A 5 month old baby wt 2.8 kg C/K/O paralytic iliacus Suggests management

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Obstruction of the bowel may be caused by ileus -- in which the bowel doesn't function correctly but there is no "mechanical" (anatomic) problem -- or by mechanical causes. Paralytic ileus, also called pseudo-obstruction, is one of the major causes of obstruction in infants and children. The causes of paralytic ileus may include the following: Medications, especially narcotics Intraperitoneal infection Mesenteric ischemia (decreased blood supply to the support structures in the abdomen) Injury to the abdominal blood supply Complications of intra-abdominal surgery Kidney or thoracic disease Metabolic disturbances (such as decreased potassium levels) Paralytic ileus may lead to complications causing jaundice and electrolyte imbalances. In the newborn, paralytic ileus that is associated with destruction of the bowel wall (necrotizing enterocolitis) is life-threatening and may lead to infection in the infant's blood and lungs. In older children, gastroenteritis may be a cause of paralytic ileus, which is sometimes associated with peritonitis and a ruptured appendix. Paralytic ileus is marked by abdominal distention, absent bowel sounds (no noise heard when listening to abdomen) and relatively little pain (as compared to mechanical obstruction).
As per look of the child, it is a case of Hirschsprung 's disease with absence of intramural ganglion cells and presence of hypertrophic nerves in the distal large bowel. Treatment in this case would be nil orally,Nasogastric suction, IV fluids and wait till paralytic ileus recovers .Once infant recovers,an adequate rectal biopsy will confirm the diagnosis. Definitive surgery may be done later on
Thank you doctor , your definitive Approach should be tried.
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Maintain hydration. Rule out Intussusception and hernia.
5 month old child....weighing stil like a newborn...so definitely its pathologic condition...1st need to evaluate full anc history, birth h/o and history till date with symptoms, feeding history to be revived. Do a proper Clinical examination,general and sytemic examination, r/o general & systemic causes of infection by doing all routine blood test, electrolytes,chest -xray, abd. Xray standing. Treatment: NBM, i.v. fluids, ryles tube , treat dehydration, iv. Antibiotics and other symptomatic treatment
Are you in hospital ? Are you a qualified paediatric ? For 5month old baby he looks malnourished, initially You should pass a ryles tube Through the nose to rlieve The distension and look for cause of the condition and treat accordingly.
Think it as a case of kwashiorkor.
This child needs to be properly worked up.. detailed history of prenatal antenatal n natal history feeding practice and workup for malabsorption syndromes as child has failure to thrive.. currently decompression of stomach using ng and bowel rest with serial XRay and monitoring is needed antibiotics cover must b given and treat similar to lines of NEC.. Let us know the progress.. and
i think wt of baby less to apropraite for age according to who chart ..you must rule out other associated anomaly like cardiac ,kidney, metabolic....and septicemia also cause paralytic ileus.....treatment before investigation Npo iv antibiotic iv fluid....after investigation definate treatment to be done
Definitely its doesnt seems to be kwashiorkar. ...but in 5 months baby, PEM is not suspected. It is FTT. May be IUGR, SGA baby. Lab investigation will help for further mx.
What were the symptoms? Admit, start IV antibiotics, monitor electrolytes promptly as child looks marasmic n pale, Keep NBM, RT aap, wait n watch
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