Necrotising Enterocolitis

Question 1

Necrotising Enterocolitis etymology?

Answer 1

Nekros – make dead
Entero – small intestine
Col – large intestine

Question 2

Cause?

Answer 2

multifactorial, no one really knows;

Question 3

pathophysiology?

Answer 3

exaggerated immune response (to infection we think) within bowel > lots of inflammation > tissues die.

Question 4

most frequently affected areas of bowel?

-2

Answer 4

Distal terminal ileum and proximal colon

Question 5

when does it present?

basically how long after birth

Answer 5

Presents at 2nd week after birth (when neonates)

Question 6

How can mum prevent necrotising Enterocolitis?

Answer 6

Breastfeed

Question 7

How else can you prevent necrotising Enterocolitis?
- drug group 1

and when do you give?

Answer 7

steroids

antenatal

Question 8

Breastfeeding reduces risk by how many times?

Answer 8

6x

Question 9

what is the most common neonatal surgical emergency?

Answer 9

necrotising enterocolitis

Question 10

necrotising enterocolitis is a big cause of death in premature infants.

true or false?

Answer 10

true

Question 11

biggest RF?

Answer 11

pre-term

Question 12

other RF?

Answer 12

IUGR 
hypoxia
polycythaemia
exchange transfusion
formula milk

Question 13

why is IUGR a risk factor?

Answer 13

causes chronic bowel ischaemia

Question 14

initial symptoms of necrotising enterocolitis?

-5

Answer 14

Poor feeding 
abdominal distension 
vomit (which may have bile in it)
bloating
do not gain weight

Question 15

initial symptoms quickly deteriorates into what symptoms?

-3

Answer 15

abdominal discolouration
bloody stools
Shock

Question 16

1st line Ix?

Answer 16

AXR

Question 17

AXR features?

-7

Answer 17

dilated bowel loops

bowel wall oedema

pneumatosis intestinalis

stricture – can develop into obstruction

obstruction

Rigler sign

football sign

Question 18

what is pneumatosis intestinalis?

Answer 18

intramural gas

Question 19

what is Rigler’s sign?

Answer 19

air both inside and outside of the bowel wall

Question 20

what is football sign?

Answer 20

air outlining the falciform ligament

Question 21

what system is used to stage necrotising enterocolitis?

Answer 21

Bell’s stage

Question 22

what happens to peritoneum in necrotising enterocolitis?

Answer 22

peritonitis; gets inflamed

Question 23

in necrotising enterocolitis bowels is at risk of doing what (starts with p)?

Answer 23

perforation

Question 24

initial Mx for necrotising enterocolitis?

-5

Answer 24

stop Milk feeds

Insert nasogastric tube – drain off their stomach contents

IV fluids

IV antibiotics 10-14 days

Give TPN – need to give bowel a rest

Question 25

surgery is rarely needed for necrotising enterocolitis and this should be managed conservatively.

true or false

Answer 25

false

surgery is oft needed

Question 26

child has necrotising enterocolitis.

disease is localised.

what surgery is done?

Answer 26

local resection

Question 27

child has necrotising enterocolitis.

disease is extensive.

what surgery is done?

Answer 27

bowel resections then anastomose bowel

Question 28

child has necrotising enterocolitis.

what other indications are there for surgery?
-3

(basically what complications can happen from necrotising enterocolitis which will need surgery?)

Answer 28

GI perforates

Bowel becomes necrotic

GI obstruction

Question 29

initial Mx for necrotising enterocolitis?

-5

Answer 29

stop Milk feeds

Insert nasogastric tube – drain off their stomach contents

IV fluids

IV antibiotics 10-14 days

Give TPN – need to give bowel a rest

Question 30

Mortality rate?

Answer 30

22% - high

Question 31

AXR features?

-7

Answer 31

dilated bowel loops

bowel wall oedema

pneumatosis intestinalis

stricture – can develop into obstruction

obstruction

Rigler sign

football sign