q

NEC incidence

A

1-3 in 1000

8% NICU

58
Q

NEC predisposing factors

A 
prematurity
resp distress
birth asphyxia 
prolonged ROM
caesarean section 
CHD
formula feeds 
foetal distress labour
59
Q

NEC presentation

A

increasing abdo distention
feed intolerance
billious vomiting

60
Q

NEC aspirates

A

billious ng aspirate

61
Q

NEC later signs

A

abdominal wall discoluration
haematochezia
apnoea, bradycardia, generalised oedema

62
Q

NEC radiography

A 
dilated loops of bowel
pneumatosis intestinalis 
pneumoperitoneum
fixed loop of bowel 
football sign = perforation
63
Q

pneumotosis intestinalis

A

NEC

64
Q

NEC management

A

IV abx triple therapy
cessation oral feeds
gastric decompression

65
Q

NEC - signs conservative management failing

A

thrombocytopenia
resp instability
worsenign acidosis
abdominal erythema

66
Q

NEC surgery

A

laparotomy - intestinal resection

anastamosis/stoma

67
Q

NEC complications post-op

A

strictures
short bowel syndrome
adhesive obstruction

68
Q

NEC mortality

A

25-40%

69
Q

meckels diverticulum is a remnant of?

A

omphalomesenteric duct

70
Q

what does meckels diverticulum contain?

A

heterotopic mucosa

71
Q

meckels diverticulum presentation

A

bleeding - ulceration
obstruction - intussusception or volvulus
inflammation

72
Q

what reduces risk of adhesional obstruction?

A

laparoscopy

73
Q

adhesional obstruction presentation

A

colicky abdominal pain
billious vomiting
abdo distention
absence flatus/stool

74
Q

adhesional obstruction diagnosis

A

AXR

contrast flow through

75
Q

adhesional obstruction treatment

A

resus fluids
NG tueb to decompress gut
laparotomy and adhesiolysis

Year 4 Repro and paeds (14 decks)

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