Fiser Chapter 43 PEDIATRIC SURGERY Flashcards
Pulmonary sequestration diagnosis
CTA
Pulmonary sequestration most common location
Left lower lobe
Drainage system of extralobar versus intralobar pulm sequestration
Extralobar systemic
Inralobar pulmonary vein
Congenital lobar emphysema treatment
Lobectomy (no chest tube)
Most common lobation of CLE
Left upper lobe
Location of bronchogenic cyst
Mediastinum (right posterior to carina)
Treatment of bronchogenic cyst
Resection of cyst
Mediastinal masses: anterior, middle, posterior
Anterior: T-cell lymphoma, teratoma, germ cell tumors, thyroid cancer
Middle: T-cell lymphoma, teratoma, cysts (cardiogenic or bronchogenic)
Posterior: T-cell lymphoma, neuroblastoma, neurogenic tumor
Choledochal cyst types
I: Fusiform of entire CBD, tx resection and hepaticoJ
II: True diverticular cyst off CBD, tx resection
III: Distal dilatation involving sphincter or Oddi, tx resection and choledochoJ via duodenotomy
IV: Intra and extra hepatic cysts, tx resection and lobectomy, maybe transplant
V: Intrahepatic (Caroli’s disease), tx lobectomy versus transplant
Neuroblastoma most common location
Adrenals, but can occur anywhere along sympathetic chain
Secretory diarrhea, raccoon eyes, hypertension, unsteady gait (opsomyoclonus), increased catecholamines, VMA, HVA, and metanephrines, in child <2 years old
Neuroblastoma
Embryological origin of neurblastoma
Neural crest cells
Indicators of worse prognosis in neuroblastoma
NSE (neuron specific elastase), LDH, HVA, diploid tumors, and N-myc amplification
Most common malignancies in kids
Overall: leukemia (ALL)
Solid: CNS tumors
Gen surg: Neuroblastoma if <2 yo; Wilms if >2 yo
Embryology of Meckel’s
Persistent vitelline duct (aka omphalomesenteric duct)
Most common cause of painless lower GIB in kids
Meckel’s
Pyloric stenosis metabolic abnormalities
Hypochloremic hypokalemic metabolic alkalosis
Tx: NS boluses until making urine, then switch to D5-NS with 10 mEq of K
Age of presentation for intususception
3 months to 3 years
Etiology of intestinal atresias
Intrauterine vascular accidents
Most common site of intestinal atresia
Jejunum
Associated abnormalities with duodenal atresias
Down’s syndrome; cardiac, renal, and other GI abnormalities
TEF types
A: complete atresia
B: proximal fistula and distal atresia
C: most common, proximal atresia and distal fistula
D: Double fistula
E: H type just fistula
VACTERL Syndrome
Vertebral Anorectal (imperforate anus) Cardiac TEF Esophageal Radius (thumb) or Renal Limb
Approach to TEF repair
Right extrapleural thoracotomy
Malrotation diagnosis
Upper GI study: duo does not cross midline, duodenojejunal junction displaced to right
Treatment of Malro
Ladd procedure: resect ladd’s bands, perform counterclockwise rotation (turn back hands of time), place cecum in left lower quadrant, duodenum in RUQ, appendectomy
Treatment of meconium ileus
Gastrograffin enema, test for CF
Appearance of abdominal x ray of meconium ileus
Dilated loops of small bowel without air fluid levels; ground glass or soap suds appearance
Classic presentation of NEC
Bloody stools after first feeding in premature neonates
Risk factors for NEC
prematurity
hypoxia
sepsis
Initial tx of NEC
resuscitation, npo, abx, TPN, orogastric tube
gastroschisis versus omphalocele
Gastroschisis: to the R of midline, no peritoneal lining
Omphalocele: midline with sac; associated congenital anomalies and Cantrell pentalogy (cardiac defects, pericardial defects, sternal cleft or abscess of sternum, diaphragmatic, omphalocele)
Hirschsprung’s disease diagnosis
Rectal biopsy, absence of ganglion cells in myenteric plexus
