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Pediatric Surgery > Congenital and Dev Disorders > Flashcards

Congenital and Dev Disorders Flashcards

1
Q

Antenatal imaging procedure to detect gastroschisis?

A

Prenatal ultrasound

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2
Q

Management options for Gastroschisis?

A

Primary reduction (Double set-up)
Silastic silo

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3
Q

Gastroschisis is most strongly associated with which anomaly/anomalies?

A

Bowel abnormalities, atresia or stenoses

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4
Q

Interventions for Gastroschisis patients made prior to transfer?

6 steps

A
  1. Wrap bowels in clean kitchen wrap (bowel bag)
  2. Maintain normothermic
  3. NPO
  4. IV Fluid
  5. NGT
  6. Explain management to parents
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5
Q

Appropriate management of gastroschisis after primary reduction?

A

Observation

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6
Q

Long term complications after recovery from gastroschisis?

A
  1. Short Bowel Obstruction
  2. Short Gut Syndrom
  3. CV catheter-related sepsis
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7
Q

Sac is covered with peritoneum without overlying skin and insertion of distal umbilical cord.

A

Omphalocele

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8
Q

Management and Treatment for Omphalocele

A
  1. Wrap in moist, sterile dressings
  2. Prompt surgical repair
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9
Q

Omphalocele > 10cm

A

Giant omphalocele

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10
Q

How can you diagnose omphalocele prenatally?

A
  1. Ultrasonography
  2. Maternal a-fetoprotein (increased)
  3. Amniocentesis with chromosomal studies (for congenital anomalies)
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11
Q

Patient presents with macroglossia, what syndrome is most likely present?

A

Beckwith-Wiedemann chromosomal syndrome
(umbilical defect, gigantism, macroglossia, visceromegaly, pancreatic islet cell hyperplasia)

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12
Q

Other coexisting abnormalities commonly seen in patients with omphalocele?

A
  1. Cardiac anomalies - VSD, ASD, TOF, Ectopia cordis
  2. GI anomalies - Duodenal atresia (common in gastroschisis)
  3. Malignant tumor, neuroblastoma, adrenocortical tumors
  4. Chromosomal anomalies
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13
Q

Pre-operative interventions for patients with omphalocele

7 steps

A
  1. NGT with cont. drainage
  2. Sterile dressing w/ moist towels
  3. Plastic foilage
  4. Lateral position
  5. IV access
  6. Transport in heated incubator
  7. Rectal irrigation - NSS
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14
Q

Treatment options for omphalocele

A
  1. Reduce ophalocele, repair abdominal wall
  2. Immediate operation
  3. Excision of the sac
  4. Cylindrical tube (silo)
  5. Non-operative management
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15
Q

Absence of an anal opening

A

Imporforate anus

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16
Q

Initial laboratory tests and imaging for patients with imporforate anus?

A
  1. Cross-table lateral radiograph (invertogram)
  2. Xray of spine and chest
  3. Ultrasonography
  4. ECG
  5. MRI
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17
Q

What are the usual associated anomalities in patients with anorectal malformations?

A

VACTERL association
1. Vertebral/spinal cord abnormalities
2. Anorectal malformations
3. Congenital cardiac disease
4. TEF
5. Esophageal atresia
6. Renal anomalies
7. Limb defects

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18
Q

Diagnostic test/Imaging for Vertebral/spinal abnormalities?

A

Xray (Babygram), MRI for spinal injury

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19
Q

Diagnostic test/Imaging for Anorectal malformation?

A

Physical Exam

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20
Q

Diagnostic test/Imaging for Congenital cardiac disease?

A

2D Echo

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21
Q

Diagnostic test/Imaging for TEF/Esophageal atresia?

A

NGT insertion resistance
Drooling/excessive salivation

22
Q

Diagnostic test/Imaging for renal anomalies?

A

Renal ultrasound

23
Q

Diagnostic test/Imaging for limb defects?

A

Observation, PE

24
Q

Plans and definitive management for patients with imporforate anus?

