EXAM #3: PEDIATRIC SURGICAL PROBLEMS Flashcards
What are the three etiologies of lymphadenopathy?
1) Infectious
2) Reactive
3) Malignancy
What is the difference between acute and chronic lymphadenopathy?
- Less than 6 weeks= acute
- Greater than 6 weeks= chronic
What is the surgical procedure to diagnose lymphadenopathy?
Biopsy
What do you need to do for the proper diagnosis of a thryoglossal duct cyst?
US to ensure there is normal thyroid tissue
What is the surgical procedure for a thyroglossal duct cyst?
Sistrunk procedure
A small incision is made over the cyst. The cyst and the entire tract are removed, as well as the middle portion of the hyoid bone
When is surgery indicated for congenital torticollis?
Failure to resolve within a year with aggressive conservative therapy
How is congenital torticollis treated surgically?
Division of the involved SCM
What is the most common type of tracheo-esophageal fistula?
Proximal atresia with distal fistula
What is the most common presenting symptom of a TE fistula?
Excessive salivation
How is a TE fistula managed surgically?
Right toracotomy and exptrapleural repair
*May require gastrostomy
What is the VATER association with TE fistula? Why is this important?
Vertebral Anorectal Cardiovascular Tracheal Esophageal Renal Limb
Any kid with a TE fistula will need to be associated for these issues as well.
What is the eponym for the most common location of a diaphragmatic hernia?
Foramen of Bochdalek in the left pleuroperitoneal membrane
When do you know if a chest wall deformity needs to be repaired?
At least 14 years of age–only intervene earlier if cardiopulmonary compromise
What anomalies are associated with omphalocele?
1) Heart
2) Urinary Tract
3) Beckwith-Wiedeman
What is the difference between major and minor omphalocele?
Minor= less than 4cm Major= greater than 4cm
What is Bechwith-Wiedeman Syndrome?
This is an overgrowth disorder usually present at birth; it is characterized by an increased risk of childhood cancer and congenital anomalies, including:
1) macroglossia (large tongue),
2) macrosomia (above average birth weight and length),
3) midline abdominal wall defects (omphalocele/exomphalos, umbilical hernia, diastasis recti),
4) ear creases or ear pits, and
5) neonatal hypoglycemia
What is Gastrochisis?
Abdominal wall defect right of the umbilicus
What is worse, gastrochisis or omphalocele?
Omphalocele
What are the complications of gastrochisis and omphalocele?
1) Heat loss–>warm
2) Third space heat loss
3) Infection–>antibiotics
At birth, what should you remember about gastrochisis or omphalocele?
Leave the umbilical cord long
What is the presentation with malrotation and volvulus?
Forceful often bilious emesis
Remember, bilious emesis is a red flag
How do you diagnose malrotation/ volvulus?
Upper GI series
What is the classic imaging for duodenal atresia?
“Double bubble sign”
How is duodenal atresia repaired surgically?
Duodenoduodenostomy
What causes midgut atresia?
In utero mesenteric vascular accident
What is the rule of two’s for Meckel’s Diverticumlum?
- 2 feet from ileocecal valve
- 2% population
- Most before age of 2
How does Meckel’s Diverticulum present?
Massive bleeding
What is the first thing you need to do if you suspect Meckel’s Diverticulum?
1) Resuscitate
2) Meckel’s Scan
How do you work-up Hirschsprung’s Disease?
1) Barium enema
2) Rectal biopsy* gold-standard
On x-ray, what is suggestive of Hirschsprung’s Disease?
No gas in the rectum
How do you treat Hirschsprung’s Disease with surgery?
1) Possible colostomy
2) Remove affected contracted region
What is an imperforate anus?
Cloaca that does NOT separate rectum and urogenital sinus
What is the typical age that you would repair an umbilical hernia?
3-5 years old
What is the classic presentation of Intussception?
- Paroxysmal, crampy abdominal pain
- Currant jelly stool (late sign)
How is Intusssception worked up?
1) US–> “target sign”
2) Barium enema
What are the buzzwords for pyloric stenosis?
- Projectile non-bilious emesis
- Olive mass
- Hypochloremic hypokalemic alkalosis (emesis contains Cl- and K+)
How does biliary atresia present?
Persistent direct hyperbilirubinemia
What is the definitive treatment for biliary atresia?
Transplant (initial surgery, “Kasai” only buys time)
What type of hernia is more common in kids?
Indirect
What increases the risk of indirect hernia?
Premature
What should you remember about pediatric inguinal hernias?
Should be fixed ASAP
When do undescended testes need to be fixed?
By 1-year (may descend by six months)
What is a horseshoe kidney?
Single kidney with fused poles
