43 - Pediatric Surgery Flashcards by CJ Unknown

Where does the foregut end

Duodenum, proximal to the ampulla

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Where does the midgut start and end

Duodenum distal to the ampulla to distal 1/3 of transverse colon

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Where does the hindgut start and end

Distal 1/3 of transverse colon to anal canal

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Which immune antibody crosses the placenta

IgG

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Immune Ab present in mother’s milk

IgA

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1 cause of childhood death

Trauma

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Trauma bolus for children

20cc/kg x2, then 10cc/kg blood

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Best indicator of shock

Tachycardia

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Congenital cyst of lung that does NOT communicate with the airway

Pulmonary sequestration

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Congenital cyst of lung that does communicate with the airway

CCAM

Congenital cystic adenoid formation

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Type of pulmonary sequestration that is more likely to have systemic venous drainage (azygous)

Extra-lobar PS

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Type of pulmonary sequestration that is more likely to have pulmonary venous drainage

Intra-lobar PS

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Cartilage fails to develop in bronchus, leads to air trapping with expiration

Congenital lobar over-inflation (emphysema)

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Lung tissue has anomalous systemic arterial supply with this congenital cyst

Pulm Sequestration

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Most common cyst of the mediastinum, usually posterior to carina

Bronchiogenic cyst

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Most common mediastinal tumor in children, posterior mediastinum

Neurogenic tumors (neurofibroma, neuroblastoma, etc)

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Anterior mediastinal masses

4 T's
T-cell lymphoma
Teratoma
Thymic tumors
Thyroid tumors

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Most common type of anterior mediastinal mass in children

Teratoma

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Middle mediastinal masses (3)

T cell lymphoma
Teratoma
Cardiogenic/bronchogenic cysts

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Posterior mediastinal masses (3)

Neurgoenic tumors
T cell lymphoma
Neuroblastoma

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Choledochal cyst type - Fusiform dilation of entire common bile duct, mildly dilated common hepatic duct, normal intrahepatic ducts

Type I

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Choledochal cyst type - A true diverticulum that hangs off the common bile duct

Type II

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Choledochal cyst type - Dilation of distal intramural common bile duct; involves sphincter of Oddi

Type III

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Choledochal cyst type - Multiple cysts, both intrahepatic and extrahepatic

Type IV

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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