A

1st - Colostomy
2nd - Posterior Sagittal Anorectoplasty (after 4-6 months)

25
What are the pertinent information on history and PE of a patient with intestinal atresia?
1. Vomiting (emesis) 2. Polyhydramnios 3. Association with congenital anomaly (Down Syndrome)
26
Differential diagnosis of Intestinal atresia?
1. Duodenal atresia 2. Malrotation (Vovulus) 3. Jejunal atresia
27
Imaging signs seen in patients with intestinal atresia?
Double bubble sign (duodenal atresia, malrotation) More bubbles in jejunal atresia
28
Diagnostic examinations for intestinal atresia?
1. Babygram AP, cross-table lateral = Double bubble sign 2. 2D Echo 3. KUB ultrasound 4. Chromosomal analysis
29
Treatment modalities for intestinal atresia
SUPPORTIVE 1. OGT insertion 2. IV Fluids 3. CBC, Blood typing, electrolytes SURGICAL 1. Exploratory laparotomy, repair of duodenal atresia
30
Possible complications of intestinal atresia?
1. VACTERL 2. Anastomotic leak
31
Presence of palpable mass on the inguinoscrotal area
Inguinal hernia
32
Differential diagnosis when inguinoscrotal mass is present?
1. Inguinal hernia 2. Hydrocele 3. Testicular torsion 4. Inguinal lymphadenopathy
33
Diagnostic tests for inguinal hernia?
1. Inguinoscrotal ultrasound - defect on the floor of inguinal area, peristalsis/bulging omentum
34
3 types of Inguinal hernia based on severity
1. Reducible *2. Incarcerated - non reducible, obstruct site *3. Strangulated - compromised blood supply, non-viable, necrotic | * TRUE SURGICAL EMERGENCIES
35
Treatment modalities for inguinal hernia
SUPPORTIVE 1. IV Fluids 2. Antibiotics SURGICAL 1. Inguinal exploration, herniotomy
36
BEST time to operate on inguinal hernia?
On diagnosis ASAP for incarcerated and strangulated
37
Complication of inguinal hernia and surgical intervention?
Strangulation
38
Most common/Initial symptom of patients with Meckel's diverticulum?
Hematochezia / Massive **painless** GI bleeding
39
Differential diagnosis of Meckel's diverticulum
1. Bleeding Meckel's diverticulum 2. Bloody diarrhea 3. Intussusception 4. Others (Trauma, anal fissure, juvenile polyp)
40
Diagnostic examinations for Meckel's diverticulum?
CBC, blood typing Meckel's diverticulum scintigraphy / Meckel's scan Colonoscopy
41
Meckel's diverticulum scintigraphy results
(+) on left upper quadrant (stomach) - normal (+) on left lower quadrant - Meckel's diverticulum
42
Treatment modalities for Meckel's diverticulum?
Supportive 1. IV Fluids 2. Blood transfusion of pRBC - correction of anemia and blood loss 3. Antibiotics based on px. clinical picture Surgical 1. **Wedge-resection anastomosis of diverticulum** via laparoscopic-assisted or open technique
42
Treatment modalities for Meckel's diverticulum?
Supportive 1. IV Fluids 2. Blood transfusion of pRBC - correction of anemia and blood loss 3. Antibiotics based on px. clinical picture Surgical 1. **Wedge-resection anastomosis of diverticulum** via laparoscopic-assisted or open technique
43
Possible complications of Meckel's diverticulum?
1. Hypovolemic shock (failure of supportive treatment) 2. Anastomotic leak
44
Rule of 2s: Meckel's diverticulum
Incidence is roughly 2% of the population If symptomatic clinically recognized at 2 y/o 2 inches in maximal dimension Located 2 ft of the ileocecal valve
45
Common location of Meckel's diverticulum?
Ileocecal valve (2 ft)
46
Vomiting, severe pain (intermittent colicky abdominal pain, blood-tinged mucoid stools, presence of mass (RLQ/LLQ)
Intussusception
47
Differential diagnosis of intussusception
1. Intussusception 2. Acute gastroenteritis 3. Strangulated inguinal hernia
48
Initial management for intussusception
1. IV Fluids 2. NGT decompression 3. IV antibiotics 4. CBC, chem panel, blood typing
49
Imaging modalities for intussusception
1. Abdominal xray 2. Ultrasound - donut/target sign on transverse, pseudokidney on longitudinal **3. Barium/air contrast enema - GOLD STANDARD**
50
Definitive treatment for intussusception
1. Surgical exploration 2. Reduction of intussusception 3. Appendectomy (optional) 4. Local / segmental resection 5. Primary anastomosis
51
Golden period of intussusception
**6-8 hours**

Pediatric Surgery (2 decks)

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