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pediatric surgery umf > abdominal wall defects > Flashcards

abdominal wall defects Flashcards

1
Q

define omphalocele

A

failure of viscera to return to the abdominal cavity , organs stick out through an opening in the muscles at the area of the umbilical region and are covered by a thin peritoneal layer.

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2
Q

What conditions are associated with omphalocele

A

Heart malformations (20 percent)
Beckwith-Wiedeman Syndrome (a condition typified by a large tongue, high insulin and low blood sugar)
Chromosomal abnormalities ( trisomy 12,18,downs,turners)
CNS
Genitourinary

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3
Q

How is omphalocele diagnosed prenatally

A
  • Ultrasound: may see herniated organs
  • Echo-cardiography: cardiac problems
  • amniocentesis: Karyotype of fetal cells for any chromosomal abnormalities
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4
Q

How is omphalocele diagnosed postnatally

A

see viscera covered by membrane

hypoglycemia- associated with Beckwith-Wiedeman Syndrome

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5
Q

How do you treat omphalocele non surgically

A

Sac is soaked in saline to reduce water loss

NG tube

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6
Q

How do you treat omphalocele surgically

A

Primary closure- excision of sac and closure by putting skin and fascia over the abdominal contents
staged neonatal closure- gradual reduction of the sac with sac excision and closure ( with mesh or surgery)
Scarification- allows development of eschar ( dead tissue) this epitheliazes over time that leaves a hernia for later repair
ruptured - create silo

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7
Q

define gastroschisis

A

Defect in abdominal wall lateral to the umbilicus
• Any part of the GI tract may protrude
• Not covered by a sac

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8
Q

What are the causes of gastroschisis

A

-failure of the mesoderm to form in the anterior
abdominal wall
-failure of the lateral folds to fuse in the midline
-thrombosis (umbilical vein) causes necrosis of the surrounding abdominal wall

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9
Q

How is gastroschisis diagnosed prenatally

A

Ultasound
High levels of maternal AFP
Bowel loops floating freely in the amniotic fluid

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10
Q

Treatment non surgical for gastroschisis

A 
Early delivery to reduce exposure of bowel loops to amniotic fluid
IV Fluids 
NG decompression 
Bowel soaked in saline
Viscera covered in bag
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11
Q

Surgical treatment of gastroschisis

A

primary closure- mesh
Intraabdominal pressure > 10-15 mmHg =ischemia use silo-

staged closure - silo- covering placed over the abdominal organs on the outside of the baby. Gradually, the organs are squeezed by hand through the silo into the opening and returned

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12
Q

define meckel’s diverticulum

A

Outpouching in the wall of the intestine due to a remnant of the embryologic vitelline
duct (connects the fetal gut with the yolk sac)

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13
Q

what is the clinical presentation of meckel’s diverticulum

A

Bleeding- Episodic painless rectal bleeding, melena, anemia
intestinal obstruction-intususseption,volvulus
diverticular inflammation- stasis of contents inside

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14
Q

how is meckel’s diverticulum diagnosed

A

Meckel radionuclide scan

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15
Q

How is meckel diverticulum treated

A

resection by diverticulectomy or ileal resection with anastomosis

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16
Q

define Intussusception

A

most frequent cause of bowel obstruction
in infants and toddlers. It is an invagination of
the proximal bowel into the distal bowel

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17
Q

Pathophysiology of Intussusception

A

bowel drags mesentery with it & produces arterial & venous obstruction & mucosal necrosis→ classic “black currant jelly” stool.

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18
Q

What is primary Intussusception

A

hypertrophy of peyer’s patches in bowel due to an infection (UTRI)

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19
Q

What is secondary intussusception

A

A leading point ( meckel’s diverticulum, polyps, appendix) causes proximal bowel to enter distal bowel helped by peristaltic activity

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20
Q

What is the clinical presentation of intussusception

A

abdominal pain- has attacks where the pain is sudden and child pulls legs towards abdomen, holds breath, vomits, between attacks child appears comfortable
Currant jelly stools
palpable sausage shaped abdominal mass
prolapse of proximal bowel through anus- bad sign

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21
Q

What is seen on the imaging of intussusception

A

xray- abnormal distribution of gas and fecal contents, air-fluid levels
US- doughnut lesion>alternating rings
of low and high echogenicity

22
Q

What is the nonsurgical treatment of intussusception

A

IV fluid, NG tube
Hydrostatic reduction- catheter is inserted into the rectum and under fluoroscopic guidance, air or water is put into the large bowel.
air reduction- pressures in the region of 60-100 mmHg are used which may reduce the intussusception back to the ileocaecal valve

