Master the board step 3

Master the Boards: USMLE Step 3
Surgical Conditions in the First 2 Months of Life
Necrotizing Enterocolitis
This shows up as feeding intolerance in premature infants when they are first
fed. There is abdominal distention and a rapidly dropping platelet count (in
babies, this is a sign of sepsis).
Basic Science Correlate
The most common pathogens in necrotizing enterocolitis are Escherichia coli
and Klebsiella pneumonia.
Treatment is as follows:
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Stop all feedings.
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Prescribe broad-spectrum antibiotics.
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Deliver IV fluids and nutrition.
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Do surgery if there are signs of necrosis or perforation (abdominal wall
erythema, portal vein gas, or gas in the bowel wall).
Meconium Ileus
Symptoms are feeding intolerance and bilious vomiting in a baby with cystic
fibrosis (look for cystic fibrosis in family history).
Basic Science Correlate
Cystic fibrosis, an autosomal recessive disease, results from a point mutation
at position 508 of the CFTR gene that causes the mistranslation of
phenylalanine.
Diagnose by x-rays, which show multiple dilated loops of small bowel and a
ground-glass appearance in the lower abdomen.
Gastrografin enema is both
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diagnostic (microcolon and inspissated pellets of meconium in the terminal
ileum); and
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therapeutic (gastrografin draws fluid in and dissolves the pellets).
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