10-Surgical Disorders Flashcards

Question

Lung hypoplasia occurs in CDH because...

Answer 1

diaphragm is developed before lungs. In CDH, when the lungs develop around week 20, the herniated intestines have settled into place in the thorax and are now competing with the developing lung for space

Answer 2

-Organ or tissue underdevelopment -This will also occur where the intestines have herniated on the affected side

Answer 3

-Pulmonary hypoplasia -Patent ductus arteriosus- Due to low oxygen. (prostaglandin E doesn’t lower) -Patent formen ovale -Malrotation – heart turning. -Scaphoid abdomen; a convex belly because the abdominal contents are in the thorax. (most obvious) -Hypoxemia leading to hypoxia -Oxygenation index > 20; concerns regarding patient’s ability to oxygenate despite high levels of support. -Pulmonary hypertension -Cardiac insufficiency

Answer 4

-Respiratory distress. -Immediate intubation prior to signs of hypoxia and hypercarbia. -Bag-mask ventilation should be avoided to prevent air inadvertently being forced into the stomach and intestines, which would further compress the lung tissue and exacerbate respiratory distress. -Nasogastric tube should be placed to remove any gastric air that may impede lung function. -FIO2 1.0 should be used during ventilation.

Answer 5

-Hemodynamic stabilization and resp. support -Conventional ventilation -High-frequency ventilation -Surfactant: due to primary surfactant deficiency. -Pulmonary vasodilators for treatment of PPHN (iNO, Sildenafil, Prostacyclin). -Inotropes: agents that improve cardiac contractility (normal saline, lactated ringers, dopamine, and dobutamine). -Analgesia and paralysis -ECMO

Answer 6

-Radiographic clearing of lung fields. -Resolution of right-to-left shunting across PDA, as a sign of improved PPHN. -Right ventricular pressures < 2/3 systemic pressures, with good right ventricular function of echocardiography. -Systemic blood pressure > 60 mm Hg consistently over previous 12 hours. -Stable urination of > 1 ml/kg/hr over previous 12 hours. -VT > 4 ml with PIP < 25 cm H2O and PEEP < 5 cm H2O. -Optimal values of ABG were reached with FIO2 < 40% for at least the previous 24 hours.

Answer 7

Open laparotomy

Answer 8

-Survival rates for CDH vary widely. -Overall survival rates range from 60% to 68%. -Patients treated with ECMO survive at lower rates, ranging from 46% to 67%. -More than half of CDH survivors have gastrointestinal dysfunction, gastroesophageal reflux disease, oral aversion, poor oral feeding skills, neurocognitive delay, delays in reaching developmental milestones, behavioral disorders, and hearing loss.

Answer 9

A midline defect with the umbilical cord rising from the middle. The small intestines, liver, and stomach are frequently the herniated organs that are encapsulated by the peritoneal sac.

Answer 10

-Cardiac -Cranial -Urogenital defects

Answer 11

-The circumference of the omphalocele and the abdomen are taken and compared. Called the OC/AC ratio -A higher ratio is associated with herniation of the liver and increased risk of respiratory insufficiency at birth.

Answer 12

In utero by gestational week 18 on fetal ultrasound.

Answer 13

-Initial management is similar to patients presenting with gastroschisis. -Nasogastric tube placed to suction for decompression of the GI tract. -Care must be taken to protect the defect from contamination should the sac rupture. -Surgical closure is based on the size of the defect.

Answer 14

-Primary closure for small defects. -Spring-loaded silo: allows for gradual reduction of visceral contents. -Tissue expanders placed under the skin and filled with saline to stretch the abdominal skin and increase space in the abdominal cavity. -Repair may be delayed for months or years due to epithelialization (growth of skin). Patients will be discharged home with topical medications such as mercurochrome, povidone-iodine, silver sulfadiazine, and neomycin-bacitracin ointments.

Answer 15

-An abdominal wall defect characterized by protrusion of the intestines through the abdominal wall not covered by amnion. -The defect develops between weeks 3 and 8 of gestation.

Answer 16

-Cigarrette smoking -Malnourishment -Recreational drug use, specifically methamphetamines -White or Hispanic mothers are at higher risk -Maternal age < 20 years

Answer 17

Fetal ultrasound around week 20, depending on the size of the defect.

Answer 18

Intestines located outside the abdominal wall are sensitive to various insults. Bowel damage occurs in utero because of exposure to amniotic fluid and constriction at the abdominal wall.

Answer 19

-Volvulus atresia (closure of part of the intestine) -Bowel (Twisting of the bowel on itself, obstruction) -Intestinal perforation (Formation of a hole in the large intestine; this portion of bowel will need resection) -Bowel necrosis (Death of a bowel tissue)

Answer 20

-Newborn should be placed in a sterile drawstring bag, known as a bowel bag. -----Protect from contamination or infection -----Prevent fluid loss. -Nasogastric tube -Temperature regulation

Answer 21

-Primary closures: Performed at the bedside in the NICU under sedation and paralysis. Patients will be intubated and placed on mechanical ventilation. -Mechanical Ventilation: Provide support during the surgical resection. Overcome newly decreased thoracic compliance.

Answer 22

Intestines and other abdominal contents to elevate the diaphragm, anatomically increasing thoracic cavity space. ---------Can cause increased work of breathing. ---------Elevated PIPs on mechanical ventilator. ---------Decreased delivered tidal volume in pressure ventilation. ---------Patients may require high-frequency ventilation.