MedBugs: SAQ #245

Case: Neonatal bilious vomiting

A 2-week-old male infant has presented to a regional mixed ED with 3 episodes of vomiting over the past 24 hours and the child has become sluggish with poor feeding for the past 6 hours. A further vomit occurs in the department and is noted to be green. Bedside BSL is 3.6mmol/L. Weight is 3.0kg.

1. List key differentials in any child presenting with bilious vomiting. 4 marks

An abdominal X-ray has been performed.

2. List relevant X-ray findings. 2 marks

3. Complete the table by listing 4 further investigations required with justification for each. 8 marks

The infant will need to be transferred to another centre approximately an hour away by road. Axillary temperature is currently 35.2°C

4. List possible contributing factors to the low temperature and for each, an action which can be taken to mitigate their impact. 4 marks

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Case: Neonatal bilious vomiting

1. List key differentials in any child presenting with bilious vomiting. 4 marks

2. List relevant X-ray findings. 2 marks

3. Complete the table by listing 4 further investigations required with justification for each. 8 marks

4. List possible contributing factors to the low temperature and for each, an action which can be taken to mitigate their impact. 4 marks

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