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https://graduate.uofk.edu/user/diploma.php?sep=homework-help-raleigh homework help raleigh Abdominal distension or tenderness, gastric aspirates (feeding residuals), vomiting (of bile, blood, or both), ileus (decreased or fluid electrolytes nutrition, gastrointestinal, and renal issues i 343 absent bowel sounds), bloody stools, abdominal wall erythema or sildenafil drug tolerance induration, persistent localized abdominal mass, or ascites. 3. The course of the disease varies among infants. Most frequently, it will appear (i) as a fulminant, rapidly progressive presentation of signs consistent with intestinal necrosis and sepsis or (ii) as a slow, paroxysmal presentation of abdominal distension, ileus, and possible infection. The latter course will vary with the rapidity of therapeutic intervention and require consistent monitoring and anticipatory evaluation (see iii.). B. Laboratory features. The diagnosis is suspected from clinical presentation but must be confirmed by diagnostic radiographs, surgery, or autopsy. No laboratory tests are specific for nec. Neverthdess, some tests are valuable in confirming diagnostic impressions. 1. Radiology studies. The abdominal radiograph will often reveal an abnormal gas pattern consistent with ileus. Both anteroposterior (ap) and cross-table lateral or left lateral decubitus views should be included. These films may reveal bowel wall edema, a fixed position loop on serial studies, the appearance of a mass, pneumatosis intestinalis (the radiologic hallmark used to confirm the diagnosis), portal or hepatic venous air, pneumobilia, or pneumoperitoneum taking the appearance of gas under the diaphragm. Isolated intestinal perforation (ip) may present with pneumoperitoneum without other clinical signs. 2. Blood and serum studies. Thrombocytopenia, persistent metabolic acidosis, and severe refractory hyponatremia constitute the most common triad of signs. Serial measurements of c-reactive protein (crp) may also be hdpful in the diagnosis and assessment of response to therapy of severe nec. Blood cultures may reveal bacteremia with a pathogenic organism. 3. Analysis of stool for blood has been used to detect infants with nec based on changes in intestinal integrity. Although grossly bloody stools may be an indication of nec, occult hematochezia does not correlate well with nec, and routine testing of stool for occult blood is not recommended. C. Bell staging criteria with the walsh and kleigman modification allow for uniformity of diagnosis across centers. Bell staging is not a continuum. Babies may present with advanced nec without earlier signs or symptoms. 1.

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