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89 Cards in this Set
- Front
- Back
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What type of movement might you see in the abdomen
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peristaltic movement a/synchronous with chest |
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Abdominal distention can be benign when it's related to these (3) things
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after feeds air swallowing from feeding/crying overflow from bagging/vent/CPAP/high flow NC |
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Abdominal distention that is pathologica may be caused by these (68 things |
Ascites Organomegal (liver/spleen/pancreas) Renal anomalies - MC cause of abdominal masses Distended bladder/uterus Gastric perforation/pneumoperitoneum NEC/peritonitis Teratomas Intestinal obstruction |
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Causes of intestinal obstruction (5)
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Atresias / stenosis Ileus (slowed peristalsis / sepsis) Mec ileus / plug Hirschsprung's dx (ganglion not at end of intestinal track Imperforate anus |
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Pneumoperitoneum
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FREE AIR in the abdominal cavity -bowel perf NOT always a/c free air -free air does NOT always mean bowel perf (could be air from lungs) |
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Normal size of girth
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Less than HC until 30-32 weeks 32-36 weeks should be = after 36 weeks should be greater than HC |
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When do babies normally have 1st stool (by weight)
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98% > 2500 gm stool 1st 24 hrs 80% infants < 1500 gm stool 1st 48 hrs 90% ELBW - by 12 days **Most pass stool before being fed 1st passage r/t GA & BW |
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An increase in abdominal girth by _____ may be abnormal |
at least 2 cm (think feeding intolerance/gastric residuals/follow carefully)
check girth just above umbilicus |
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IS bilious residual OK in preemie? (what might be a cause)
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a little is OK, may be tube too deep into small intestine (also sphincter sometimes loose)
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Epigastric distention with visible peristalsis may be a sign of
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duodenal/jejunal obstruction pyloric stenosis |
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When does hypertrophic pyloric stenosis present? What are the main signs (4)?
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~ 3 weeks of age, but can begin at birth more prevalent in males -failure to advance transpyloric tubes -feeding intolerance -projectile vomiting -olive shape in pyloric area (felt 1-2 cm just above umbilicus, midline or sl. to R - check after emesis) |
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Linea nigra
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line down midline under umbilicus; seen often, normal, dt maternal hormones
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Omphalocole: incidence / size / what it is
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-3/10,000 live births -> 4 cm in diameter -herniation of umbilicus through which abdominal contents and other organs protrude through umbilicus (6th week guts out, 10th week SHOULD come back in) -covered by a translucent membrane -high incidence of other congenital abnormalities (get echo, RUS, be sure nothing else is going on) |
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Syndromes associated with an omphalocele
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beckwith-wiedemann syndrome, trisomy 13/18/21 May have to stage repair |
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Beckwith-Wiedemann
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Overgrowth syndrome -large abdominal viscera -large tongue -omphalocele/hernia -ear pits -hypoglycemia -kidney abnormalities -at risk for cancerous and noncancerous tumors |
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Gastroschisis: incidence / what is it
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-to SIDE of umbilical cord -1/10,000 -herniation of abdominal contents and other organs through opening -distinguished from omphalocele by location (to R of midline, does NOT include umbilicus) -no membranous sac -fewer congenital anomalies associated -protruding bowel appears dark or necrotic (exposure to amniotic fluid) |
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Risk to baby if they have an abdominal defect (5)
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-Infection -Hypothermia -Fluid loss -Electrolyte imbalance -Requires immediate surgical attention --> plastic bag to minimize hypothermia/fluid loss --> put baby on side and watch bowel color, could get kinked, etc |
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exstrophy of the bladder - what is it; commonly seen with what other sign
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Fissure between anterior abdominal wall & Urinary bladder visible over bladder area epispadia - common finding in males with this condition
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Eagle-Barrett syndrome
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"prune belly" -No abdominal muscles -cryptorchidism (tests in abdomen) -renal anomalies (increased risk of UTIs) |
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Diastasis recti
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Gap between rectus muscles -common in healthy nbn -palpable and visible when infant cries -benign in basence of hernia |
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umbilical hernia:MC seen in ____ / cause / how do you confirm diagnosis / what do you do to fix?
