peds GI confusion - medplus254

[ArchivalUser]

wat is the most common cause of intestinal obstruction in neonates? Hirschsprung's or intussecption?

q2 wat is the best initial test to diagnose intussception...X ray or US?

mtb3 says X ray
kaplan notes /FA says US ?

thanks

[ArchivalUser]

For Q1 its difficult to establish since Hirshprungs is mainly diagnosed in first week or even less, whereas Intussuception can happen up to 2 years of age.

For INTUSSUCEPTION:
best initial test and GOLD standard: Ultrasound (doughnut sign)
next best step after diagnosing is: water soluble or air enema both therapeutic and MOST accurate test.

this is from uworld.

[ArchivalUser]

Hirshsprung is the most common for bowel obstruction in neonates

2nd qsn---
Even i had same confusion when i read kaplan and mtb
But take it this way...

Best initial is :plain axr (to rule out obstruction)
when a child presents first in ER with colicky abd pain it is must to rule out obstruction which is a medical emergency right??

So when u first rule obstruction, atleast u ruled out the emergency one first

Then go with usg-- best initial test for diagnosing intussusception
(Doughnut sign or target sign)

Most accurate is: air enema
Which is both diagnostic and therapeutic!!

( i dont think they will confuse us with both usg and xray ,, even if they do i suppose we should first rule out obstruction by doing xray ))

[ArchivalUser]

Also, u can rule out perforation by xray so if there is perforation u have to go with emergency surgery rather than diagnosing intussusception by usg and u cannot even do reduction if there is already perforation!!

So i think best approach will be to do xray and rule out obstruction and perforation 1st

[ArchivalUser]

@happy

it is also mentioned in FA that sometimes obstrction is not evident early enough to be seen on X ray s i guess US is the best . cause if X ray negative then you do US so why not first

thanks for replying

[ArchivalUser]

So what if the patient has perforated bowel already (which can be seen as free air in plain xray of course))
In that case which one is the medical emergency to you??
Diagnosing intussception by usg or running for emergency surgery??

[ArchivalUser]

I still think doing plain xray to rule out obstruction and perforation is the best approach!!

[ArchivalUser]

thanks happy, thats a good point actually, didnt think of that.

FIRST go with abd xray to rule out perforation (i.e air under diaphgram)
and after ruling that out ---> ultrasound.

[ArchivalUser]

@ medplus

These questions are for ur peds revision again!!
(Self)

1.C/v:: 4 week old infant with lethargy,poor feeding,fatigue, pallor.p/e--webbed neck,cleft palate,triphalangeal thumbs,place mucus membrane.,mcv-104 fl,decreased hb and reticulocyte,increased ADA
Q.diagnosis and treatment?

2.c/v 1 year old child with lethargy,poor feeding,fatigue, pallor.,h/o viral illness 2 weeks back, p/e: normal findings ,lab:: normal mcv and normal rbc and normal ADA
Q.diagnosis and treatment?

3.c/v 4 years child with microcephalic,microphthalmia ,short stature ,absent radii and thumb,lab--decreased hb,macrocytosis, WBC and platelets counts low
Q> dx and treatment

[ArchivalUser]

@happy peds revision i have just started doing it but no excuse i have no idea .....but i will think all your qs ...
now my daughter is back ...so bye till i get back .happy long weekend!