Presentation of Neonatal Abdominal Obstruction

Prenatal-Polyhydramnios, dilated bowel Feeding intolerance Emesis Abdominal distension Failure to pass meconium

WHAT DO I DO
PHYSICAL EXAM ABCS RESCITATION ALONG WITH EVALUATION FIGURE OUT THE PROBLEM

FURTHER EVALUATION
SERIAL ABDOMINAL XRAYS OROGASTRIC TUBE CONTRAST STUDIES
UGI TO R/O MALROTATION BE TO EVALUATE LOWER GI TRACT REMEMBER TO GIVE FLUIDS

WHEN DO I CALL A SURGEON?

SUSPICION OF BOWEL OBSTRUCTION SUSPICION OF BOWEL INFLAMMATION SUSPICION OF SURGICAL EMERGENCY SUSPICION

IF NOTHING ELSE REMEMBER THIS

BILIOUS EMESIS IS A SURGICAL EMERGENCY UNTIL PROVEN OTHERWISE

Oh oh, the baby isnt feeding right

Coughing and sputtering Excess salivation Gently pass an OGT Doesnt go easily. Next step?

ESOPHAGEAL ATRESIA/TEF
INCREASED SALIVATION RESP DISTRESS/CYANOSIS ABDOMINAL DISTENSION PNEUMONIA

EA/TEF-MANAGEMENT
HEAD ELEVATED AND PRONE POSITION REPLOGLE TUBE IN THE POUCH IV ACCESS IV ANTIBIOTICS AVOID INTUBATION IF POSSIBLE

EA/TEF-ASSOCIATED ANOMALIES
VATER SYNDROME
CARDIAC ECHO-EVAL SIDE OF AORTIC ARCH RENAL SONO PERINEAL EXAM

DUODENAL OBSTRUCTION
MALROTATION UNTIL PROVEN OTHERWISE PARTIAL VS COMPLETE OBSTRUCTION VOLVULUS IS A TRUE SURGICAL EMERGENCY

SMALL BOWEL OBSTRUCTION

ATRESIA MOST COMMON STENOSIS, INCARCERATED HERNIA, MECONIUM ILEUS, INTUSSESCEPTION LESS LIKELY VOLVULUS UNTIL PROVEN OTHERWISE RECESCITATION WITH EVALUATION

MECONIUM ILEUS
VOMITING/DISTENSION XRAYS-DISTAL DILITATION, SOAP BUBBLE IN LUMEN CONTRAST ENEMA-MICROCOLON WITH MECONIUM PELLETS IV/IV ANTIBIOTICS CYSTIC FIBROSIS TESTING

HIRSCHSPRUNGS DISEASE
SLOWER ONSET OF SYMPTOMS DISTENSION, DELAYED MECONIUM PASSAGE, ENTERCOLITIS XRAYS-DILATED COLON LOOPS DDX-HYPOPLASTIC LEFT COLON SYNDROME, INTESTINAL DYSPLASIA CONTRAST ENEMA RECTAL BIOPSY MANDATORY

ANORECTAL MALFORMATION
FAILURE TO PASS MECONIUM PHYSICAL EXAM MANDATORY SERIAL XRAYS ULTRASOUND HELPFUL ASSOCIATED ANOMALIES
RENAL U/S MANDATORY VATER SYNDROME

GASTROSCHISIS
DEFECT TO RIGHT OF UMBILICUS FLUID/TEMPERATURE LOSSES COVER BOWEL IN BAG/MOIST GAUZE LATERAL POSITION/SUPPORT BOWEL FREQUENT EXAMS REPLOGLE TUBE/IV ANTIBIOTICS

OMPHALOCELE
DIFFERENT THAN GASTROSCHISIS VARYING DEGREES OF HERNIATION LESS FLUID/HEAT LOSSES ASSOCIATED ANOMALIES
CARDIAC GENETIC BECKWITH-WEIDEMANN-SUGARS

Necrotizing Enterocolitis
Most common surgical ICN emergency Major risks-Prematurity, ?early feeds Minor risks-Stress, shock Most often affects small bowel Despite theories-Unclear etiology

NEC-Clinical diagnosis
Distension, lethargy, feeding intolerance Bilious emesis, bleeding KUB-Pneumatosis intestinalis, portal venous gas, pneumoperitoneum

NEC-BELL CLASSIFICATION
A-Suspected NEC
Mild distension, vomiting, mild ileus

B-Definite NEC
Marked distension, bleeding, pneumatosis, PV gas

C-Advanced NEC
Sepsis, shock, pneumoperitoneum, surgical Rx

NEC-MEDICAL MANAGEMENT
ABCs Pan-culture, begin triple antibiotics Correct coagulopathy Serial exams, X-Rays, labs Surgical input