II. Technique: Abdominal exam

  1. Perform abdominal exam with infants hips and knees flexed
    1. Hold knees up with non-dominant hand while palpating with the opposite hand
    2. Relaxes the newborn's Abdomen
  2. Palpate for masses
    1. Use flats of fingers (instead of finger tips)
    2. Infant liver is typically palpable just below the costal margin

III. History: Vomiting

  1. See Vomiting in Children
  2. Differentiate spitting-up from Vomiting
    1. True Vomiting in young infants, expecially if forceful requires a thorough evaluation
  3. Vomiting Red Flags
    1. Bilious Emesis
      1. Malrotation, mid-gut Volvulus or Small Bowel Obstruction
    2. Projectile Emesis
      1. Pyloric Stenosis
    3. Abdominal Distention with bloody stools and Emesis
      1. Necrotizing Enterocolitis
    4. Intractable Vomiting with a benign Abdomen
      1. Brain Mass
      2. Non-accidental Trauma

IV. Exam: Abdominal findings

  1. Linea Nigra
    1. Hyperpigmented vertical line from the Umbilicus to the Pubic Symphysis and resolves with time from maternal Hormone exposure
  2. Scaphoid Abdomen
    1. Suggests congenital Diaphragmatic Hernia
  3. Persistent Abdominal Distention or mass
    1. Generalized distention
      1. Consider Bowel Obstruction or Ascites
    2. Localized mass
      1. See Abdominal Mass in Newborns
      2. Renal Masses (50% of abdominal lesions)
        1. Wilms tumor
        2. Renal vein thrombosis
        3. Multicystic dysplastic Kidneys
        4. Hydronephrosis
      3. Non-Renal Masses
        1. Teratoma
        2. Ovarian Torsion
        3. Ovarian Cyst
        4. Neuroblastoma
        5. Gastric Duplication Cyst
    3. Abdominal wall defect
      1. Diastasis Recti abdominis
        1. Weak fascia at midline between the rectus Muscles, resolves spontaneously with time
      2. Umbilical Hernia
        1. Rarely incarcerated or strangulated in infants and spontaneously resolve by 3 years old in most cases
      3. Evisceration
        1. Gastroschisis (Intestines protrude through right abdominal wall without a sac)
        2. Omphalocele (Intestines protrude through the midline abdominal wall in a sac)
  4. Umbilicus
    1. See Umbilical Cord
    2. Observe for umbilical infection or bleeding
    3. Single Umbilical Artery
      1. Associated with renal anomalies, IUGR and prematurity
      2. Renal Ultrasound is no longer indicated in isolated cases
  5. Liver
    1. See Hepatomegaly in Newborns
    2. Usually palpable 2 cm below costal margin
  6. Kidneys
    1. Usually palpable

V. Exam: Rectum and Anus findings

  1. Anus patent and not ectopic
  2. Imperforate anus
    1. Isolated or
    2. Associated with Trisomy 18 and Trisomy 21 or
    3. Associated with VACTERL
      1. Vertebral/vascular anomalies
      2. Anorectal anomalies
      3. Cardiac anomalies
      4. Transesophageal anomalies
      5. Radial/renal anomalies
      6. Limb anomalies
  3. Cutaneous Signs of Dysraphism
    1. Simple sacral dimples do not require additional evaluation
      1. Shallow sacral dimple <0.5 cm in diameter AND
      2. Within 2.5 cm from anal verge
      3. And no hairy patches or Hemangiomas
    2. Further evaluate sacral dimples that do not meet these criteria or other midline defects
      1. Ultrasound for Spinal Dysraphism by 3 months of age is typical but is controversial as it may not change management
      2. Chem (2012) J Neurosurg Pediatr 9(3): 274-9 [PubMed]
  4. Expect meconium passed within 24-48 hours of birth
    1. Consider Hirschprung's Disease if not present

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