Vomiting Flashcards
Differentials of bilious vomiting
- Intestinal Obstruction –
Malrotation with Volvulus,
Meconium Ileus, etc
2.Duodenal Atresia/Stenosis
3.Hirschsprung’s Disease
4.Necrotizing Enterocolitis
How does Malrotation with volvulus present?
- Bilious emesis
- abdominal distension
- abdominal pain
- bloody stool
- shock
List three investigations for a year old child that presents with billious of vomiting, abdominal distension, abdominal pain, and bloody stool
Diagnosis is Malrotation with volvulus
- AXR,
- upper GI series,
- contrast enema
AXR: obstruction of proximal SBO, double bubble sign, intestinal
wall thickened
Immediate UGI: dilated duodenum, duodenojejunal segment (Ligament of Treitz) right of midline and not fixed posteriorly over the spinal column, “corkscrew” sign indicating volvulus
U/S: “whirlpool” sign, abnormal SMA/SMV relationship indicates
UGI to rule out rotational anomalies
What sign of UGI indicates volvulus?
CORK SCREW SIGN
What is the clinical presentation of Hirschsprung disease?
- Bilious vomiting
- Abdominal distension,
- Abdominal pain,
- FAILURE TO PASS STOOL
- Failure to pass meconium*
- **spontaneously within*
- 48 h of life***
- FTT, Enterocolitis, Sepsis
- Squirt/blast sign
What is the GOLD standard investigation for Hirschsprung’s disease?
List 3 other investigations
- RECTAL BIOPSY
Aganglionosis and neural hypertrophy-seen
Others
- AXR
- Contrast enema to find
narrow rectum and
transition zone
- Anal manometry
unreliable in infants
– classic finding is
absence of rectoanal
inhibitory reflex
What is the treatment for Hirschsprung’s disease?
Duhamel pull-through
procedure: surgical
resection of aganglionic
intestinal segment and
anastomosis of remaining
intestine to anus
Either in the newborn period
or staged if extensive
aganglionosis
List the complications of Hirschsprung’s disease?
- fecal incontinence
- constipation,
- postoperative enterocolitis (medical emergency if progresses to sepsis)
List the clinical features of Necrotizing enterocolitis
- Premature neonate,
- Bilious emesis,
- Bloody stools,
- Abdominal distension,
- Intolerance of feeds,
What investigations would you do for Necrotizing enterocolitis?
- AXR,
- CBC,
- Electrolytes, Cr, BUN,
- Blood culture
What are the suggestive findings of duodenal atresia?
- Bilious emesis,
- Abdominal distension,
- Often seen in DOWN SYNDROME,
- Jaundice,
- Polyhydramnios during pregnancy,
- hypokalemic, hypochloremic metabolic alkalosis
What diagnostic investigations would you do for patients with duodenal atresia?
- AXR,
- upper GI series (‘double bubble’ sign)
What two neonatal conditions present with bloody stools and bilious vomiting?
- Malrotaion with volvolus
- Necrotizing enterocolitis
- The difference is that NE is seen in premature neonates and intolerant feeds
List two neonatal conditions with double bubble signs on X-ray
- Malrotation with volvulus
- Duodenal atresia-Look out for Down syndrome, Polyhydramnios during pregnancy
