Chapter 5: Pediatric Surgery Flashcards
Esophageal atresia sx?
- excessive salivation shortly after birth
- choking spells when first feeding attempted
- NG tube curled in upper test on x-ray
- if normal gas pattern in bowel-> baby has blind pouch into esophagus and fistula bw lower esophagus and tracheobronchial tree
- 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
Tx of esophageal atresia?
surgical repair preferred but if delay–> gastrostomy done to protect lungs from acid reflux
How to examine for imperforate anus?
- look for fistula near vagina or perineum
Management of imperforate anus?
- if there’s a fistula–> repair can be delayed until further growth
- 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
How to determine level of pouch in imperforate anus?
upside down x-ray w metal marker taped to anus
Congenital diaphragmatic hernia presentation?
- always on left
- bowel up in chest
- hypoplastic lung that has feta-type circulation
Tx for congenital diaphragmatic hernia?
- ET intubation
- low-pressure ventilation (don’t want to blow up other lung)
- sedation
- NG suction
- potentially ECMO
must delay repair 3-4 days to allow for maturation of lung
Gastroschisis:
- umbilical cord is normal
2. to the right of the cord there’s no protective membrane and bowel is angry and matted
Omphalocele
- umbilical cord goes to defect
2. thin membrane with normal-looking bowel ad sliver of liver
Management of gastroschisis and omphalocele:
- small defects: close on their own
- large defects: require Silastic “silo” house construction to protect bowel
- silo is then squeezed into belly a little every day until complete closure over a week
- give parenteral nutrition also bc bowel won’t work for 1 month
Management of bladder exstrophy?
- transfer baby immediately to specialized center where repair can be done in first 1-2 days of life
- delayed repairs don’t work
DDx for green vomiting with double-bubble on x-ray?
- duodenal atresia
- annular pancreas
- malrotation
Dx for malrotation?
- contrast enema (not always diagnostic)
- upper GI study (more risky)Intestinal atreasia
- see normal gas pattern beyond the double-bubble
Intestinal atresia presentation:
- green vomiting
2. multiple air-fluid levels throughout abdomen
Etiology of intestinal atresia?
- vascular accident in utero
2. don’t need to suspect other congenital anomalies