Bilious vomiting in neonates

Question 1

What are the causes?

Answer 1

1. duodenal atresia
2. malrotation with volvulus
3. jejunal/ilieal atresia
4. meconium ileum
5. necrotising enterocolitis

Question 2

What is the incidence and cause of duodenal atresia?

Answer 2

1 in 5000

higher in downs syndrome

Question 3

what age does duodenal atresia occur?

Answer 3

few hours after birth

Question 4

how is duodenal atresia diagnosed?

Answer 4

AXR shows double bubble sign

Question 5

what is the treatment doe duodenal atresia?

Answer 5

duodenoduodenostomy

Question 6

what is the incidence and causation of malrotation with volvulus?

Answer 6

incomplete rotation during embryogenesis

Question 7

What age does malrotation with volvulus occur?

Answer 7

3-7 days after birth

Question 8

How is malrotation with volvulus diagnosed?

Answer 8

Upper GI contrast study

USS

Question 9

What is the management of malrotation with volvulus?

Answer 9

Ladd’s procedure

Question 10

What is the incidence and causation of jejunal/ileal atresia?

Answer 10

vascular insufficiency in utero

usually 1 in 3000

Question 11

when does jejunal/ileal atresia occur

Answer 11

with in 24 hours of birth

Question 12

how is ideal/jejunal atresia diagnosed?

Answer 12

AXR air fluid levels

Question 13

What is the management of jejunal/ileal atresia?

Answer 13

laparotomy with primary resection and anastomosis

Question 14

What is the incidence and causation of meconium ileum?

Answer 14

15-20% with babies with cyst fibrosis

1 in 5000 otherwise

Question 15

when does meconium ileum occur?

Answer 15

first 24-48 hours of life with abdominal distension and bilious vomting

Question 16

how is meconium ileum diagnosed?

Answer 16

AXR air-fluid levels on AXR

sweat test CF

Question 17

What is the management of meconium ileum?

Answer 17

surgical decompression

serial damage may require segmental resection

Question 18

what is the incidence and causation of necrotising enterocolitis?

Answer 18

up to 2.4 per 1000 births

risks increased in prematurity and inter-current illness

Question 19

when does necrotising neetrocolitis occur?

Answer 19

usually 2nd week of life

Question 20

how is necrotising enterocolitis diagnosed?

Answer 20

AXR. dilated bwel loops, pnematosis and portal venous air

Question 21

what is the management for necrotising enterocolitis?

Answer 21

Conservative and supportive for non perforated cases,

laparotomy and resection in cases of perforation of ongoing clinical deterioration