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Phase 3a Paeds > Neonates GI > Flashcards

Neonates GI Flashcards

1
Q

What is necrotising enterocolitis?
what age is it common in?

A

2-4 week premature baby

Necrosis (tissue death)
+/- infection (KEEPS) of the intestine due to ischemia + infection, inflammation

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2
Q

RF for necrotising enterocolitis?

A

Indomethacin use (NSAID)
Low breast fed
premature
low birth weight

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3
Q

Sx of necrotising enterocolitis?

A

Abdo distension (with absent bowel sounds)
Erythematous shiny taught skin
Bile streaked vomiting
Bloody stools
Resp distress + feed intolerance

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4
Q

Dx of necrotising enterocolitis?

A

Bloods - FBC, U+E, Clotting screen, sepsis culture, MC+S

Abdo xray

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5
Q

What is seen on abdominal xray in necrotising enterocolitis?

A

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)

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6
Q

Tx of necrotising enterocolitis?

A

Total parenteral feed (through vein)
IV ceftriaxone + vancomycin
Last line = laparotomy (remove necrotic bowel)

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7
Q

Complications of necrotising enterocolitis?

A

perforation
sepsis
shock
DIC

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8
Q

What is oesophageal atresia?

A

Congenital defect where the oesophagus terminates into a blind pouch rather than connecting normally to stomach - separates upper and lower oes
blind ending oesophagus

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9
Q

What is the MC oesophageal atresia, what is it called when it is distally?

A

MC = Proximal blind ending 85%

Distally = tracheo-oesophageal fistula (abnormal connection between trachea + oesophagus)

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10
Q

Rf for oesophageal atresia?

A

Trisomies
VACTERL (Vertebral defects, anorectal anomalies, cardiac defects, trachea-oesophageal fistula/oesoph atresia)
IVF baby

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11
Q

Sx antenatally and postnatally of oesophageal atresia?

A

Antenatal = Polyhydramnios (baby’s inability to swallow and absorb amniotic fluid)

Postnatally =
feed regurgitation,
frothy saliva,
3C (cough, choke, cyanotic),
Difficulty passing NG tube

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12
Q

Dx of oesophageal atresia?

A

NG tube radiologically guided = blind end

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13
Q

Tx of oesophageal atresia?

A

Anastamosis surgery ASAP after birth

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14
Q

What is duodenal atresia?

A

Congenital defect = blind ending duodenum, duodenal stenosis at Ampulla of vater (just distal) - intestinal obstruction

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15
Q

RF for duodenal atresia?

A

Downs!!!
Maternal GDM
VACTERL
CHD
IVF baby
Annular pancreas (ring of pancreas surrounding 2nd part of duodenum)

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16
Q

1/3 of all duodenal atresia are Px who have?

A

Downs

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17
Q

Sx of duodenal atresia?

A

post feed bilous vomiting

18
Q

Dx of duodenal atresia?

A

Abdo X ray

19
Q

What would be seen on an abdo xray in a Px with duodenal atresia?

A

Double bubble sign (bubble in stomach + patent part of duodenum)

20
Q

Tx of duodenal atresia?

A

duodenoduodenostomy
IV fluids
NG decomp ASAP

21
Q

Neonatal Jaundice:
<24hr causes?

A

Pathological
TORCH,
haemolytic anemia,
Rh/ABO incompatability,
Sepsis

22
Q

Neonatal Jaundice:
1 day to 2 weeks causes?

A

Physiological (low RBC lifespan initially)
Breastfeeding

23
Q

Neonatal Jaundice:
>2 weeks causes?

A

Pathological:
Biliary atresia
choledochal cyst (biliary cyst)
Hypothyroid (congenital)
Criggler Najjar
CF

24
Q

what are the days for physiological jaundice for term and preterm babies?

A

<14d term
<21d pre term

25
Q

Dx of neonatal jaundice?

A

Bloods: FBC, U+E, LFT, TFT
(if High bilirubin = 24hr transcutaneous bilirubinometer)

26
Q

Tx of neonatal jaundice?

A

> 359 = phototherapy (bili = lumirubin = renally excreted)

> 428 = exchange transfusion

27
Q

Complication of neonatal jaundice?

A

if unconjugated = Kernicterus (unconj bilirubin accumulation in basal ganglia therefore neurological Sx) - risk of dyskinetic CP

28
Q

What is biliary atresia?

A

1 or more extrahepatic duct stenosed - obstructive jaundice
F>M 1/12000

29
Q

RF for biliary atresia?

A

CFC5
Downs
maternal DM

30
Q

Sx of biliary atresia?

A

Prolonged jaundice with biliary obstruction Sx (dark urine, pale/chalky white stool)

31
Q

Dx of biliary atresia?

A

High conjugated bilirubin

Abdo USS = triangle cord sign + Gall bladder abnormality

Cholangiography

32
Q

Ddx of biliary atresia?

A

choledochal cyst

33
Q

Tx of biliary atresia?

A

‘Kasai’ procedure = hepatoportoentero-ostomy (creates new pathway from liver to gut to bypass fibroses bile ducts)

34
Q

When is the best time to Treat biliary atresia?

A

the earlier the better <10 weeks = ‘golden period’

35
Q

What is gastroschisis and omphalocele?

A

congenital defects of abdo wall resulting in intestinal herniation

36
Q

Gastroschisis:
adjacent to?
peritoneum?
systemically?
AFP?
RF?
Mode of delivery?

A

Adjacent to abdo wall
No peritoneum
systemically well
High AFP (Abdo wall defect) - immediate repair
Prematurity
Can try vaginal delivery

37
Q

Omphalocele:
through?
peritoneum?
% have CHD/NTD?
AFP?
RF?
Mode of delivery?

A

Through umbilicus
Layer of peritoneum
40-80% have CHD/NTD - staged repair over 12 months
High AFP
Trisomies
should do C - section

38
Q

What is neonatal hepatitis syndrome?

A

Neonatal hepatitis is inflammation of the liver that occurs only in early infancy, usually between one and two months after birth

39
Q

Causes of neonatal hepatitis syndrome?

A

Galactosemia - can’t metabolise milk properly (cow, formula, breast) - jaundice + hepatomegaly = gram -ve sepsis

A1AT
Viral
Idiopathic

40
Q

Dx of neonatal hepatitis syndrome?

A

High conjugated bilirubin + liver biopsy - multinucleate rolettes

41
Q

Tx of neonatal hepatitis syndrome?

A

Dietician initiates special, non milk feed soy milk formula

Phase 3a Paeds (14 decks)

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