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* Free150 - Peds - GI question
 #863190  
  mocha260 - 09/11/20 02:17
 
  A 10-day-old female newborn is brought to the emergency department because of a 2-day history of bilious
vomiting. She was born at term following an uncomplicated pregnancy and spontaneous vaginal delivery. She was
50.8 cm (20 in) in length and weighed 3260 g (7 lb 3 oz) at birth. Examination following delivery showed no
abnormalities, and she was discharged at the age of 2 days. She is exclusively breast-fed. She appears ill. Today, she
is 50.8 cm (20 in) in length and weighs 3062 g (6 lb 12 oz). Temperature is 38.3C (100.9F), pulse is 180/min, and respirations are 52/min. The abdomen is distended; the patient cries on palpation of the abdomen. Which of the following is the most likely diagnosis?

(A) Duodenal atresia
(B) Intussusception
(C) Meconium ileus
(D) Necrotizing enterocolitis
(E) Volvulus
---------------------

How is it volvulus? Can anyone rule these out

I picked D because of fever + bilious vomit.
 
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* Re:Free150 - Peds - GI question
#3390062
  miska0102 - 09/11/20 12:44
 
  There is an anki chart with bilious vomiting. Necrotizing enterocolitis usually happens in premature first boy infants that are bottle fed. Meconium ileus could present with bilious vomiting but would present with failure of passing meconium in first 2 days of life. Duodenal atresia could present with bilious vomiting but xray would show double bubble sign and would probably not cause fever and abdominal distention to mechanical obstuction such as volvulus.  
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* Re:Free150 - Peds - GI question
#3390075
  mocha260 - 09/12/20 01:58
 
  @Miska0102... Thank you very much! ... For volvulous I was thinking there would no fever. why is there fever? And why is it happening?

This is how I ruled it out.

Duodenal atresia - MC in down syndrome + double bubble

Intucessuption - Current jelly stool - post viral?

Meconium ileus = MC in CF pts

Volvulous - no fever.... :(

then I was left with Necrotizing enterocolitis -
 
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