Surgical Problems of the Neonate Flashcards
List the 3 ways a tube can become obstructed.
- External pressure.
- Something in the lumen, intra-luminal obstruction
- Something in the wall.
At what day, should you be concerned if a baby has no passed faeces?
By day 3
Describe a babies first poo.
Black, like tar (this is called meconium) – if it doesn’t come through then you start to worry
What is meconium ileus the initial presentation of?
CF
How many babies with CF will present with meconium ileus?
1/3
What is meconium ileus?
Lumen is full of meconium – thick and black
Where is the obstruction in meconium ileus?
LUMEN OF THE BOWEL !!!
What is the characteristic sign of meconium ileus?
Soap sign/foaming sign
What is the Ix for meconium ileus?
Water soluble contrast, given rectally - x ray
What would be seen on x-ray of a child with meconium ileus?
Distended loops of bowel upstream
Tangled bit of bowel – filled with ‘stuff’ which we can’t move, doughy
Distended small bowel
Describe the presentation of a baby with meconium ileus.
Baby has not passed faeces yet (48 hrs should be upper limit)
Tummy big, and baby is vomiting. Initially keen to eat.
What is the treatment for meconium ileus?
Make an incision in the bowel and squeeze the meconium out, but this meconium is not normal
What is jejunal atresia a problem of?
An obstruction in the wall of the bowel
What may there be evidence of in jejunal atresia?
There may be evidence on scanning of the bowel being a wee bit more dilated than normal, or a bit more echoic
Describe the presentation of a baby with jejunal atresia.
Baby not pooing, but there might be a wee bit of something
Abdomen might be a bit distended. Likely to want to feed, but feeds don’t stay down ie. they’re vomiting.
What would be seen on x-ray of a baby with jejunal atresia?
Obstructed
Very big loops, in little ladders (making straight lines)
No gas in the rectum – nothing getting through.
Jejunal atresia can be described as what type of obstruction?
Quite a high obstruction – not much area for distension of abdomen
Outline the treatment of jejunal atresia.
Remove the very distended bowel and re-attach
What Ix can be done for jejunal atresia? Describe this.
Water soluble lower GI contrast (inserted rectally)
Stuff in the lumen – goes across, but then there’s a big loop.
What would there be an absence of at the site of a hernia?
Groin crease
What is a hernia a problem of?
Obstruction outside the wall
Why might there be an obvious mass in the scrotum of a baby with a hernia?
A loop of bowel has come down through the inguinal canal
Failure of what to close can result in hernias?
Peritoneal lining
Failure of what to close can result in hernias?
Peritoneal lining
That leaves room for a loop of bowel or omentum to come down.
What would be seen on an x-ray of a baby with a hernia?
Big loops, ladder effect (don’t like to see straight lines). X-ray shouldn’t really have been taken – waste of time, should’ve just called the surgical team.
‘Laddering’ ….
An x-ray sign seen in hernias
‘Laddering’ ….
An x-ray sign seen in hernias
The more lines there are, the lower down the obstruction
GREEN VOMITING IN BABIES IS BAD
Think malrotation
What is bile?
A breakdown product of bilirubin, secreted into jejunum
Describe the colour of bile?
Moss green
Fairy liquid green
If a child is vomiting a moss green colour, what is it until proven otherwise?
MALROTATION !!
What Ix is used for a child vomiting bile?
Upper GI contrast with follow-through, a water solube contrast is used + FOLLOW THROUGH – this is very important as you need pictures of the contrast moving further down
Describe a normal upper GI tract contrast and follow through.
C shape of duodenum and normal bowel crossing vertical column
Describe an abnormal upper GI tract contrast and follow through.
Fixed points being low and to the right
What is the longest diameter in the bowel?
DJ flexure to caecum !!!!
2 points joined by line – from top left to bottoms right – is the longest point in belly.
Along that line, all the blood supply to the midgut comes off. From superior mesenteric artery. These points should be fixed and stable
Describe malrotation.
DJ flexure is lying low and caecum is lying high.
All blood supply is going to midgut through a narrow base. Get twist around point, and bowel is at risk of ischaemia. Needs an operation as unstable and bowel is at risk of ischaemia.
‘Air in the wrong place’ …. what is this?
Pneumoperitoneum
Hole in the bowel, air has gone from gassy bowel to the outside
Who gets ‘air in the wrong place’?
Premature neonates
What is necrotising enterocolitis?
An acquired pathology because baby’s gut hasn’t formed properly
