0071643192.pdf

TREATMENT

■ Appendectomy is the standard of care.

■ Clinical observation with serial abdominal exams may be warranted if

diagnosis is not clear.

■ The patient should be NPO and should receive IV fluids and antibiotics

that cover anaerobes, enterococci, and Gram-negative GI flora.

COMPLICATIONS

■ Perforation—seen in almost 20% of cases

■ Periappendical abscess

■ Peritonitis

Necrotizing Enterocolitis

The most serious and frequent GI disorder of predominantly premature infants,

it presents around 10 days after birth. It is characterized by necrosis, ulceration,

and sloughing of intestinal mucosa; and may progress to full-thickness bowel

necrosis. Clustering of cases in nurseries suggests an infectious etiology, but

other risk factors include intestinal ischemia and immunologic immaturity of

the gut. More than 80% of cases are found in premature infants weighing

<2500 g, but it is seen in a small proportion of term infants as well.

SYMPTOMS/EXAM

■ Bilious vomiting, abdominal distention, bloody stools, lethargy

■ Exam may reveal abdominal distention, abdominal wall erythema, crepi-

tus, and edema.

■ Bradycardia, hypotension, apnea, and temperature instability are also pos-

sible findings.

DIAGNOSIS

■ Labs: Leukocytosis or leukopenia, thrombocytopenia, and acidosis

■ AXR: May demonstrate dilated bowel loops, pneumatosis, and free air

with perforation; contrast-enhanced studies contraindicated due to risk of

perforation

TREATMENT

■ Stop feedings, begin fluid resuscitation, correct electrolyte abnormalities,

and initiate broad spectrum antibiotic coverage.

■ Emergent surgical consultation is required.

■ Bowel resection is indicated for perforation or severe extensive disease.

COMPLICATIONS

■ Bacteremia, sepsis, shock, ascites with SBP, extensive bowel resection →

short gut syndrome, intestinal strictures.

Ulcerative Colitis

This chronic, recurrent disease is characterized by mucosal and submucosal

inflammation of the colon. Less than 20% involve the entire colon with most

cases isolated to the rectum and sigmoid colon. Bimodal distribution: onset is

typically from 15–35 years old, but another spike occurs at 50–70 years of age.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Ultrasound is the initial study

of choice in children and

pregnant women to rule out

appendicitis.

Appendicitis remains the most

common extrauterine surgical

emergency in pregnancy. The

diagnosis should be

considered in pregnant

women with abdominal pain

and gastrointestinal

symptoms.

Beware of atypical

presentations of appendicitis

in the very young and the very

old and in pregnant patients.

These groups of patients have

much higher rates of delayed

diagnosis and postoperative

complications.