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Surgery > Chapter 5: Pediatric Surgery > Flashcards

Chapter 5: Pediatric Surgery Flashcards

1
Q

Esophageal atresia sx?

A
  1. excessive salivation shortly after birth
  2. choking spells when first feeding attempted
  3. NG tube curled in upper test on x-ray
  4. if normal gas pattern in bowel-> baby has blind pouch into esophagus and fistula bw lower esophagus and tracheobronchial tree
  5. VACTER constellation must be r/o before surgical repair:
    a. vertebral: check x-ray for abnormalities
    b. anal: check for imperforation
    c. cardiac: do echo
    d. tracheal
    e. esophageal
    f. renal: use sonogram to look for abnormalities
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2
Q

Tx of esophageal atresia?

A

surgical repair preferred but if delay–> gastrostomy done to protect lungs from acid reflux

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3
Q

How to examine for imperforate anus?

A
  1. look for fistula near vagina or perineum
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4
Q

Management of imperforate anus?

A
  1. if there’s a fistula–> repair can be delayed until further growth
  2. if there’s no fistula–> colostomy needs to be done for high rectal pouch or primary repair if blind pouch is almost at the anus
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5
Q

How to determine level of pouch in imperforate anus?

A

upside down x-ray w metal marker taped to anus

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6
Q

Congenital diaphragmatic hernia presentation?

A
  1. always on left
  2. bowel up in chest
  3. hypoplastic lung that has feta-type circulation
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7
Q

Tx for congenital diaphragmatic hernia?

A
  1. ET intubation
  2. low-pressure ventilation (don’t want to blow up other lung)
  3. sedation
  4. NG suction
  5. potentially ECMO
    must delay repair 3-4 days to allow for maturation of lung
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8
Q

Gastroschisis:

A
  1. umbilical cord is normal

2. to the right of the cord there’s no protective membrane and bowel is angry and matted

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9
Q

Omphalocele

A
  1. umbilical cord goes to defect

2. thin membrane with normal-looking bowel ad sliver of liver

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10
Q

Management of gastroschisis and omphalocele:

A
  1. small defects: close on their own
  2. large defects: require Silastic “silo” house construction to protect bowel
  3. silo is then squeezed into belly a little every day until complete closure over a week
  4. give parenteral nutrition also bc bowel won’t work for 1 month
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11
Q

Management of bladder exstrophy?

A
  1. transfer baby immediately to specialized center where repair can be done in first 1-2 days of life
  2. delayed repairs don’t work
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12
Q

DDx for green vomiting with double-bubble on x-ray?

A
  1. duodenal atresia
  2. annular pancreas
  3. malrotation
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13
Q

Dx for malrotation?

A
  1. contrast enema (not always diagnostic)
  2. upper GI study (more risky)Intestinal atreasia
  3. see normal gas pattern beyond the double-bubble
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14
Q

Intestinal atresia presentation:

A
  1. green vomiting

2. multiple air-fluid levels throughout abdomen

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15
Q

Etiology of intestinal atresia?

A
  1. vascular accident in utero

2. don’t need to suspect other congenital anomalies

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16
Q

Necrotizing entercolitis

A
  1. appears after first feeding
  2. feeding intolerance
  3. abdominal distention
  4. rapidly dropping pt count (sign of sepsis in babies)
17
Q

Tx for necrotizing enterocolitis?

A
  1. stop all feedings
  2. administer broad-spectrum abx
  3. IV fluids
  4. IV nutrition
18
Q

What signs indicate it’s time for surgical intervention in necrotizing enterocolitis?

A
  1. abdominal wall erythema
  2. air in portal vein
  3. intestinal pneumatosis (air in bowel wall)
  4. pneumoperitoneum
19
Q

Meconium ileus x-ray findings?

A
  1. multiple dilated loops of small bowel

2. ground glass in lower abdomen

20
Q

Meconium ileus Dx:

A
  1. Gastrografin enema
    a. diagnostic
    b. therapeutic
21
Q

Hypertrophic pyloric stenosis sx:

A
  1. most common in firstborn boys
  2. nonbilious projectile vomiting
  3. dehydrated baby
  4. peristaltic gastric waves
  5. olive-size mass in RUQ
  6. hypochloremic
  7. hypokalemic metabolic alkalosis
22
Q

Hypertrophic pyloric stenosis dx:

A

felt

if not, sonogram is diagnostic

23
Q

Tx for hypertrophic pyloric stenosis?

A
  1. correct hyperchloremic, hypokalemic met alk

2. ramstedt pyloromyotomy or balloon dilation

24
Q

Presentation of biliary atresia? Dx?

A
  1. progressive jaundice in 6-8 week olds (substantial conjugated fraction)
  2. do serology and sweat test to r/o other problems
  3. HIDA scan after 1 week of phenobarbital (a powerful choleric)
  4. if no bile reaches duodenum-> surgical exploration necessary
25
Q

Tx of biliary atresia?

A
  1. 1/3: long-lasting surgical derivation
  2. 1/3: need liver transplant after they survived for a while with a surgical derivation
  3. 1/3: need liver transplant right away
26
Q

Hirschsprung Disease (aganglionic megacolon) Presentation?

A
  1. can be recognized in early life or may go undiagnosed for many years
  2. Chronic constipation is cardinal Sx
  3. rectal exam may lead to explosive expulsion of stool and flatus w relief of abdominal distention
  4. X-ray: distended proximal colon (normal part) and “normal-looking” distal colon (a ganglionic part)
27
Q

Differential diagnosis Hirschsprung Disease?

A

Psychogenic Problems

–presence of fecal soiling suggests this diagnosis

28
Q

How to diagnose Hirschsprung Disease? Tx?

A

Dx: full-thicknes biopsy of rectal mucosa
Tx: ingenious operations devised to preserve unique sensory input of motor-impaired rectum

29
Q

Intussusception presentation?

A
  1. seen in 6-12 mth old chubby, healthy-looking kids
  2. colicky abdominal pain–> double up and squat
  3. pain lasts for ~1 minute , happy after episode ends
    * Physical Exam:
  4. vague mass on right side of abdomen
  5. “empty” RLQ
  6. “currant jelly stools”
30
Q

Dx of intussusception?

A

barium or air enema is both diagnostic and therapeutic

31
Q

Tx of intussusception?

A

if can’t reduce radiologically (barium or air enema)…do surgery

32
Q

Child abuse typical injuries:

A
  1. subdural hematoma + retinal hemorrhages (shaken baby syndrome)
  2. multiple fractures in different bones at different stages of healing
  3. all scalding burns (particularly burns of both buttocks)
33
Q

Meckel diverticulum presentation?

A
  1. lower GI bleeding in pediatric age group

2. do radioisotope scan looking for gastric mucosa

Surgery (9 decks)

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