Lyrics · 完整歌詞
The assessment of a vomiting newborn begins with the timing
and character of the vomiting,
followed by examination and appropriately selected imaging.
When did the vomiting begin, and does it contain bile?
Bile enters the duodenum at the ampulla of Vater,
so obstruction beyond the ampulla produces bilious vomiting, whereas obstruction above it,
including pyloric stenosis, does not.
The plain film then counts bubbles.
A double bubble with no distal gas is duodenal atresia,
associated with Down syndrome in about 30 per cent
and with maternal polyhydramnios.
Multiple air-fluid levels indicate jejunoileal atresia, usually from a prenatal vascular accident.
Dilated bowel with no anal opening is anorectal malformation,
which travels with the VACTERL association.
Hypertrophic pyloric stenosis presents at three to six weeks with projectile non-bilious vomiting,
a hungry infant, visible gastric peristalsis and a palpable olive.
Because gastric acid is lost with every vomit, hydrogen and chloride fall,
volume depletion raises aldosterone, and the kidney excretes potassium and hydrogen.
The result is hypochloraemic, hypokalaemic metabolic alkalosis with paradoxical aciduria.
Ultrasound confirms the thickened, elongated pylorus.
Surgery is never an emergency:
chloride-containing fluid with potassium corrects the alkalosis first, and pyloromyotomy follows,
splitting the muscle without breaching the mucosa.
The assessment of a vomiting newborn begins with the timing
and character of the vomiting,
followed by examination and appropriately selected imaging.
Abdominal wall defects are separated by position and covering.
Gastroschisis lies beside the cord, usually on the right, has no membrane,
and is most often complicated by intestinal atresia rather than other anomalies.
Omphalocele is midline, covered by peritoneum and amnion,
and carries associated anomalies in about half of cases,
particularly cardiac and chromosomal.
Malrotation with midgut volvulus announces itself with bilious vomiting
and a corkscrew duodenum,
and demands Ladd's procedure: counterclockwise detorsion, division of Ladd's bands,
widening of the mesenteric base and appendicectomy.
Between three months and three years, intussusception brings colicky pain, redcurrant-jelly stool,
a sausage-shaped mass and a target sign on ultrasound.
Air or contrast enema reduces 70 to 90 per cent of cases;
surgery is reserved for perforation, peritonitis or failed reduction.
Necrotising enterocolitis follows prematurity, ischaemia, bacterial colonisation and feeding, producing pneumatosis intestinalis,
portal venous gas in severe disease and thrombocytopenia.
Most infants are managed with bowel rest, decompression, antibiotics and fluids;
pneumoperitoneum is the absolute indication for surgery.
Persistent conjugated jaundice in a newborn raises the question of biliary atresia.
A hepatobiliary scan showing no excretion into the bowel supports it,
but liver biopsy is the diagnostic gold standard.
The Kasai portoenterostomy restores drainage and succeeds most often
when performed within 60 days of birth.
The assessment of a vomiting newborn begins with the timing
and character of the vomiting,
followed by examination and appropriately selected imaging.