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MC seen in LBW & AA infants in 1st year of life -Non AA? Think hypothyroid. = between males and females -Cause: separation of rectus muscle with herniation of omentum & sometimes bowel -palpation confirms diagnosis -note size & protrusion -large hernia or strangulation of abdominal contents into herniated area = SURGERY -most close spontaneously by 5 yo (diameter less than size of nickel will probably close) |
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What does 1 artery mean in umbilical cord? What % of infants have it?
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1 artery in 1% of newborns -associated with othe ranomalies particularly genitourinary -if no other congenital malformation or chromosomal abnormality further screening is controversial |
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Normal length of umbilical cord / what determines length
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30-90 cm, average is 55 cm (2 ft) intrauterine space and fetal movement determines length (inactive babies have shorter cords... down's, neuromuscular d/o) |
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Normal umbilical cord color
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bluish white & gelatinous at birth yellow/green - exposure to mec at least 6-12 hrs prior to delivery |
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umbilical cord thickness
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1-2 cm in diameter |
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what does wharton jelly's reflect? What is it's job? |
Reflects nutrition -Protects umbilical vessels from compressions |
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Abnormalities of umbilical cord (4)
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-Unusual color -Uneven diameter (strictures / hematomas) -Redness, foul smelling -Drainage |
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When do cords usually fall off? What may cause longer cord separation?
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7-14 days Longer cord separation: -preterm infants and c/s infants -when cleansed with alcohol rather than sterile water (up to 3 weeks) *A small amount of blood may be noted at time of separation |
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If your umbilical cord is attached longer than 3 weeks, what diagnosis might you consider? Tell me more about it :)
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LAD (leukocyte Adhesion Deficiency) -rare, 1:1 million, x-linked recessive -late cord separation -presents with h/o recurrent bacterial and fungal infections due to neutrophil dysfunction |
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What are you thinking if your umbilical cord continues to bleed and bleed?
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Think hemophilia or blood d/o
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Why do some nbns develop a small rim of erythema around the drying cord?
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Thought to related to the normal WBC infiltration that occurs with cord separation
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Cord hematoma
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rupture of umbilical vein - could be lethal -if large, could lead to high output cardiac failure (can act similar to AV fistula if large enough) |
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Cord hemangioma
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-if large, could lead to high output cardiac failure (can act similar to AV fistula if large enough) -deaths have been reported |
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umbilical granuloma
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granulation tissue, can be normal, is excessive use vaseline around area 1st, then silver nitrate |
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patent urachus
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persistence of embryonic connection between bladder and umbilicus
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vitelline (omphalomesenteric) duct abnormalities (3)
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--> abnormal connections between intestine and skin @ umbilicus, see pg. 15 for image -Vitelline band - should go away completely. Can become a volvulus or ischemic/atresia area like an amniotic band -Vitelline duct cyst -Vitteline sinus - stool drips out of umbilicus;(persistent vitelline duct from ileum to umbilicus) |
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what is the omphalomesenteric duct
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-embryonic tract connecting ileum to the umbilicus -ileal liquid seeps out of the duct -fecal drainage from cord - fistula between omphalomesenteric duct & colon |
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Meckel's Diverticulum |
-MOST COMMON vitelline duct abnormality -Can be a problem - start of intussusception -Blind pouch -The most common presenting symptom is painless rectal bleeding such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus, and intussusception |
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Intussusception |
-EMERGENCY, ischemia = death -Currant jelly stool -the inversion of one portion of the intestine within another |
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What reflex do you check in the perianal area? Also look for meconium where? |
Wink reflex (scratch side of anus) - look for meconium in urethral or vaginal orifice or along perineum in females; in urethral orifice or along median raphe in males --> thinking some type of fistula, ex. rectovaginal fistula (not fixed right away) |
