Necrotizing enterocolitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Work-Up=== | ===Work-Up=== | ||
*CBC | *CBC | ||
*Chem | *Chem | ||
*Sepsis evaluation | *Sepsis evaluation | ||
*Coags | *Coags | ||
*Stool +/- heme positive | |||
===Radiography=== | ===Radiography=== | ||
*Pneumatosis on XR is hallmark | *Pneumatosis on XR is hallmark | ||
**Get KUB in supine position and left lat decubitus | **Get [[KUB]] in supine position and left lat decubitus | ||
*US | *US | ||
**Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim | **Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim | ||
Revision as of 11:57, 19 December 2015
Background
- Abreviation: NEC
- Intestinal necrosis in previously well infant
- Predominantly affects preemies; 10-15% occurs in full-term pts
- Bacterial overgrowth in bowel, translocation of bacteria into bowel wall, subsequent bacterial endotoxin and gas production
Clinical Features
- Poor feeding, lethargy, abd distention/tenderness
- Sepsis, pneumoperitoneum
Differential Diagnosis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Diagnosis
Work-Up
- CBC
- Chem
- Sepsis evaluation
- Coags
- Stool +/- heme positive
Radiography
- Pneumatosis on XR is hallmark
- Get KUB in supine position and left lat decubitus
- US
- Pseudo-kidney sign - bowel wall with hyperechoic center and hypoechoic rim
- Assess for gas bubbles in liver and portal veins
Treatment
- NPO
- Aggressive IV hydration
- Ampicillin + gentamycin + clindamycin
- Surgery consult
See Also
Source
Tintinalli