Necrotising Enterocolitis Flashcards
What is necrotising enterocolitis (NEC)?
It is defined as a surgical emergency, in which acute bowel inflammation results in necrosis
What is the most common surgical emergency in the neonatal period?
Necrotising Enterocolitis
What is the pathophysiological cause of necrotising enterocolitis?
There is damage to the intestinal mucosa due to vascular insults, toxin exposure, infection or genetic factors
This damage allows pathogenic colonisation of normal commensal bacteria
What is the pathophysiological consequence of necrotising enterocolitis?
It can lead to bowel perforation, peritonitis and ultimately septic shock
What seven risk factors are associated with necrotising enterocolitis?
Premature < 32 Weeks
Low Birth Weight
Formula Feeding
Enteral Feeding
Respiratory Distress
Congenital Heart Disease
Antibiotic Administration
When does necrotising enterocolitis tend to present?
A corrected gestational age of 30 – 33 weeks
What are the seven clincial features of necrotising enterocolitis?
Feeding Intolerance
Green Bile Vomiting
Abdominal Distension
Abdominal Tenderness
Palpable Abdominal Mass
Reduced Bowel Sounds
Haematochezia
What is haematochezia?
It is defined as the presence of fresh blood in stools
What four investigations are used to diagnsoe necrotising enterocolitis?
Blood Tests
Arterial Blood Gas (ABG)
Abdominal Ultrasound Scans
Abdominal X-Rays
What four blood test results indicate necrotising enterocolitis?
Decreased Neutrophil Levels
Decreased Platelet Levels
Increased CRP Levels
Positive Blood Culture
What three ABG features indicate necrotising enterocolitis?
Decreased pH Levels
Increased Bicarbonate Levels
Increased Lactate Levels
When are abdominal ultrasound scans used to diagnose necrotising enterocolitis?
They are the first line investigation
What are the three features of necrotising enterocolitis on abdominal ultrasound scans?
Portal System Air Bubbles
Abdominal Ascites
Bowel Perforation
What is the gold standard investigation used to diagnose necrotising enterocolitis?
Abdominal X-Rays
What are the seven features of necrotising enterocolitis on abdominal x-rays?
Dilated Bowel Loops
Thickened Bowel Wall
Pneumatosis Intestinalis
Portal Venous Gas
Pneumoperitoneum
Rigler Sign
Football Sign
What is pneumatosis intestinalis?
It is defined as the presence of gas in the bowel wall
What is pneumoperitoneum? What does it indicate in necrotising enterocolitis?
It is defined as the presence of free gas in the peritoneal cavity
Bowel Perforation
What is Rigler sign?
It is when both sides of the bowel wall are visble
It occurs when there is presence of gas inside the bowel lumen and within the peritoneal cavity
What is the football sign?
It is when air outlines the falciform ligament
What is the most appropriate management option in suspected necrotising enterocolitis?
Urgent referral to paediatric surgery
What are the five immediate management options of necrotising enterocolitis?
Nil By Mouth
Total Parenteral Nutrition
Nasogastric Tube Insertion
IV Fluids
IV Antibiotics
Name two antibiotics used to manage necrotising enterocolitis
Cefotaxime
Metronidazole
What is the surgical management option of necrotising enterocolitis?
Bowel Laparoscopy
When is bowel laparoscopy used to manage necrotising enterocolitis?
It is used to manage necrotising enterocolitis, in which bowel perforation development has occurred
What is bowel laparoscopy?
It involves removal of the perforated and necrotic bowel from the abdomen
What are the six complications used to manage necrotising enterocolitis?
Bowel Perforation
Peritonitis
Septic Shock
Short Bowel Syndrome
Bowel Strictures
Bowel Abscess