Q:

BILIOUS VOMITING IN A NEONATE

belongs to book: 100 cases in pediatrics|Joseph Raine, Aubrey Cunnington, Joanna Walker|| Chapter number:-| Question number:81

waelhammad

Save to bookmark

|

2022-10-26

|

104

0

BILIOUS VOMITING IN A NEONATE

History

A baby boy on the postnatal ward starts vomiting at 12 hours of age. The first two vomits consist of milk but subsequent vomits are green-coloured. The infant has not yet passed meconium. The mother was well in pregnancy but the obstetric notes document polyhydramnios. The father has ulcerative colitis and has had multiple operations.

Examination

The boy is apyrexial. His pulse is 196/min, blood pressure 72/35 mmHg and peripheral capillary refill 5 s. His abdomen is not distended. There are no masses, tenderness or organomegaly. There are no other signs.

INVESTIGATIONS

Normal

Haemoglobin 18.5 g/dL 14.0–22.0 g/dL

White cell count 27.7 109/L 9.0–30.0 109/L

Platelets 361 109/L 150–400 109/L

Sodium 143 mmol/L 135–145 mmol/L

Potassium 5.0 mmol/L 3.5–5.0 mmol/L

Urea 6.2 mmol/L 1.1–4.3 mmol/L

Creatinine 110 mol/L 27–88 mol/L

X-ray – see Figure 81.1

Questions

• What does the X-ray show?

• With what condition is this disorder associated?

• What is the treatment?

Medicine, textbook solutions, Medicine textbook-solutions,

login and add your own answer to this question

All Answers

waelhammad

2022-10-26

need an explanation for this answer? contact us directly to get an explanation for this answer

The X-ray demonstrates the classic double bubble appearance due to dilatation of the stomach and the proximal duodenum found in duodenal atresia. It is an erect film which also shows a fluid level in the stomach and duodenum. There is a paucity of gas in the remainder of the abdomen. The polyhydramnios is secondary to the inability of the infant to swallow amniotic fluid (conversely, inability to excrete amniotic fluid in the urine due to renal agenesis or dysgenesis leads to oligohydramnios). As the obstruction is in the upper gastrointestinal tract, there is no abdominal distension. Down’s syndrome is associated with duodenal atresia in 20 per cent of cases. Duodenal atresia is also associated with malrotation, oesophageal atresia and congenital heart disease. Contrast studies are occasionally needed, primarily to rule out malrotation and volvulus. The pulse rate is raised (normal in a neonate is 100–180 beats/min), the blood pressure is normal and the peripheral capillary refill is prolonged. The urea and creatinine are slightly raised. Initial treatment is with intravenous rehydration to correct the dehydration. A nasogastric tube is inserted and the stomach emptied. Where there is one congenital abnormality, one should look for other abnormalities. Duodenal atresia is associated with heart disease and this needs excluding prior to surgery.

KEY POINTS

• Bilious vomiting in a newborn should be regarded as a surgical emergency until proven otherwise.

• Duodenal atresia leads to a double bubble appearance on the X-ray.

• There is a strong association with Down’s syndrome.

need an explanation for this answer? contact us directly to get an explanation for this answer

total answers (1)