Neonates GI Flashcards
What is necrotising enterocolitis?
what age is it common in?
2-4 week premature baby
Necrosis (tissue death)
+/- infection (KEEPS) of the intestine due to ischemia + infection, inflammation
RF for necrotising enterocolitis?
Indomethacin use (NSAID)
Low breast fed
premature
low birth weight
Sx of necrotising enterocolitis?
Abdo distension (with absent bowel sounds)
Erythematous shiny taught skin
Bile streaked vomiting
Bloody stools
Resp distress + feed intolerance
Dx of necrotising enterocolitis?
Bloods - FBC, U+E, Clotting screen, sepsis culture, MC+S
Abdo xray
What is seen on abdominal xray in necrotising enterocolitis?
Pneumatosis intestinalis (gas within bowel)
Pneumoperitoneum (air in abdo cavity)
Dilated bowel loops
-Rigler sign (‘double walled’ sign - gas outlining both sides of bowel wall)
-Football sign
(both indicate pneumoperitoneum)
Tx of necrotising enterocolitis?
Total parenteral feed (through vein)
IV ceftriaxone + vancomycin
Last line = laparotomy (remove necrotic bowel)
Complications of necrotising enterocolitis?
perforation
sepsis
shock
DIC
What is oesophageal atresia?
Congenital defect where the oesophagus terminates into a blind pouch rather than connecting normally to stomach - separates upper and lower oes
blind ending oesophagus
What is the MC oesophageal atresia, what is it called when it is distally?
MC = Proximal blind ending 85%
Distally = tracheo-oesophageal fistula (abnormal connection between trachea + oesophagus)
Rf for oesophageal atresia?
Trisomies
VACTERL (Vertebral defects, anorectal anomalies, cardiac defects, trachea-oesophageal fistula/oesoph atresia)
IVF baby
Sx antenatally and postnatally of oesophageal atresia?
Antenatal = Polyhydramnios (baby’s inability to swallow and absorb amniotic fluid)
Postnatally =
feed regurgitation,
frothy saliva,
3C (cough, choke, cyanotic),
Difficulty passing NG tube
Dx of oesophageal atresia?
NG tube radiologically guided = blind end
Tx of oesophageal atresia?
Anastamosis surgery ASAP after birth
What is duodenal atresia?
Congenital defect = blind ending duodenum, duodenal stenosis at Ampulla of vater (just distal) - intestinal obstruction
RF for duodenal atresia?
Downs!!!
Maternal GDM
VACTERL
CHD
IVF baby
Annular pancreas (ring of pancreas surrounding 2nd part of duodenum)
1/3 of all duodenal atresia are Px who have?
Downs
Sx of duodenal atresia?
post feed bilous vomiting
Dx of duodenal atresia?
Abdo X ray
What would be seen on an abdo xray in a Px with duodenal atresia?
Double bubble sign (bubble in stomach + patent part of duodenum)
Tx of duodenal atresia?
duodenoduodenostomy
IV fluids
NG decomp ASAP
Neonatal Jaundice:
<24hr causes?
Pathological
TORCH,
haemolytic anemia,
Rh/ABO incompatability,
Sepsis
Neonatal Jaundice:
1 day to 2 weeks causes?
Physiological (low RBC lifespan initially)
Breastfeeding
Neonatal Jaundice:
>2 weeks causes?
Pathological:
Biliary atresia
choledochal cyst (biliary cyst)
Hypothyroid (congenital)
Criggler Najjar
CF
what are the days for physiological jaundice for term and preterm babies?
<14d term
<21d pre term
Dx of neonatal jaundice?
Bloods: FBC, U+E, LFT, TFT
(if High bilirubin = 24hr transcutaneous bilirubinometer)
Tx of neonatal jaundice?
> 359 = phototherapy (bili = lumirubin = renally excreted)
> 428 = exchange transfusion
Complication of neonatal jaundice?
if unconjugated = Kernicterus (unconj bilirubin accumulation in basal ganglia therefore neurological Sx) - risk of dyskinetic CP
What is biliary atresia?
1 or more extrahepatic duct stenosed - obstructive jaundice
F>M 1/12000
RF for biliary atresia?
CFC5
Downs
maternal DM
Sx of biliary atresia?
Prolonged jaundice with biliary obstruction Sx (dark urine, pale/chalky white stool)
Dx of biliary atresia?
High conjugated bilirubin
Abdo USS = triangle cord sign + Gall bladder abnormality
Cholangiography
Ddx of biliary atresia?
choledochal cyst
Tx of biliary atresia?
‘Kasai’ procedure = hepatoportoentero-ostomy (creates new pathway from liver to gut to bypass fibroses bile ducts)
When is the best time to Treat biliary atresia?
the earlier the better <10 weeks = ‘golden period’
What is gastroschisis and omphalocele?
congenital defects of abdo wall resulting in intestinal herniation
Gastroschisis:
adjacent to?
peritoneum?
systemically?
AFP?
RF?
Mode of delivery?
Adjacent to abdo wall
No peritoneum
systemically well
High AFP (Abdo wall defect) - immediate repair
Prematurity
Can try vaginal delivery
Omphalocele:
through?
peritoneum?
% have CHD/NTD?
AFP?
RF?
Mode of delivery?
Through umbilicus
Layer of peritoneum
40-80% have CHD/NTD - staged repair over 12 months
High AFP
Trisomies
should do C - section
What is neonatal hepatitis syndrome?
Neonatal hepatitis is inflammation of the liver that occurs only in early infancy, usually between one and two months after birth
Causes of neonatal hepatitis syndrome?
Galactosemia - can’t metabolise milk properly (cow, formula, breast) - jaundice + hepatomegaly = gram -ve sepsis
A1AT
Viral
Idiopathic
Dx of neonatal hepatitis syndrome?
High conjugated bilirubin + liver biopsy - multinucleate rolettes
Tx of neonatal hepatitis syndrome?
Dietician initiates special, non milk feed soy milk formula
