neonatal surgical emergency and biliary atresia

What can you suspect a bilious vomiting is unless proven otherwise?

Bowel obstruction

80% of bowel obstructions are due to which conditions?

Atresia

What are the clinical presentations of a bowel obstruction?(3)

1. Bilious vomiting

2. Abdominal distention

3. Not passing meconium

What clinical examinations can be done if you suspect a neonatal bowel obstruction?(4)

1. Distended / flat

2. Abdominal wall erythema

3. Tenderness

4. Inspect anus and check for patency

What special investigations can be done if you suspect a neonatal bowel obstruction?(2)

1. Supine CXR (air in rectum / level of obstruction)

2. Lateral shotthrough AxR (abdominal x ray)

What is the most common type of small bowel atresia?

Duodenal atresia (60% premature & 805 distal to Ampulla of Vater)

What are the duodenal atresia associated abnormalities? (2)

1. VACTERL

2. Trisomy 21 (Down syndrome)

On abdominal X-ray what will you see with a duodenal atresia?

Double bubble sign

What is the management of a duodenal atresia?(4)

1. Resuscitation

2. Fluids & electrolytes

3. Nasogastric tube

4. Surgery > wife diamond shaped duodenal-duodenosotomy

What is the cause of a jejunal / ileal atresia ?

Intra-uterine vascular accident

What the types of jejunal/ ileal atresia? (4)

1. Membranous obstruction of lumen

2. Thin fibrous with no mesenteric defect

3. Multiple atresia (string of sausages)

4. Large mesenteric / apple-peel

Clinical signs of jejunal atresia? (3)

1. Bile stained vomiting

2. Abdominal distention

3. Multiple air-filled levels with no air in rectum on AXR

What is the management of jejunal atresia? (3)

1. Resuscitation

2. Nasogastric tube

3. Surgery> resection, anastomosis, injection of water / air

Define meconium ileus

Distal ileal obstruction ‘sticky” meconium associated with cystic fibrosis in 10% of cases

Treatment of meconium ileus

1. IV hydration

2. Sometimes surgery

Define meconium plugs

Distal colon and rectum causing obstruction

Treatment of meconium plug

Saline rectal washouts

What is CXR finding of a malrotation and volvulus?

Corkscrew sign

Which side is Gastroschisis usually?

Right of the umbilical cord (often in premature neonates)

What associated defects are wtih gastroschisis? (3)

1. Intestinal atresia

2. Undescended testes

3. Gastroesophgeal reflux

What are the associated defects with an omphalocele (covered by a sac)? (7)

1. Cardiac

2. Chromosomal

3. Down’s syndrome

4. Cryptorchidism

5. Macrosomia

6. Neural tube defects

7. Renal abnormalities

When should an inguinal hernia closure by which gestation?

30 - 35 weeks gestation

Which side is an inguinal hernia common?

Right (mostly males)

How is the classification of Anorectal malformations done?

According to anatomical position of fistula