Chapter 43 - Pediatrics I COPY Flashcards
What makes up the foregut?
Lungs, esophagus –> duodenum to ampulla + pancreas, liver, gallbladder
What makes up the midgut?
Duodenum from ampulla –> distal 1/3 of transverse colon
What makes up the hindgut?
Distal 2/3 transverse colon –> anal canal
Which way/how far does the midgut rotate?
270 degrees counterclockwise
What defines low birth weight? Premature?
<2,500g, <37wks
What makes up infant’s immunity at birth?
IgA from milk, IgM synthesized in child
What is the #1 cause of childhood death?
Trauma
What makes up a trauma bolus for kids?
20cc/kg x2; then give blood 10cc/kg
What is the best indicator of shock in peds?
Tachycardia Neonate: 150+ < 1 yo: 120+ > 1yo: 100+
What is the normal UOP for ped?
2-4cc/kg/hr
What % GFR capacity do kids have compared to adults?
25%; poor concentrating ability
What makes up the umbilical vessels?
2 arteries and 1 vein
What are maintenance IV fluids
4cc/kg/hr for the 1st 10 kg
2cc/kg/hr for the 2nd 10 kg
1cc/kg/hr for everything after that
What is pulmonary sequestration?
nonfunctioning mass of normal lung tissue that lacks normal communication with the tracheobronchial tree, and that receives its arterial blood supply from the systemic circulation.
- Arterial supply MC from thoracic aorta or abdominal aorta through inferior pulmonary ligament.
- Extra lobar: systemic venuous drainage via azygous system
- Intra Lobar: pulmonary vein drainage
What is the most common presentation of pulmonary sequestration? Treatment?
Infection, respiratory compromise, abnormal CXR
Tx: Ligate arterial supply first (risk of severe hemorrhage) then lobectomy
What is congenital lobar overinflation (emphysema)?
Cartilage fails to develop in bronchus leading to air trapping with expiration
- normal vascular suply
- normal lobes
- LUL most commonly affected
Presentation of congenial lobar overinflation? Treatment?
Can get vascular compromise (same mechanism as tension pneumo) or respiratory insufficiency
Tx: Lobectomy
What is congenital cystic adenoid malformation? (CCAM)
Alveolar structure not well developed although lung tissue is present, connects with airway
Presentation of congenital cystic adenoid malformation? Treatment?
Resp compromise and recurrent infection
Tx: Lobectomy
What is a bronchiogenic cyst?
Extrapulmonary cysts formed from bronchial tissue and cartilage wall
- MC cyst of the mediastinum, usually posterior to the carina.
Presentation of bronchiogenic cyst? Treatment?
Presents as mediastinal mass filled with milky fluid, can compress adjacent structures or become infected
Tx: Cyst resection
What is the most common mediastinal mass in children?
Neurogenic tumors (neurofibroma, neuroganglionoma, neuroblastoma)
- Usually located posterior
What symptoms are common to all mediastina masses regardless of location?
Respiratory symptoms, dysphagia
What are anterior mediastinal masses?
T cell lymphoma, teratoma (and other germ cell tumors), thymoma, thyroid ca
What are middle mediastinal masses?
T cel lymphoma, teratoma, cyst (cardiogenic, bronchiogenic)
What are posterior mediastinal masses?
T cell lymphoma, neuroblastoma, neurogenic tumors
What is the treatment for choledochal cysts?
Etiology?
All need resection do to risk of cholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice
Etiology: Reflux of pancreatic enzymes into biliary system in utero
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, culture and sensitivity, 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
Tx: 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
