A 4 week old child is brought to your emergency department with a distended abdomen Marking What six 6 questions would you ask to aide you with your diagnosis 6 marks p assage meconium first 48 hours vomiting history ID: 464552
Download Presentation The PPT/PDF document "Feedback: Q6" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Feedback: Q6
A 4 week old child is brought to your emergency department with a distended abdomen. Slide2Slide3
Marking
What
six (6) questions would you ask to aide you with your diagnosis? (6 marks)
p
assage meconium first 48 hours; vomiting history ?
b
ilious; bowel opening history; tolerating feeds/ passing urine; distressed/ unwell; premature; significant PMH
eg
bowel surgery
Needed to ask about passage meconium to get 6/6
questionSlide4
Marking
State two (2) positive and two (2) relevant negative findings on the AXR. (4 marks)
XR +
ve
:
dilated bowel loops (large and small)
paucity
of air in
rectum
XR-
ve
:
No free air (football sign,
rigler’s
/ double wall sign)
No
pneumatosis
intestinalis
No double bubble signSlide5
Marking
What is the most likely diagnosis? (1 mark)
Hirschsprungs
Name two (
2
) differential diagnosis
.(
2 marks
)
c
auses bowel obstruction
malrotation
, imperforate anus, constipation
, meconium plug/ ileus,
incarcerated
hernia, NECSlide6
Marking
State three management steps. (3 marks)
Surgery referral, NBM, NGT on free drainage, iv access and fluids, analgesia if
distressedSlide7
Hirschsprung Disease
Absence of ganglion cells in bowel wall from anus proximally
Delayed passage meconium (99% full term infants pass meconium in 48 hours)
Chronic constipation
Risk of
enterocolitis
if not
Dx
early
AXR- obstruction and paucity
gass
rectum
Rectal suction biopsy for
Dx
then definitive surgerySlide8Slide9
Malrotation
Incomplete rotation of intestine as
foetus
Mesentery (including SMA) tethered by narrow stalk which can twist producing
midgut
volvulus
Can also cause duodenal obstruction (Ladd bands)
Present 1
st
year of life with about 40% presenting first week and 50% by first month
Bilious emesis, bowel obstruction and significant abdominal pain (especially with volvulus)Slide10Slide11
Necrotizing Enterocolitis
Newborn
emergency- disease of the NICU
Multifactorial
Mucosal/
transmural
necrosis of intestine
Incidence and mortality increase with decreasing BW and GA
90% in premature infant
Can be secondary disease- including
Hirschsprung
!
Usually 2
nd
-3
rd
week of life but can be as late as 3 months in VLBW infants
AXR-
pneumatosis
intestinalisSlide12Slide13
Intussusception
2 months to 2 years (can occur any age)
Peak incidence 5 to 9 months (weaning)
Intermittent severe colicky
abdo
pain
Typically 2-3/ hour and at least 1/hour
Usually
assoc
with vomiting, pallor, lethargy
Blood in stool is late sign
Mass hard to feelSlide14
Intussusception: Imaging
USS:
diagnostic investigation of choice
Air enema:
diagnostic and therapeutic
AXR:
only if concerned perforated or obstructed
Target sign- 2 concentric circular radiolucent lines usually in RUQ
Crescent sign- a crescent shaped
lucency
usually LUQ with a soft tissue massSlide15Slide16
http://
radiologymasterclass.co.uk
/tutorials/
abdo
/
abdomen_x-ray_abnormalities
/
pathology_bowel_gas_perforation.html#top_fifth_img
PerforationSlide17Slide18Slide19Slide20
Small Bowel
vs
Large Bowel Obstruction
Small bowel tends to be centralSlide21