Common Surgical Problems in the Neonate Flashcards
what is necrotising enterocolitis?
occurs in prematurity where the immature gut perforates and air escapes round the body (under diaphragm, into biliary tract etc)
gut is underdeveloped so cant cope with feeding etc so immature mucosa is damaged and wall perforates
what can damage but in newborn?
congenital problem
prematurity
obstruction
where can bowel obstruction occur?
in the lumen
in the wall
outside the wall (something compressing the lumen)
case
baby is keen to feed initially but 24 hrs later they are vomiting green vomit, have a distended abdomen and has not pood
what is done and what is the likely diagnosis?
contrast enema
small bowel obstruction
likely cause of obstruction in a newborn?
meconium (meconium ilieus)
baby should pass meconium within 48 hrs of birth
features of meconium obstruction in newborn?
doughy abdomen
another common cause of bowel lumenal obstruction in newborn?
Cystic fibrosis (can cause meconium ileus) - newborns often present with bowel problems before lung problems can also just be constipated
what is atresia?
congenital dead end of bowel
problem with the integrity of the wall
fed after birth, looks normal, born close to term but after 6 hours starts vomiting green and abdomen looks a bit full, baby has not pood
contrast enema shows loss of connection between 2 sections of bowel
likely diagnosis?
likely a higher up obstruction as it only took 6 hours for vomiting to start
high atresia
inguinal area swelling
swelling extends into scrotum on same side asymmetrical greases around groin
what is the likely diagnosis?
inguinal hernia
risks of inguinal hernia?
bowel can be strangulated as canal is tight
sign of obstruction on X ray?
“laddering”
horizontal layers of bowel
green vomit is what until proven otherwise?
malrotation
what test is done to confirm malrotation?
upper GI contrast
where should the DJ shpincter be?
high and lateral
