Surgery in Neonates Flashcards
When are congenital problems of the gut usually found?
Antenatally
What are the ways that obstructions of the bowel can arise?
Blockage in the lumen, issue in the bowel wall, external compression of the bowel
When may a luminal blockage present?
At 48hrs old = not opened bowels, vomiting, distended doughy abdomen
How is a luminal blockage investigated?
X-ray with contrast = shows distended loops above blockage and narrowed loops below blockage
What does a narrow bowel in a baby indicate?
That the bowel hasn’t been used (i.e no food has passed through the bowel)
What is the soap bubble sign?
Haziness on x-ray that shows structure is less solid = sign of luminal blockage due to meconium ileus
What is one possible cause of an intralumenal blockage?
Cystic fibrosis = causes meconium ileus
How does a meconium ileus arise in cystic fibrosis?
Sticky substance in bowel prevents passage of meconium
What is atresia?
Dead end in the gut
What are some indications that a baby may have atresia?
Abnormal gut detected antenatally, vomiting at 6hrs after birth, distended abdomen, dilated bowel loops
What are some indications that a baby may have a blockage high up in their GI tract?
Early vomiting, dilated bowel loops high up in tract
What may still be passed in a baby with atresia?
Meconium = able to pass by blockage
Why does a baby with atresia have a distended abdomen?
All that the baby has swallowed in utero and since birth (i.e air) is stuck in the bowel
What may be a subtle sign of an inguinal hernia?
Unilateral loss of groin crease
What is the bowel at risk of in an inguinal hernia?
Perforation = being compressed by narrow inguinal canal
What is laddering?
Bowel loops lining up in an x-ray = sign of obstruction
What appearance does bile stained vomit have?
Moss green colour (liver bile is yellow but changes once it passes through the stomach)
How is a baby vomiting bile investigated?
Urgent upper GI contrast with follow through
Why may a baby start vomiting bile?
Has malrotation of bowel with volvulus
What causes malrotation with a volvulus?
Bowel is in wrong place = duodenum has not gone over to left side
When do infants with malrotation with a volvulus present?
From within first month to first year of life
Why is the bowel at risk of ischaemic death from malrotation with volvulus?
Midgut supplied by SMA = if bowel in wrong place then mesentery narrows and may twist, cutting off blood supply to the gut
