[醫如往常] Junior Clerkship Day 38: Ileal atresia

20151026

Morning Meeting: Polyhydramnios & Ileal atresia

R2 林醫師 A曹醫師

Symptoms & Signs

Polyhydramnios (20-35%)

Orogastric bile

Bilious vomiting

Abdominal distension

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UGI (吳醫師補充)

1:3 Urografin enema 避免 induced NEC 

Microcolon:五種疾病
MIMCA

M: Meconium

I: Ileal atresia

M: Megacystic

C: colon atresia

A: aganglionic Ileal atresia

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UGI 彭醫師

Suspect Meconium plug syndrome

Defecation 後排除

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CVC culture cons

Staphylococcus

給Vancomycin

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外科林醫師開腹手術

Lig. Trazi 開始都是脹的
Ileal atresia type 3a

推測可能是Meconium plug induced

破掉之後癒合後造成Ileal  atresia

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一些比較

Real Meconium plug 是白色的

這次排出來的沒有那麼白，比較偏向Ileal  atresia

• Meconium peritonitis可以找到Calcification
• Meconium plug主要在Colon
• Meconium atresia主要在Small intestine

Iliealcecal valve的保存與預後有關(Small bowel syndrome)

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黃主任補充：

最近流行Enterovirus D68

NHI給付腸病毒做一次PCR

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Fever

High fevers between 103 F (39.4 C) and 106 F (41.1 C)

Infants

• < age 3 months and has a rectal temperature of 100.4 F (38 C) or higher.
• Between ages 3 to 24 months and has a temperature up to 102 F (38.9 C)
• A newborn and has a lower than normal temperature — less than 97 F (36.1 C).