Necrotising enterocolitis Flashcards
Definition
Portion of the bowel undergoes ulceration and necrosis
Most commonly affected area
Ileum and colon
Epidemiology
1-5% preterm infants in NICU
Clinical presentation
Within first few days of life Feeding intolerance, delayed gastric emptying Abdominal distension Blood stools Ileus- decreased bowel sounds Evidence of perforation
Etiology (3)
Hypoxic-ischemic injury Enteral feeding Infection
Describe hypoxic-ischemic injury mechanism
Associated with hyotension, anemia, PDA, indomethacin, umbilical vessel catheterisation Intestinal injury due to reduced ability of neonate to regulate intestinal blood flow Tissue hypoxia= mucosal injury and bacterial invasion
Describe the enteral feeding mechanism
Never seen (usually) until enteral feeds +nutrient absorption= +oxygen demand–> GI dysmotility and stasis->+bacterial growth and invasion of ischemic mucosa and ischemic stress
Describe the infectious disease mechanism
+Bacterial proliferation
Risk factors (5)
Preterm
Physical exam findings (think systemic and system)
Systemic- lethargy, poor feeding, febrile, jaundice CV- hypotension, +CRT Resp- tachypnea, distress, apnea GI- distension, tenderness, erythema, hematochezia, +aspirated, billous vomiting
Findings when perforation
Sepsis Shock Peritonitis DIC
Investigations
FBC ABG Lactate Coagulation UEC, LFTs Blood and stool culture Abdominal xray
Findings on FBC
Leukocytosis or -ve Anemia Thrombocytopenia Repeat every 6 hours
Findings on BC
Negative- must exclude bacterial sepsis
Findings on serum electrolyte panel
Hyponatremia
Why do ABG
Determine need for respiratory support
Findings on abdominal xray
Dilated bowel Abnormal gas pattern Thickened bowel wall
What is the pathognomonic finding on AXR and what is the finding
Pneumostasis intestinalis Train-track lucency->intramural bubbles are gas produced by bacteria
Findings on US
Identify areas/location of abscessed with a walled off perforation
Management
NPO Fluid resuscitation NG decompression Supportive therapy Correct electrolyte abnormalities Antibiotics (ampicillin, gent, metronidazole if suspect perforation) Serial AXR to detect perforation Surgical resection of necrotic bowel and surgery for complications
Complications
Perforation
Strictures
Fistulae
Abscess
Recurrent
Short gut syndrome
Malabsorption
Cholestasis
Enterocysts
