Necrotizing enterocolitis: Difference between revisions
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==Background== | ==Background== | ||
* usu 24-48 hr of life/neonates & premature infants | * usu 24-48 hr of life/neonates & premature infants | ||
* It is d/t intestinal wall necrosis | * It is d/t intestinal wall necrosis | ||
==Diagnosis== | ==Diagnosis== | ||
* 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 | ||
Clinical triad : Abdominal. Distension + GI bleeding + Pneumatosis intestinalis | Clinical triad : Abdominal. Distension + GI bleeding + Pneumatosis intestinalis | ||
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 | ||
Signs of peritonitis & perforation: Ascites, erythema & edema of abdominal wall, localized mass or rigidity | 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 | Systemic signs : respiratory distress, Apnea / bradycardia, Lethargy, thermal instability, irritability, poor feeding, hypotension (shock), oliguria, bleeding diathesis, sclerema | ||
Triad of: | Triad of: | ||
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Hyponatremia | Hyponatremia | ||
Stools are heme + | Stools are heme + | ||
===Radiography=== | |||
*Pneumotosis is hallmark | |||
**Get KUB and left lat decubital | |||
==DDx== | ==DDx== | ||
#Sepsis | |||
#pneumonia | |||
#malro/volvulus | |||
#intuss | |||
#feeding intolerance (exclusion) | |||
==Treatment== | ==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) | * Rx= 80% nd only medical mgt (bowel rest, ngt, fluids, abx to cover bowel flora), 20% need bowel surgery (if perf etc) | ||
* 15% mortality | * 15% mortality | ||
==Source== | ==Source== | ||
Adapted from Pani | Adapted from Pani | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 21:38, 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
Clinical triad : Abdominal. Distension + GI bleeding + Pneumatosis intestinalis
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
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