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Anal atresia vs anal stenosis How long does it take most terms to pass stool? |
Atresia - no passage of stool Stenosis - small, thin stool Mechanical or functional obstruction --> abdominal distention, vomiting (quickly if no stool). 94% of terms pass stool in 1st 24 hrs, most 1st 12 hrs |
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How long do you have to listen to the abdomen to claim no bowel sounds? |
5 minutes |
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When are bowel sounds present after birth? Preemie? Sedated baby? |
audible in 1st 15 minutes preterm? Less active BS sedated? Less active or absent BS |
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What do bowel sounds sound like? How often are they heard? What might the baby have if BS are absent? If they're hyperactive? |
Metallic, tinkling quality - heard about every 15-20 seconds Absent? ileus Hyperactive? just fed or obstruction Frictional rubs? present with peritoneal irriation |
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If you hear a bruit over the abdomen you might be thinking.... |
abnormal umbilical, hepatic vascularization, renal stenosis, hepatic hemangioma |
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What might you be feeling if you feel a sausage shape in lower L quadrant? Same shape in upper R or L quadrant? |
meconium in descending colon may be intussusception |
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Mass between umbilicus and R lower costal margin likely ____ ? Solid or cystic masses likely _____? |
pyloric stenosis renal in origin |
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Tense rigid tone think --> Flaccid tone think --> |
Tense - peritoneal irritation Flaccid - neuromuscular disease, perinatal compromise or maternal meds causing depression |
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How do you check turgor? |
gently pink a small piece of skin and release it |
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When do you use percussion? What two sounds do you hear and what do they mean? |
Use to distinguish between tympanic and dull sounds -Tympanic - sounds over organs that contain air (stomach) -Dull - over liver, spleen, and bladder suggests organ enlargement / masses |
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How do you assess liver? Where should you feel it? |
Index finger just above the groin, gently compressing motions gradually move finger upward toward liver edge Normal - edge is up to 1-2 cm below RCM at midclavicular line (may be lower with hyperexpanded lungs) |
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Normal vs abnormal vs congested liver (how do they each feel)? |
Normal - smooth, firm with sharp well defined edge Abnormal - hard, nodular liver Congestion - rounded liver edge |
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Downward displacement of liver... this is called ____ potentially caused by ____ (4) |
Hepatomegaly -Perinatal infection -Blood group incompatibilities -CHF -Hyper-expanded chest wall may cause downward displacement but liver can be a normal size |
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What do you see with a ruptured liver? What may cause it? |
Rupture may be d/t difficult delivery or aggressive resuscitation -Life-threatening -May appear well 1st 24-48 hrs -mass in liver region -ab. distention as free blood fills peritoneal cavity |
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Where do you feel spleen? What do you see with a ruptured spleen? |
Usually NOT felt; may be felt at left costal margin. If > 1 cm below check for infection, erythroblastosis fetalis -Rupture - suspect with breech that presents with anemia NOT associated with jaundice in 1st 24-72 hrs |
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Where do you feel kidneys? When are concerned? |
Difficult to palpate after 1st few hours Left easily to palpate than R (bc liver) Ideally immediately after birth before they eat / intestines fill with air Do @ end (disturbing) of exam Normal - equal in size and smooth to touch Concerned? Nodular or enlarged kidney |
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Adrenal glands - risks at delivery |
Relatively large @ birth and vulnerable to trauma -Hemorrhage is usually unilateral and more commonly on R (bc liver/spine might compress) -Incidence increases with organomegaly |
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Bladder - where is it felt; what problems might you have if its frequently distended? |
Start palpating 1-4 cm above symphysis pubis -Feel bladder between fingers -Continuous/frequent distention may be d/t CNS defects or urethral obstruction |
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What is an inguinal hernia? MC on which side of body? Who is it most common in? |
Muscle wall defect, bowel enters scrotal sac in males or soft tissue in females --> MC in males -R more often than L (if L involved, likely bilateral) -Frequent in preemies, seen when infant gets stronger (more active & stooling more) |
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If you see a bulge in the labia majora you're thinking.... |
Inguinal hernia vs ovary vs testis - possible hermaphrodite |
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How often should you try to reduce an inguinal hernia? |
DON'T do regularly, only need to determine if it remains without discoloration or change in consistency. Be sure it's soft & not discolored. If you see changes - then try to reduce incarcerations/strangulation = surgery |
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What is your main concern with a baby with oligo? |
