Necrotizing enterocolitis: Difference between revisions
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* S/S: feeding intolerance, jaundice, abdominal distension, change in stooling pattern, heme + stools | * S/S: feeding intolerance, jaundice, abdominal distension, change in stooling pattern, heme + stools | ||
* radiology= pneumotosis intestinalis, pneumobilia, pneumoperitoneum, air in portal vein, gasless abdomen | * radiology= pneumotosis intestinalis, pneumobilia, pneumoperitoneum, air in portal vein, gasless abdomen | ||
Signs of functional Intestinal obstruction : Abdominal distension, progressive decreased Peristalsis, Bilious vomiting, hematemesis and blood in stools | Signs of functional Intestinal obstruction : Abdominal distension, progressive decreased Peristalsis, Bilious vomiting, hematemesis and blood in stools | ||
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Systemic signs : respiratory distress, Apnea / bradycardia, Lethargy, thermal instability, irritability, poor feeding, hypotension (shock), oliguria, bleeding diathesis, sclerema | Systemic signs : respiratory distress, Apnea / bradycardia, Lethargy, thermal instability, irritability, poor feeding, hypotension (shock), oliguria, bleeding diathesis, sclerema | ||
Triad of | ===Triad of=== | ||
#Thrombocytopenia | |||
Thrombocytopenia | #Metabolic acidosis | ||
#Hyponatremia | |||
Metabolic acidosis | |||
Hyponatremia | |||
===Clinical triad=== | |||
#Distension | |||
#GI bleeding | |||
#Pneumatosis intestinalis | |||
Stools are heme + | Stools are heme + | ||
Revision as of 21:52, 7 June 2011
Background
- usu 24-48 hr of life/neonates & premature infants
- It is d/t intestinal wall necrosis
Diagnosis
- S/S: feeding intolerance, jaundice, abdominal distension, change in stooling pattern, heme + stools
- radiology= pneumotosis intestinalis, pneumobilia, pneumoperitoneum, air in portal vein, gasless abdomen
Signs of functional Intestinal obstruction : Abdominal distension, progressive decreased Peristalsis, Bilious vomiting, hematemesis and blood in stools
Signs of peritonitis & perforation: Ascites, erythema & edema of abdominal wall, localized mass or rigidity
Systemic signs : respiratory distress, Apnea / bradycardia, Lethargy, thermal instability, irritability, poor feeding, hypotension (shock), oliguria, bleeding diathesis, sclerema
Triad of
- Thrombocytopenia
- Metabolic acidosis
- Hyponatremia
Clinical triad
- Distension
- GI bleeding
- Pneumatosis intestinalis
Stools are heme +
Radiography
- Pneumotosis is hallmark
- Get KUB and left lat decubital
DDx
- Sepsis
- pneumonia
- malro/volvulus
- intuss
- feeding intolerance (exclusion)
Treatment
- NPO
- CBC, lytes, BCx, x-ray
- Amp/gent/clinda x 48 hrs
- Serial CBC, lytes, x-ray (q6)
- NG to suction
- Volume replacement
Surgery Indications
- Perforation
- portal/biliary air
- rapidly deteriorating
Prognosis
- Rx= 80% nd only medical mgt (bowel rest, ngt, fluids, abx to cover bowel flora), 20% need bowel surgery (if perf etc)
- 15% mortality
Source
Adapted from Pani