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Fiser's ABSITE Review > Chapter 43 - Pediatrics II > Flashcards

Chapter 43 - Pediatrics II Flashcards

1
Q

Where is Meckel’s diverticulum found?

What is the rule of 2s?

A

Antimesenteric border of the small bowel

2 ft from ileocecal valve
2% of the population
2% symptomatic
2 tissue types (pancreatic, gastric)
2 presentations (diverticulitis, bleeding)
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2
Q

What is the embryology of Meckel’s diverticulum?

A

Persistent vitelline duct

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3
Q

What type of tissue is most commonly found in Meckel’s diverticulum? What type is most likely to be symptomatic?

A

Most common: Pancreatic

Symptomatic: Gastric

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4
Q

Treatment for Meckel’s diverticulum?

A

Resection with symptoms, suspicion of gastric mucosa, narrow neck
Segmental resection if diverticulitis involving the base or if base is >1/3 the size of the bowel

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5
Q

What is the presentation of pyloric stenosis? Exam findings? Lab abnormality?

A

3-12wks, firstborn males with projectile vomiting
Olive mass in stomach
Hypochloremic, hypokalemic metabilic alkalosis

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6
Q

US findings with pyloric stenosis?

A

Pylorus >4mm thick, >14mm long

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7
Q

Treatment for pyloric stenosis?

A 
IVF resuscitation (initially with NS, then switch to D5NS)
Pyloromyotomy (RUQ incision, proximal extent should be the circular muscles of stomach)
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8
Q

Presentation of intussusception? Exam findings?

A

3mo - 3y; currant jelly stools (from vascular congestion, not an indication for resection)
Sausage mass, abdominal distention, RUQ pain, vomiting

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9
Q

Lead points for intussusception in children?

A

1 Peyer’s patches, lymphoma, Meckel’s

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10
Q

What % of intussusception in children recur after reduction?

A

15%

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11
Q

Treatment for intussusception in children?

A

Reduce with air-contrase enema (80% successful), proceed to OR if exceed ed max pressure (120mmHg) or max column height (1m)

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12
Q

Why do intestinal atresias develop?

A

As a result of intrauterine vascular accidents

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13
Q

Symptoms of intestinal atresias?

A

Bilious emesis, distention, most do not pass meconium

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14
Q

Most common location of intestinal atresias? Treatment?

A

Jejunum, can be multiple

Barium enema to r/o Hirschsprung’s, resection

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15
Q

What other anomalies is duodenal associated with?

A

Polyhydramnios in mother

Cardiac, renal, other GI anomalies

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16
Q

Duodenal atresia is associated with what syndrome? %?

A

Down’s syndrome 20% of patients

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17
Q

Abd xray findings with duodenal atresia?

A

Double bubble

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18
Q

Treatment for duodenal atresia?

A

Resuscitation

Duodenoduodenostomy or duodenoj

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19
Q

What is the most common type of TE fistula?

A 
Type C (80-90%)
Proximal esophagus atresia and distal TE fistula
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20
Q

Symptoms of type C TE fistula?

A

Newborn spits up feeds, has excessive drooling and resp symptoms with feeding, cannot place NGT in stomach

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21
Q

What is type A TE fistula? Symptoms?

A

Esophageal atresia without fistula

Similar to type C

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22
Q

What is type E TE fistula?

A

H configuration of esophagus and trachea

Most likely to present as adult, not associated with atresia

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23
Q

What does VACTERL stand for?

A

Vertebral, anorectal (imperforate anus), cardiac, TE fistula, radius/renal and limb anomalies

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24
Q

Treatment for TE fistula?

A

Right extrapleural thoracotomy, primary repair, place G tube

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25
Q

Complications of repair?

A

GERD, leak, emphysema, stricture, fistula

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26
Q

What is the presentation of malrotation?

A

Sudden onset bilious vomiting due to Ladd’s bands causing duodenal obstruction

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27
Q

When do most present with malrotation?

