kausiksur
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02.09.08 (4 months ago)
#24
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It is INTUSSUCEPTION According to
NELSONS TEXTBOOK OF PEDIATRICS
'In typical cases there is sudden onset, in a previously well child, of severe paroxysmal colicky pain that recurs at frequent intervals and is accompanied by straining efforts with legs and knees flexed and loud cries. The infant may initially be comfortable and play normally between the paroxysms of pain; but if the intussusception is not reduced, the infant becomes progressively weaker and lethargic. At times, the lethargy is out of proportion to the abdominal signs. Eventually a shocklike state may develop with fever. The pulse becomes weak and thready, the respirations become shallow and grunting, and the pain may be manifested only by moaning sounds. Vomiting occurs in most cases and is usually more frequent early. In the later phase, the vomitus becomes bile stained. Stools of normal appearance may be evacuated during the first few hours of symptoms. After this time, fecal excretions are small or more often do not occur and little or no flatus is passed. Blood generally is passed in the first 12?hr but at times not for 1–2 days and infrequently not at all; 60% of infants pass a stool containing red blood and mucus, the currant jelly stool. Some patients have only irritability and alternating or progressive lethargy.
Palpation of the abdomen usually reveals a slightly tender sausage-shaped mass, sometimes ill defined, which may increase in size and firmness during a paroxysm of pain and is most often in the right upper abdomen, with its long axis cephalocaudal. If it is felt in the epigastrium, the long axis is transverse. About 30% of patients do not have a palpable mass. The presence of bloody mucus on the finger as it is withdrawn after rectal examination supports the diagnosis of intussusception. Abdominal distention and tenderness develop as intestinal obstruction becomes more acute. On rare occasions, the advancing intestine prolapses through the anus. This prolapse can be distinguished from prolapse of the rectum by the separation between the protruding intestine and the rectal wall, which does not exist in prolapse of the rectum'
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