Chapter 43 - Pediatrics I Flashcards by Joe Fahmy

What makes up the foregut?

Lungs, esophagus - duodenum to ampulla, pancreas, liver, gallbladder

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What makes up the midgut?

Duodenum from ampulla - distal 1/3 of transverse colon

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What makes up the hindgut?

Distal 2/3 transverse colon - anal canal

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Which way/how far does the midgut rotate?

270 degrees counterclockwise

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What defines low birth weight? Premature?

<37wks

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What makes up infant’s immunity at birth?

IgA from milk, IgM synthesized in child

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What is the #1 cause of childhood death?

Trauma

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What makes up a trauma bolus for kids?

20cc/kg x2; then give blood 10cc/kg

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What is the best indicator of shock in peds?

Tachycardia

Neonate >150, 120, rest >100

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What is the normal UOP for pes?

2-4cc/kg/hr

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What % GFR capacity do kids have compared to adults?

25%; poor concentrating ability

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What makes up the umbilical vessels?

2 arteries and 1 vein

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What is pulmonary sequestration?

Lung tissue with systemic and arterial supply and either systemic venous or pulmonary vein drainage
Intra or extralobar; neither communicates with tracheobronchial tree

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What is the most common presentation of pulmonary sequestration? Treatment?

Infection

Lobectomy

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What is congenital lobar overinflation (emphysema)?

Cartilage fails to develop in bronchus leading to air trapping with expiration

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Presentation of congenial lobar overinflation? Treatment?

Can get vascular compromise (same mechanism as tension pneumo), respiratory insufficiency
Lobectomy

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What is congenital cystic adenoid malformation?

Alveolar structure not well developed although lung tissue is present, connects with airway

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Presentation of congenital cystic adenoid malformation? Treatment?

Resp compromise, recurrent infection

Lobectomy

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What is a bronchiogenic cyst?

Extrapulmonary cysts formed from bronchial tissue and cartilage wall

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Presentation of bronchiogenic cyst? Treatment?

Presents as mediastinal mass filled with milky fluid, can compress adjacent structures or become infected
Cyst resection

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What is the most common mediastinal mass in children?

Neurogenic tumors (neurofibroma, neuroganglionoma, neuroblastoma)
Usually posterior

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What symptoms are common to all mediastina masses regardless of location?

Respiratory symptoms, dysphagia

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What are anterior mediastinal masses?

T cell lymphoma, teratoma (and other germ cell tumors), thymoma, thyroid ca

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What are middle mediastinal masses?

T cel lymphoma, teratoma, cyst (cardiogenic, bronchiogenic)

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What are posterior mediastinal masses?

T cell lymphoma, neuroblastoma, neurogenic tumors

What is the treatment for choledochal cysts? Etiology?

All need resection du/t risk of pholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice Reflux of pancreatic enzymes into biliary system

What is a type I choledochal cyst? %?

Fusiform dilation of entire common bile duct, mildly dilated CHD, normal intrahepatic ducts 85%

What is a type II choledochal cyst? %?

True diverticulum that hangs off the common bile duct | 3%

What is a type III choledochal cyst? %?

Dilation of distal intramural common bile duct, involves sphincter of Oddi 1%

What is a type IV choledochal cyst? %?

Multiple cysts, both intra and extrahepatic | 10%

What is type V choledochal cyst? Other name? %?

Caroli's disease | Intrahepatic cysts, get hepatic fibrosis, may be associated with congenital hepatic fibrosis and medullary sponge kidney

What is lymphadenopathy most likely caused by?

Acute suppurative adenitis associated with URI or pharyngitis

Workup for fluctuant lymphadenophathy? Asymptomatic?

Fluctuant: FNA, C/S, abx; may need I&D Asymptomatic: abx for 10d, excisional biopsy if no improvement (lymphoma until proven otherwise)

What causes chronic fluctuant lymphadenopathy?

Cat scratch fever, atypical mycoplasma

What is cystic hygroma? Treatment?

Lymphangioma Found in lateral cervical and submandibular regions in neck, gets infected Resection

Overall survival of diaphragmatic hernias?

50%

What % of diaphragmatic hernias have associated anomalies? What are they?

80% | Cardiac and neural tube defects, malrotation

Diaphragmatic hernias are increased on which side?

Left

Treatment for diaphragmatic hernias?