23
Q

when is surgical treatment of intussusception used

A

Nonoperative reduction is unsuccessful
There are signs of peritonitis
Symptoms last more than 48h

24
Q

What technique is used for intussusception

A

open/laparoscopic

25
Q

define hypertrophic pyloric stenosis

A

Thickening of the pylorus muscle resulting in obstruction of gastric contents

26
Q

clinical signs of hypertrophic pyloric stenosis

A

nonbilious, projectile vomiting , starts infrequently then is after every feeding.
content =recent digested milk
dehydration- sunken fontanelle, wrinkles
visible peristaltic waves

27
Q

physical examination of hypertrophic pyloric stenosis

A

visible peristaltic waves in stomach region

palpable pyloric mass under liver

28
Q

imaging in hypertrophic pyloric stenosis

A

US: muscle thickness of ≥4 mm and a pyloric length of ≥16 mm

29
Q

Differential diagnosis of HPS

A 
GERD,
gastroenteritis,
 increased intracranial pressure  
metabolic disorders.
gastric tumors,
30
Q

What is the treatment of HPS non surgical

A

Hydration and electrolytes to correct hypochloremic, hypokalemic metabolic alkalosis

31
Q

What is the surgical treatment of HPS

A

pyloromyotomy: open and laproscopic

32
Q

define appendicitis

A

inflammation on appendix

33
Q

What are the causes of appendicitis

A 
obstruction of the appendix lumen with:
 stool
lymphoid hyperplasia
neoplasm
bacteria,virus
34
Q

Clinical signs of appendicitis

A 
begins with anorexia and periumbilical pain 
pain radiates to right lower abdomen
nausea, vomitting
Diarrhea in perforated appendicitis
fever
35
Q

Physical examination of appendicitis

A

pain when pressing mcburney point RLQ
Rovsing - pain on right when pressing left
obturator sign- RLQ pain with rotation of right hip
Psoas sign-RLQ pain when right leg extended

36
Q

imaging in appendicitis

A

xray- fecolith
US- Fluid filled appendix >6mm diameter
ct-

37
Q

What is the differential diagnosis of appendicitis

A 
GI:
Crohn
meckel diverticulum
gastroenteritis
pancreatitis
GU
UTI
renal stones
wilm's tumour
ovarian torsion/cyst
testicular torsion
38
Q

treatment of nonperforated appendicitis

A

Fluids
broad spectrum antibiotics
appendectomy (not encourged)

39
Q

treatment of perforated appendicitis

A

triple antibiotic therapy- ampicillin, gentamicin , clindamycin, nasogastric drainage IV fluids

40
Q

Treatment of gangrenous appendicitis

A

IV antibiotics, enema, peritoneal drainage

41
Q

complications of appendicitis

A

Infection
Postoperative occlusion
fever, abdominal pain, vomitting

42
Q

define inguinal hernia

A

bulge or protrusion that is seen or felt in the groin area or the scrotum

43
Q

Cause of indirect inguinal hernia

A

most common type in children
Testis descend from abdomen to scrotum via the inguinal canal .
In this, the canal does not close> abdominal organs go through this canal.

44
Q

Cause of direct hernia

A

weakness in the abdominal wall that allows intestines to protrude through

45
Q

classification of inguinal hernia

A

MDs don’t LIe:
o Medial to inferior epigastric vessels = Direct hernia
o Lateral to inferior epigastric vessels = Indirect hernia

46
Q

clinical presentation of inguinal hernia

A
  1. A bulge in the inguinal area or scrotum. This bulge may reduce in a supine position.
  2. Usually, painless, severe pain raises concern for a strangulated hernia.
  3. Bowel sounds in the scrotum
    . 4. Silk glove sign: gently pass the fingers over the pubic tubercle to reveal a patent process vaginalis.
47
Q

Diagnosis of inguinal hernia

A

US

48
Q

Treatment of inguinal hernia

A

For open hernia repair surgery, a single long incision is made in the groin. direct hernia-, the bulge is pushed back into place.(indirect)- the hernia sac is either pushed back or tied off and removed.

49
Q

define hydrocele

A

fluid in the scrotum or inguinal canal in

boys or in the inguinal/labial area in girls

50
Q

classification of hydrocele

A

Non-communicating hydrocele- no connection between scrotum and abdomen
reactive hydrocele- type of non-communicating hydrocele caused by trauma, infection or testicular torsion.
communicating hydrocele - canal connecting abdomen to scrotum fails to completely close , the fluid is able to travel back and forth through the canal, size of scrotum changes may also cause inguinal hernia

hydrocele of the cord -fluid collecting along the spermatic cord

pediatric surgery umf (5 decks)

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