common surgical problems of neonate

Question 1

main issues-
baby born too soon or
born with a condition

Answer 1

jejunal atresia 
inguinal hernia
malrotation
meconium ileus 
NEC

Question 2

X-ray interpretation

air looks black on xray

Answer 2

air in the bowel 
liver appear like lungs
hernia filled with air 
parallel running lines in the bowl 
air on both sides of a loop of bowel 
air in liver crack 
lots of signs of perforation due to being born too soon and gut not meant to used 
Dx- Necrotising enterocolitis 
special feed is given to manage NEC

Question 3

obstruction- term babies or otherwise who don't feed well. happens 
in the lumen
in the wall
outside the way 
maybe high or low

Answer 3

baby born at term keen to eat
at 48hr starts vomiting green stuff with distended
xray abdomen- a contrast from the from the bottom showing contracted large colon with bits that are dialted containing meconium in the bowel doughy feel to abdomen
meconium too dry to be passed and is due to cystic fibrosis and giving fluid can free up the meconium
Dx- meconium ileus

Question 4

congenital dead end in bowel can happen anywhere from mouth to anus- atresia

Answer 4

baby seen on xray had slight concerns in antenatal scans
fed after birth starts vomiting green stuff even after 6hrs tummy appears full and baby hasn’t passed motion
x-ray - very distended bowels and considerably higher up futher contrast investigation done showing dead-end of large bowel surgical connection of two ends required
Dx- atresia

Question 5

swelling in groin going into the scrotum and asymmetrical crease marks on the abdomen

Answer 5

crease marks used to make incisions to prevent nasty scars
bowel descends through the inguinal canal with the testes area of weakness
xray shows laddering or stacked up bowels

Question 6

malrotation - 60% of infants present within the 1st year and bilious vomitus is malrotation until proven otherwise
talk about colour of the vomitus

Answer 6

upper gi contrast xray ng tube contrast passes through the stomach down to the dueodenal-jejunal junction which is low and medial whereas it is supposed to be high and next to the stomach. this position is unstable and can lead to the rotation called midgut volvulus
the midgut is supplied by the superior mesenteric artery