A

90% by 1y

75% in 1st month

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28
Q

Diagnosis of malrotation? Treatment?

A

UGI duodenum does not cross midline

Resect Ladd’s bands, counterclockwise rotation, cecum in LLQ with cecopexy, duodenum in RUQ, appendectomy

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29
Q

What is the presentation of meconium ileus?

A

Distal ileal obstruction, abdominal distention, bilious vomiting and distended loops of bowel
Can cause perforation causing meconium pseudocyst or free perf

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30
Q

What other tests are necessary after diagnosis of meconium ileus?

A

Sweat chloride or PCR for Cl channel defect

Occurs in 10% of CF pts

31
Q

What are the abd xray findings with meconium ileus?

A

Dilated loops of small bowel without air-fluid levels (meconium is too thick to separate from bowel wall), can have ground-glass or soap suds appearance

32
Q

Treatment for meconium ileus?

A

Gastrograffin enema (80% effective)
Could also use N-acetylcysteine enema
Surgery: manual decompression and create vent for N-acetylcysteine enema antegrade enema

33
Q

Classic presentation of NEC?

A

Bloody stools after 1st feeding in preemies

34
Q

Risk factors for NEC?

A

Prematurity, hypoxia, hypotension, anemia, polycythemia, sepsis

35
Q

Symptoms of NEC?

A

Lethargy, resp decompensation, abdominal distention, vomiting, blood pre rectum

36
Q

Abd xray findings with NEC?

A

Pneumatosis intestinalis,free air, portal vein air

37
Q

Treatment for NEC?

A

Resuscitation, NPO, abx, TPN, orogastric tube

38
Q

Indications for operation for NEC?

A

Free air, peritonitis, clinical deterioration

39
Q

Mortality with NEC?

A

10%

40
Q

Indication for surgery for congenital vascular malformation?

A

Hemorrhage, ischemia, CHF, nonbleeding ulcers, functional impairment, limb-length discrepancy

41
Q

Treatment for congenital vascular malformation?

A

Embolization and resection

42
Q

Characteristics of high imperforate anus? Treatment?

A

Meconium in urine or vagina

Colostomy, later anal reconstruction with posterior sagittal anoplasty

43
Q

Treatment for low imperforate anus?

A

Posterior sagittal anoplasty (pull anus down into sphincter mechanism); no colostomy needed

44
Q

Post-op complications after surgery for imperforate anus?

A

Pts prone to constipation

Need anal dilation to avoid stricture

45
Q

What is gastroschisis?

A

Intrauterine rupture of umbilical vein; does not have peritoneal sac
To the right of midline, stiff bowel from exposure to amniotic fluid, low rate of congenital anomalies except malrotation

46
Q

Treatment for gastroschisis?

A

Initially place saline-soaked gauzes and resuscitation; TPN, NPO
Repair when stable, place bowel back in abdomen, may need Vicryl mesh silo and primary closure at later date

47
Q

What is omphalocele?

A

Failure of embryonal development, midline defect

Increased risk of congenital anomalies (50%), has peritoneal sac with cord attached

48
Q

What is Cantrell pentalogy?

A

Cardiac defects, pericardium defects (usually at diaphragm), sternal cleft or absence of lower sternum, diaphragmatic septum transversum abscence, omphalocele

49
Q

Treatment for omphalocele?

A

Saline-soaked gauze and resuscitation, TPN, NPO

Repair when stable, try to place bowel in abdomen, may need vicryl mesh and delayed primary closure

50
Q

What is the most common sign of Hirschsprung’s? Other presentations?

A

Infants fail to pass meconium in 1st 24h
Can also present in older age groups as chronic constipation, distention, colitis
Explosive release of watery stool with rectal exam

51
Q

Diagnosis of Hirschsprung’s?

