43 - Pediatric Surgery Flashcards
Where does the foregut end
Duodenum, proximal to the ampulla
Where does the midgut start and end
Duodenum distal to the ampulla to distal 1/3 of transverse colon
Where does the hindgut start and end
Distal 1/3 of transverse colon to anal canal
Which immune antibody crosses the placenta
IgG
Immune Ab present in mother’s milk
IgA
1 cause of childhood death
Trauma
Trauma bolus for children
20cc/kg x2, then 10cc/kg blood
Best indicator of shock
Tachycardia
Congenital cyst of lung that does NOT communicate with the airway
Pulmonary sequestration
Congenital cyst of lung that does communicate with the airway
CCAM
Congenital cystic adenoid formation
Type of pulmonary sequestration that is more likely to have systemic venous drainage (azygous)
Extra-lobar PS
Type of pulmonary sequestration that is more likely to have pulmonary venous drainage
Intra-lobar PS
Cartilage fails to develop in bronchus, leads to air trapping with expiration
Congenital lobar over-inflation (emphysema)
Lung tissue has anomalous systemic arterial supply with this congenital cyst
Pulm Sequestration
Most common cyst of the mediastinum, usually posterior to carina
Bronchiogenic cyst
Most common mediastinal tumor in children, posterior mediastinum
Neurogenic tumors (neurofibroma, neuroblastoma, etc)
Anterior mediastinal masses
4 T's T-cell lymphoma Teratoma Thymic tumors Thyroid tumors
Most common type of anterior mediastinal mass in children
Teratoma
Middle mediastinal masses (3)
T cell lymphoma
Teratoma
Cardiogenic/bronchogenic cysts
Posterior mediastinal masses (3)
Neurgoenic tumors
T cell lymphoma
Neuroblastoma
Choledochal cyst type - Fusiform dilation of entire common bile duct, mildly dilated common hepatic duct, normal intrahepatic ducts
Type I
Choledochal cyst type - A true diverticulum that hangs off the common bile duct
Type II
Choledochal cyst type - Dilation of distal intramural common bile duct; involves sphincter of Oddi
Type III
Choledochal cyst type - Multiple cysts, both intrahepatic and extrahepatic
Type IV
Choledochal cyst type - Caroli’s disease: intrahepatic cysts; get hepatic fibrosis;
Type V
Tx for Type I choledochal cyst
Resection with hepaticojejunostomy
Tx for Type II choledochal cyst
Resection of diverticulum off CBD
Tx for Type III choledochal cyst
Resection or marsupilization
Tx for Type IV choledochal cyst
Resection +/- lobectomy
Tx for Type V choledochal cyst
Resection +/- lobectom +/- liver txp
Mass like lesion usually found in lateral cervical regions, gets infected
Cystic hygroma
Cystic hygroma are normally found _ to the SCM
Lateral
Anterior located congenital diaphragmatic hernia
Morgagni’s hernia
Posterior located congenital diaphragmatic hernia
Bochdalek’s hernia
Chest sinking in, requires strut for fixation
Pectus excavatum
Chest protrusion, pigeon chest, strut not necessary for repair
Pectus Carinatum
Most common branchial cleft cyst
2nd branchial cleft cyst
Branchial cleft cyst at the anngle of the madible, connect with external auditory canal
1st
1st branchial cleft cyst of often associated with _
Facial nerve
Branchial cleft cyst on anterior border of SCM, goes through carotid bifurcation into tonsillar pillar
2nd
Branchial cleft cyst in lower neck, medial to SCM, associated with piriform sinus
3rd
Midline cervical mass
Thyroglossal duct cyst
Tx of thyroglossal duct cyst
Excision of cyst, tract and hyoid bone
Hemangioma tx
Observation (<8yo) Oral steroids (>8yo)
1 solid abdominal tumor in children
Neuroblastoma
Neuroblastoma is derived from _ cells
Neural crest
Nephroblastoma (Wilm’s) frequently metastasizes to (2)
Bone, Lung
Differentiating factor of nephroblastoma vs neuroblastoma on abd CT
Nephroblastoma - replacement of renal parenchyma
Neuroblastoma - Displaces renal parenchyma
Chemo drug for neuroblastoma
Doxorubicin
Chemo drug for Wilm’s tumor
Actinomycin and vincristine
Most common malignant liver tumor in children
Hepatoblastoma
1 children’s malignancy overall
Leukemia (ALL)
1 solid tumor class
CNS tumors
1 general surgery tumor
Neuroblastoma
1 tumor in children <2yo
Neuroblastoma
1 tumor in children >2yo
Wilm’s tumor
1 cause of duodenal obstruction in newborns
Duodenal atresia
1 cause of duodenal obstruction after newborn period
Malrotation
1 cause of colon obstruction
Hirschsprung’s dz
1 liver tumor in children
Hepatoblastoma
1 lung tumor in children
Carcinoid
1 Painful lower GI bleeding
Benign anorectal lesions (fissure)
1 Painless lower GI bleeding
Meckel’s diverticulum
1 cause of upper GI bleed <1yo (2)
Gastritis, esophagitis
1 cause of upper GI bleed >1yo (2)
Esophageal varicies, esophagitis
Meckel’s diverticulum results from
Persistent vitelline duct
Most common tissue type in Meckel’s diverticulum
Pancreatic
Most likely tissue type to be symptomatic in Meckel’s diverticulum
Gastric
Firstborn males, projectile vomiting (nonbilious), olive-like mass in stomach
Pyloric stenosis
Metabolic derangement of pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis
1 cause of lead point in children with intussusception
Enlarged Peyer’s patches
Intestinal atresia occurs as a result of _
Intrauterine vascular accidents
Intestinal atresia most common in _
Jejunum
Double bubble sign on abdominal XR
Duodenal atresia
Distal to ampulla of Vater, bilious vomiting, associated with Down’s
Duodenal atresia
Most common type of tracheoesophageal fistula
Type C
Type of TE fistula with proximal esoph atresia and distal TE fistula
Type C
Type of TE fistula with esophageal atresia and no fistula
Type A
VACTERL syndrome
Vertebral Anorectal (imperforate anus) Cardiac TE fistula Radial/Renal Limb abnormalities
Causes distal ileal obstruction, abd distention, bilious vomiting
Meconium ileus
Does not have peritoneal sac, right of midline
Gastroschisis
Has peritoneal sac with cord attached, failure of embryonal development
Omphalocele
Hirschsprung’s dz is due to _
Absence of ganglion cells in myenteric plexus
Inguinal hernia is due to _
Persistent processus vaginalis
Undescended teticles put one at risk for
Seminoma
2 independent groups and variables is quantitative; compares mean
Student T-test
Before and after studies, variable is quantitative
Paired t-test
Compare quantitative variables for more than 2 groups
ANOVA
