Examkin

Question

Difficulty: MediumNeonatal Disorders

Match each clinical presentation of a neonatal gastrointestinal emergency to the most appropriate next step in diagnosis or management.

  • A 4-week-old firstborn male infant presents with worsening projectile, nonbilious vomiting immediately after feeding. A palpable 'olive-shaped' mass is felt in the right upper quadrant.Perform an abdominal ultrasound to assess pyloric muscle thickness and length.
  • A 3-day-old infant born at 28 weeks gestation develops temperature instability, abdominal distension, and bloody stools. Abdominal radiography reveals pneumatosis intestinalis.Initiate immediate bowel rest, broad-spectrum intravenous antibiotics, and obtain serial abdominal radiographs.
  • A 1-day-old term infant with Down syndrome presents with bilious emesis. An abdominal radiograph demonstrates a classic 'double bubble' sign with a lack of distal bowel gas.Plan for surgical evaluation for duodenoduodenostomy following stabilization and gastric decompression.
  • A 2-day-old term infant has not passed meconium. He develops progressive abdominal distension and bilious vomiting. A contrast enema reveals a transition zone between a narrow distal colon and a dilated proximal segment.Perform a rectal suction biopsy to confirm the absence of ganglion cells in the submucosal plexus.

Answer

Each clinical presentation corresponds to a distinct neonatal gastrointestinal disorder requiring a specific diagnostic or management step. Pyloric stenosis requires an ultrasound, necrotizing enterocolitis requires bowel rest and antibiotics, duodenal atresia requires surgical repair, and Hirschsprung disease requires a rectal suction biopsy.
The matching correctly pairs pathognomonic clinical and radiographic findings with their established guidelines for next step in diagnosis or management. Nonbilious projectile vomiting (pyloric stenosis) requires ultrasound; pneumatosis intestinalis (NEC) requires bowel rest and antibiotics; 'double bubble' sign (duodenal atresia) requires surgical correction; and delayed meconium with a transition zone (Hirschsprung disease) requires rectal biopsy.

Step-by-Step Solution

1
Analyze the first clinical presentation: projectile nonbilious vomiting and an 'olive' mass in a 4-week-old.
Identified as infantile hypertrophic pyloric stenosis.
These classic findings dictate that the next step is confirming the diagnosis with an abdominal ultrasound.
2
Analyze the second presentation: premature infant with bloody stools and pneumatosis intestinalis.
Identified as necrotizing enterocolitis (NEC).
The initial management for uncomplicated NEC (without pneumoperitoneum) involves bowel rest, IV antibiotics, and close monitoring with serial X-rays.
3
Analyze the third presentation: bilious emesis and 'double bubble' sign in a neonate with Down syndrome.
Identified as duodenal atresia.
This is a surgical emergency that is managed definitively with a duodenoduodenostomy after initial stabilization.
4
Analyze the fourth presentation: failure to pass meconium and a transition zone on contrast enema.
Identified as Hirschsprung disease.
The contrast enema is suggestive, but definitive diagnosis requires a rectal suction biopsy to demonstrate aganglionosis.

Key Concept

Recognition and appropriate next step in management for common neonatal gastrointestinal emergencies.
Rate this question

Topics

Neonatal Disorders

More questions from this topic