A

Barium enema: may be normal, often with spastic distal segment and dilated proximal segment
Rectal biopsy with absence of ganglion cells in myenteric plexus

52
Q

Treatment for Hirschsprung’s?

A

Resect colon until proximal to where ganglion cells appear; may need to bring up colostomy initially, eventually connect the colon to the anus (Soave or Duhamel procedure)

53
Q

What is Hirschsprung’s colitis?

Treatment?

A

Rapidly progressive, manifested by abdominal distention, foul smelling diarrhea; lethargy and signs of sepsis
Rectal irrigation, may need emergency colectomy

54
Q

Treatment for hydrocele?

A

Surgery at 1y if not resolved or if though to be communicating (waxing/waning size), resect and ligate processus vaginalis

55
Q

Treatment for umbilical hernia?

A

Repair if not closed by age 5 or incarceration or if pt has VP shunt

56
Q

Inguinal hernias are in what % of infants? % R. vs. L.? % bilateral?

A

3% due to failure of closure of processus vaginalis

60% right, 30% left, 10% bilateral

57
Q

Treatment of inguinal hernias?

A

Emergent operation if not able to reduce, otherwise elective repaire with high ligation
Explore contralateral side if left sided, female, or child <1y

58
Q

Where is cystic duplication most commonly found? Treatment?

A

In ileum, often on mesenteric border

Resect cyst

59
Q

What is the most common cause of neonatal jaundice requiring surgery?

A

Biliary atresia

60
Q

Presentation of biliary atresia? Diagnosis?

A

Progressive jaundice (suggestive of atresia if persists >2wks after birth), cholngitis, continued cirrhosis, eventual hepatic failure

61
Q

Diagnosis of biliary atresia? Treatment?

A

US and cholangiography; liver biopsy showing periportal fibrosis, bile plugging, cirrhosis
Kasai procedure before age 3 mo. (hepaticoportojejunostomy): 1/3 get better, 1/3 go on to liver transplant, 1/3 die

62
Q

Where do mets from osteosarcoma go? Treatment?

A

Lung

Resection of primary and pulmonary mets if isolated

63
Q

Lab findings with teratoma? Type found in neonates? Treatment?

A

Elevated AFP and beta-HCG
Sacrococcygeal
Excision

64
Q

What % of sacrococcygeal teratomas are benign at birth?

A

90%; >2mo usually malignant

Great potential for malignancy

65
Q

Treatment for teratoma?

A

Coccygectomy and long-term followup

66
Q

Treatment for undescended testicles?

A

Wait until 2yo
Orchiopexy through inguinal incision, if not able to get testicles down, close and wait 6mo and try again, if will not come down, perform division of spermatic vessels

67
Q

Cancer risk with undescended testicles?

A

Seminoma risk

Risk stays the same even if testicle brought down into scrotum

68
Q

What is prune belly syndrome?

A

Rare; hypoplasia of the abdominal wall, urinary tract abnormalities with dilated urinary system and bilateral cryptorchidism

69
Q

What is the most common cause of airway obstruction in infants?

A

Laryngomalacia; caused by immature epiglottis cartilage with intermittent collapse of the epiglottis airway

70
Q

Symptoms of laryngomalacia?

A

Intermittent respiratory distress and stridor exacerbation in the supine position

71
Q

Treatment for laryngomalacia?

A

Most children outgrow by 12mo

Surgical trach if necessary

72
Q

What is choanal atresia? Symptoms? Treatment?

A

Obstruction of choanal opening by either bone or mucus membrane (usually unilateral)
Intermittent respiratory distress, poor suckling
Surgical correction

73
Q

What is the most common tumor of the pediatric larynx?

A

Laryngeal papillomatosis

74
Q

Cause of laryngeal papillomatosis? Treatment?

A

From HPV in mother during passage through birth canal

Frequently involutes after puberty, can treat with endoscopic removal or laser; frequently recurs

Fiser's ABSITE Review (50 decks)

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