Main concern is LUNGS May not develop well with minimal fluid |
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How is oligohydramnios related to renal function? What do you see with oligo? What syndrome has NO fluid? |
Little fluid = little urine from baby in utero. Either PIH or baby renal problem --> will see flattened facies, malformed ears, contraction deformities of limbs --> a/c CV, neuro, GI, and musculoskeletal systems Potter - NO fluid, contorted |
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When does a healthy nbn void? |
healthy nbn - 1st 24 hrs 99% of all nbn - by 48 hrs No urine for 36 hrs? possible renal dx, obstruction, renovascular accident or malformation of urinary tract |
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Normal UOP |
LOW during 1st 2 days 25-60 ml total in 24 hrs Increases to 100-300 ml by 3-10 days Normal output: 1-2 ml/kg/hr on DOB-DOL2 3-4 ml/kg/hr thereafter |
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UOP rule of thumb for term baby |
Day 1 - 1 wet diaper Day 2 - 2 diapers Day 3 - 3 diapers *DOCUMENT void in DR if it happens |
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How long is a little bit of vaginal blood normal in term girls? |
Around day 5 After 1 week - abnormal |
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When does rugae begin to form on ventral surface of scrotum |
36 weeks |
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Term scrotum looks like ? |
Scrotum fully rugated and more deeply pigmented than surrounding skin |
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When do testes descend? |
Prior to 28 weeks - testes in abdomen 28-30 weeks - begin to descend Term - should be in scrotum IMPORTANT: keep on finger on inguinal ring to prevent pushing testis back into inguinal canal 2 testes up at birth? May not be a boy |
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Is the prepuce easily retractable? |
Prepuce (foreskin) may NOT be retractable which is normal. It is usually tight. Don't worry if peeing Phimosis - nonretractable foreskin. NORMAL in young males Pull skin forward and see if it will pucker at meatus |
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Antenatal testicular torsion |
Twisting of spermatic cord -results into acute ischemia with its resultant sequelae such as abnormality of testicular function and fertility |
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Hypoplastic urethra |
assess adequacy of skin circumferentially paying attention to ventral side - if you can see catheter #s through skin, should NOT be circ'ed |
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Megameatus |
A variant of hypospadias Occurs with a normal foreskin Does not need foreskin for repair (can be fixed once older) |
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Normal penis length |
3.5 cm +/- 0.7 cm Erections are normal Observe force and direction of urine stream |
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Chordee vs penile torsion |
Chordee - bent shaft, sometimes also see hypospadias Torsion - VERY crooked, needs surgery |
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Where do you check for hypospadias? |
Glanular Penoscrotal Perineal |
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Epispadias and exstrophy of bladder |
Usually go together... :) |
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Cremasteric reflex |
Contraction of cremaster muscle Gently stroke inner thigh longitudinally = drawing up of the ipsilateral testes (some say not present until 3 mo but can illicit in full term) |
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Hydrocele |
Peritoneal fluid enters scrotal sace Cause: incomplete obliteration of processus vaginalis - connection between peritoneal cavity and scrotum Appearance - fluid filled sac in an enlarged scrotum Brightly transluminates *Inguinal could transilluminate if bowel filled with air |
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Cryptorchidism |
May interfere with fertility / become malignant -Undescended tests in an extrascrotal position -Common in male sexual differentiation -Descend by 3 months corrected age -Increased in preemies -Other anomalies + ambiguous genitalia = get karyotype |
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Ectopic testes |
Testes missed scrotal sac entirely -Prepenile -Superficial ectopic -Transverse scrotal -Femoral -Perineal |
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What does a normal female genitalia look like for 1st 8 weeks of life |
Prominent labia Meatus difficult to visualize White vaginal discharge and / or bleeding (all d/t maternal estrogen) Breech? may be edematous & ecchymotic |
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Preterm vs term labia |
Preemie - labia minora and clitoris are prominent and labia majora small Term - labia majora larger, more adipose tissue. Labia majora coveres clitoris & minora |
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Can the urethra be easily visualized? |
Not always dt tissue estronization from maternal hormones also look for clitoris and check for voiding |
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What are you looking for when palpating labia, inguinal, and suprapubic area? |
masses / hernias |
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What are you looking for when assessing female perineum? |
Smooth No dimples/fistulas Full term (wide as fingertip at least) Urethral and anal orifices |
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Hymen |
thick avascular membrane with central orifice, tag is common (tag typically involutes) |
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Hydrometrocolpos |
Vagina is obstructed, incise the area |
