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Flashcards in 2: Surgical problems in newborns Deck (29)
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1

Surgical problems in newborns often affect which system?

Gastrointestinal system

2

What are the two main causes of surgical GI problems in newborns?

Pre-term birth

Congenital malformations

3

What is pneumoperitoneum?

Free gas within the peritoneal cavity

4

What event precedes most cases of pneumoperitoneum?

Bowel perforation

5

Apart from bowel perforation, what are some other causes of pneumoperitoneum?

Mechanical ventilation

Pneumothorax, pneumomediastinum

Post-operative free air

Oral sex

6

What disease most commonly causes bowel perforation in pre-term babies?

Necrotising enterocolitis (NEC)

7

In which population is necrotising enterocolitis most commonly encountered?

Pre-term babies

8

What is the pathophysiology of NEC?

Idiopathic inflammation, ischaemia and perforation of the bowels

9

What are the symptoms of NEC in a pre-term baby?

Poor feeding

Bile-stained vomiting

Abdominal distension

Bloody stools

Diarrhoea

10

What are the signs of NEC on an abdominal X-ray?

Dilated bowel loops

Pneumoperitoneum

11

What are the three general types of bowel obstruction?

1. Intralumenal obstruction

2. Obstruction caused by the bowel wall itself

3. Compression of bowel from outside structures

12

What area of the small bowel is characteristically affected in Crohn's disease?

Distal ileum

13

What is meconium?

What does it look like?

First stool passed by a foetus

Usually dark, black and thick in appearance

14

Which disease causes abnormally thickened secretions?

Cystic fibrosis

15

In cystic fibrosis, a baby's meconium will be (thicker / thinner) than usual.

thicker

16

If a baby has cystic fibrosis, their meconium may be thicker than usual. 

Where can it become stuck?

Which kind of obstruction does this cause?

Distal ileum meconium ileus

Intralumenal obstruction

17

What are the signs and symptoms of meconium ileus?

Bile-stained vomiting

Abdominal distension

Failure to pass first stool by 2 days post-birth

18

Which investigation can be used to diagnose meconium ileus?

Abdominal X-ray with contrast enema

19

What is the appearance of meconium ileus on an abdominal X-ray with contrast enema?

Dense from rectum to distal ileum

Bubbly, patchy lucent appearance from there on - indicates meconium build-up

20

Which type of contrast is used in the diagnosis of meconium ileus?

Water-soluble contrast

21

How meconium ileus treated?

Water-soluble contrast enema usually clears the blockage out

Otherwise surgery

22

What congenital bowel wall problem may cause bowel obstruction in newborns?

Atresia

Duodenal, jejunal, ileal, colonic...

23

What is atresia?

Incomplete formation of a structure

In this case the bowel wall, causing incomplete or complete blockage if the tube is blind-ended

24

What problem, in which an organ protrudes somewhere it shouldn't, can cause bowel obstruction?

Herniation

inguinal/femoral bowel herniation, leading to compression, ischaemia and perforation

25

Which condition must you exclude in any newborn with bile-stained vomiting?

Malrotation / Volvulus

26

Why must malrotation or volvulus be excluded in any newborn with bile-stained vomiting?

Ischaemia --> Necrosis --> Loss of huge length of small bowel

27

Which investigation can identify malrotation?

X-ray with contrast swallow

28

If you want a contrast swallow for a baby with suspected malrotation, what should you ask the radiographers for specifically?

Abdominal X-ray with water-soluble contrast swallow AND follow through

29

What surgical emergency should you suspect if a baby's stool is "jelly-like" or "hard and sausage-shaped"?

Intussusception

telescoping of the bowel, causing ischaemia and necrosis