Necrotizing enterocolitis: Difference between revisions

Revision as of 23:20, 22 June 2011

Background

Intestinal necrosis in previously well infant
Predominantly affects preemies; 10-15% occurs in full-term pts

Diagnosis

Poor feeding, lethargy, abd distention/tenderness
Sepsis, pneumoperitoneum
Stool is +/- heme +

Work-Up

Labs

CBC
Chem
Sepsis evaluation

Imaging

Cross-table lateral
- Pneumatosis intestinalis, pneumobilia, pneumoperitoneum,

Radiography

Pneumotosis is hallmark
- Get KUB and left lat decubital

DDx

Sepsis
pneumonia
malro/volvulus
intuss
feeding intolerance (exclusion)

Treatment

NPO
Aggressive IV hydration
Amp/gent/clinda x 48 hrs
Surgery consult

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-* usu 24-48 hr of life/neonates & premature infants
+*Intestinal necrosis in previously well infant
-* It is d/t intestinal wall necrosis
+*Predominantly affects preemies; 10-15% occurs in full-term pts
 ==Diagnosis==
-* S/S: feeding intolerance, jaundice, abdominal distension, change in stooling pattern, heme + stools
+*Poor feeding, lethargy, abd distention/tenderness
-* radiology= pneumotosis intestinalis, pneumobilia, pneumoperitoneum, air in portal vein, gasless abdomen
+*Sepsis, pneumoperitoneum
+*Stool is +/- heme +
-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 +
+==Work-Up==
+Labs
+*CBC
+*Chem
+*Sepsis evaluation
+Imaging
+*Cross-table lateral
+**Pneumatosis intestinalis, pneumobilia, pneumoperitoneum,
 ===Radiography===
@@ Line 39: / Line 30: @@
 ==Treatment==
 #NPO
-#CBC, lytes, BCx, x-ray
+#Aggressive IV hydration
 #Amp/gent/clinda x 48 hrs
-#Serial CBC, lytes, x-ray (q6)
+#Surgery consult
-#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
+Tintinalli
 [[Category:Peds]]
 [[Category:GI]]