Neonatal Nurse Practitioner Practice Exam

What condition should be suspected in a neonate with bilious vomiting and abdominal distension?

1. Pyloric stenosis

2. Intestinal malrotation

3. Hirschsprung's disease

4. Necrotizing enterocolitis

The correct answer is: Intestinal malrotation

Bilious vomiting and abdominal distension in a neonate are significant clinical findings that warrant further investigation. These symptoms often suggest a serious gastrointestinal condition. When considering these symptoms, intestinal malrotation is a critical condition to suspect. This condition involves an abnormal positioning of the intestine that can lead to twisting (volvulus) and obstruction. The presence of bilious vomiting indicates that there is a blockage distal to the entry of bile into the intestine. Abdominal distension suggests that there is a build-up of gas and fluid due to the obstruction, which can be a result of intestinal malrotation. Other conditions, while they may also cause vomiting and distension, are less likely considering the specific combination of bilious vomiting and significant abdominal distension. For instance, pyloric stenosis typically presents with non-bilious vomiting and may not cause significant abdominal distension in the early stages. Hirschsprung's disease is associated with a lack of ganglion cells in the bowel, leading to constipation rather than bilious vomiting. Necrotizing enterocolitis, while it can cause abdominal distension, usually presents with other signs like feeding intolerance and bloody stools and is more commonly seen in preterm infants. Thus, the clinical presentation of bilious vomiting alongside abdominal