High-frequency ventilation, ECMO, prostacyclin (pulmonary vasodilator); stabilize before operating, reduce bowel, repair +/- mesh, look for visceral anomalies (run the bowel)

What is Bochdalek's hernia?

Most common diaphragmatic hernia | Posterior

What is Morgagni's hernia?

Rare diaphragmatic hernia | Anterior

What is eventration?

Failure of diaphragm to fuse

Treatment for pectus excavatum?

(Sinks in) Sternal osteotomy, need strut Performed if causing respiratory symptoms or emotional distress

Treatment for pectus craniatum?

(Pigeon chest) Strut not necessary Repair for emotional distress

Branchial cleft cyst causes what?

Cysts, sinuses, fistulas

Where is a 1st branchial cleft cyst? Associated with which nerve?

Angle of mandible, may connect with external auditory canal | Facial nerve

Where is a 2nd branchial cleft cyst?

On anterior border of SCM muscle, goes through carotid bifurcation into tonsillar pillar

Where is a 3rd branchial cleft cyst?

Lateral neck

What is the treatment for branchial cleft cysts? Which is most common?

Resection | 2nd branchial cleft cyst most common

Where is a thyroglossal duct cyst? Presentation?

From descent of thyroid gland from foramen cecum, goes through hyoid Presents as midline cervical mass

Treatment for thyroglossal duct cyst?

Resection of cyst, tract, and hyoid bone

Characteristics of hemangioma?

Appears at birth or shortly after | Rapid growth between 6-12mo, then begins to involute

Treatment of hemangioma?

Observation | Steroids, laser/surgery if uncontrollable growth, impairs function (eyelid/ear canal), persistent after age 8

What is the #1 solid abdominal malignancy in children?

Nueroblastoma

How do neuroblastomas usually present?

Asymptomatic mass | Can have secretory diarrhea, raccoon eyes (orbital mets), HTN, opsomy oclonus syndrome (unsteady gait)

What is the most common location of neuroblastomas?

Adrenals; can occur anywhere on sympathetic chain

Most common lab findings with neuroblastoma?

Elevated catecholamines, VMA, HVA, metanephrines

Abd xray findings of neuroblastoma?

Stippled calcifications in tumor

What is elevated in all patients with neuroblastoma mets?

Elevated NSE

Treatment for neuroblastoma?

Resection (30-40% cured), chemo if initially unresectable

Presentation of Wilms tumor?

Usually as asymptomatic mass | Hematuria, HTN, 10% bilateral

What is prognosis of Wilms tumor based on?

Tumor grade | Anaplastic and sarcomatous variations with worst prognosis

Where do mets from Wilms tumor go?

Bone and lung; can resect lung mets

What syndromes are Wilms tumors associated with?

Beckwith-Widermann (hemihypertrophy, cryptorchidism, Drash syndrome, aniridia)

What are CT findings with Wilms tumors?

Replacement of renal parenchyma | NOT displacement as seen with neuroblastoma

Treatment for Wilms tumor?

Nephrectomy (80-90% cured) Examine contralateral side for implants Avoid rupture of tumor Actinomycin and vincristine (except for stage I <500g)

What is the most common malignant tumor in children?

Hepatoblastoma

What lab value is elevated in hepatoblastoma? Presentation?

Elevated AFP in 90% | Fractures, precocious puberty (from beta-HCG release)

Hepatoblastomas are associated with what syndrome?

Beckwith-Wiedemann syndrome

Treatment for hepatoblastoma?

Resection; otherwise doxorubicin-cisplatin based chemo

What is the #1 children's malignancy overall?

ALL

What is the #1 solid tumor class?

CNS tumors

What is the #1 general surgery tumor in child 2?

2y: Wilms tumor

What is the #1 cause of duodenal obstruction in newborns?

Duodenal atresia

What is the #1 cause of duodenal obstruction after newborn period and overall?

Malrotation

Wat is the #1 cause of colon obstruction?

Hirschsprung's disease

What is the #1 liver tumor in children?

Hepatoblastoma

What is the #1 lung tumor in children?

Carcinoid

What is the #1 cause of painful lower GI bleeding?

Benign anorectal lesion (fissure, etc.)

What is the #1 cause of painless lower GI bleeding?

Meckel's diverticulum

What are the causes of upper GI bleeding in children 0-1? 1-adults?

0-1y: gastritis, esophagitis | 1-adult: esophageal varices, esophagitis