Neonatal and Infant Gastrointenstinal - Jaundice, Transient hypoglycemia Flashcards
Causes of neonatal jaundice in 1st 24hrs
Hemolytic disorders
-G6PD
-hereditary spherocytosis
-rhesus/ABO hemolytic disease
Causes of neonatal jaundice in 2nd day - wk2
Physiological - disappears after 1st week
Combination of factors
-more RBC
-more fragile RBC
-less developed liver function
Breast milk
Sepsis
Polycythemia
Cephalohematoma
Hemolytic disorders
Causes of neonatal jaundice that appears or persists after wk2
Biliary atresia
Hypothyroidism
Galactosemia
UTI
Breast milk jaundice
Prematurity
-immature liver function
-increased risk of kernicterus
Congenital infection
Biliary atresia
-what is it
-presentation
Obliteration or discontinuity in the extrahepatic biliary system => obstruction of bile flow
Jaundice beyond physiological 2wks
Dark urine, pale stool
Appetite and growth disturbance
Hepatosplenomegaly
LFTs - cholestatic
Total bilirubin - normal
Conjugated bilirubin - HIGH
Possible other differentials
A1AT - deficiency can also cause neonatal cholestasis
Sweat chloride test - CF affects biliary tree
Definitive - surgical intervention
-ABx coverage and bile acid enhancers postop
Pyloric stenosis
-what is it
-presentation
-diagnosis
-management
Idiopathic thickening of pyloric sphincter muscles => difficulty in eating
2wk onwards
Projectile non-bilious vomit 30mins after feeding
Palpable mass in upper abdo
Low Cl, K alkalosis
US
Ramstedt pyloromyotomy
Intussusception
-what is it
-presentation
Telescoping bowel
6-18months
Intense crying
Ischemia of affected bowel segment => acute cyclical colicky abdo pain
Vomiting
Late sign - red currant jelly stool
US
1st line - radiology-guided reduction by air insufflation
If fails or peritonitic => SURGERY
Intestinal malrotation
-what is it
-presentation
-investigations
-management
Cecum confined to RUQ => increased risk of volvulus and obstruction
FIRST MONTH OF LIFE
Bilious vomiting
Bowel obstruction distal to ampulla of Vater
Circulatory compromise => peritoneal signs
US - abnormal orientation of SMA, SMV
UGI contrast - DJflexure more medial
BO drip and suck
Surgery - Ladd’s procedure
-dividing peritoneal (Ladd’s) bands, and placing bowel in correct place
Hirschsprungs disease
-what is it
-risk factors
-presentations
-investigations
-management
Developmental failure of PNS Auerback and Meissner’s plexuses in rectum => uncoordinated peristalsis and functional obstruction
PRESENTS FROM BIRTH
Downs
Neonatal - failure/delay to pass meconium
Older children - constipation, abdo distention
AXR
Gold standard - rectal biopsy
Initial - rectal washout/bowel irrigation
Definitive - surgery
Esophageal atresia
-what is it
-presentation
Upper esophagus not continuous with lower esophagus
End blindly instead
Pooling of secretions
Choking, drooling, inability to feed
Non bilious vomit
Meconium ileus
-what is it
-associations
-presentation
-investigations
-management
Meconium is sticker and thicker than usual => obstruction
hrs-days after birth
CF!
Hirsprungs
Abdo distention
Bilious vomit
AXR
Contrast enema
Drip and suck
Enema
Surgery
Necrotising enterocolitis
-what is it
-presentation
Neonatal GI immaturity =>
-reduced acid prod
-reduced intestinal barrier
-immature immune function
-immature digestion
-immature motility
Made worse by frequent ABx use
Shiny distended abdo
Periumbilical erythema
Abdo tender
Bloody stool
Abdo discolouration, perforation and peritonitis
AXR
-Dilated bowel loops
-Bowel wall edema
-Pneumatosis intestinalis
-Portal venous gas
-Pneumoperitoneum
-Rigler’s sign
Blood cultures, gas, CRP, routine biochem
Drip and suck
Broad spec IV ABx - pen, gent, met
Surgery - peritoneal drain, laparotomy and stoma creation
Meckels diverticulum
-what is it
Congenital diverticulum of small intestine containing
-ectopic ileal, gastric, pancreatic mucosa
2 feet from ICV
2 inches long
Abdo pain - appendicitis mimic
Rectal bleeding - most common cause of painless massive GI bleeding needing transfusion in children
GI obstruction
Hemodynamically stable, less severe - Meckel’s scan (Tc99 has affinity for gastric mucosa)
Severe - mesenteric arteriography
Remove if narrow neck/symptomatic
GERD
-prevalence
-risk factors
-presentation
-diagnosis
-management
MOST COMMON CAUSE OF VOMITING IN INFANCY - some overlap with normal physiological processes
-lower esophageal sphincter has not fully developed
Preterm delivery
Neurological disorders
Develops before 8wks
Vomiting/regurgitation
-milky vomit after feed
-often after laying flat
Excessive crying, especially while feeding
Clinical diagnosis
Supportive
-30deg head up during feed
-infant sleeps on back
-don’t overfeed, have smaller and frequent feeds
1st line - gaviscon if breastfed
1st line - feed thickener if bottlefed
Can trial 4wk PPI if
-unexplained feeding difficulties
-distressing behaviour
-faltering growth
Neonatal hypoglycemia
-what is it
-risk factors
-presentation
-
Very common in the 1st 24hrs of life
Persistent/severe if
-preterm
-maternal DM
-IUGR
-hypothermia
-neonatal sepsis
-inborn errors of metabolism
Asymptomatic - utilise ketones, lactate
Autonomic
-jittery, irritable
-highRR => apnoea
-pale
-hypothermia
Neuroglycopenic
-poor feeding
-weak cry
-drowsy
-hypotonia
-seizures
Asymptomatic
-normal feeding
-monitor BM
Symptomatic or v low
-SCBU
-IV 10% dextrose
