Gen Surg Flashcards
Presentation of Pyloric Stenosis
- age
- risk factors
NONbilious projectile vomiting
2 weeks - 2 years
RF: +ve FHx, first born, maternal feeding patterns
Investigations for Pyloric stenosis
- cutoffs
Abdo u/s:
pylorus
>/= 14mm length
>/= 4mm thickness
(UGI: string sign)
Pyloric stenosis
- labs
hypochloremic metabolic alkalosis
```
paradoxical aciduria
With ensuing volume contraction, kidney reabsorbs Na+ and volume at expense of H+ and K+
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Pyloric Stenosis
- mgmt
1) Fluid resuscitation w NS until UO resumes
2) maintenance fluids w dextrose and K
3) Need to normalize metabolic acidosis
4) Surgery - pyloromyotomy
What is the MOST COMMON pathologic lead point seen with intussusception
Meckel’s diverticulum
Intussusception
- peak age
- M or F?
3 weeks to 3 years
M>F
Intussusception
- most common type
ileocolic
Intussusception
- Pathological lead points
- Meckel’s diverticulum (most common)
- Polyps, Intestinal duplication
- Henoch-Schonlein purpura
- Appendix, hemangioma, foreign body, ectopic mucosa, hamartoma (Peutz-Jaeger’s)
- Malignancy (lymphoma, SB tumors, melanoma)
Intussusception
- Gold standard test
Ultrasound
- Air enema to confirm
Intussusception
- Mgmt
- NPO
- CBC, lytes
- IVF: resuscitations w bolus then maintenance
- Non operative: pneumatic reduction
Intussusception
- contraindications to reduction
- Peritonitis
- Persistent hypotension
- Free air/pneumoperitoneum
Meckels: Rule of 2s
2% of population 2:1 M:F 2-6% symptomatic, complicated 50-75% symptomatic by age 2 years within 2 feet of ileocecal valve 2 inches long 2 types of heterotopic mucosa: gastric, pancreatic
Congenital diaphragmatic hernia
- first step in mgmt
Immediate placement of a nasal or oral gastric tube
Intubate immediately
Which major anomaly occurs MOST frequently with EA-TEF
cardiovascular
Presentation of TEF
- Choking/cyanotic episodes with feeding
- profuse oral secretions
Most common TEF
EA w distal TEF
2nd isolated EA
TEF - oligo or poly hydramnios
polyhydramnios
Ddx bilious vomiting in neonate
(a) Hirschsprung’s disease
(b) Malrotation +/- Midgut volvulus
(c) Intestinal atresia (small bowel)
(d) Ileus
Malrotation/volvulus
Bilious vomiting
+/- Scaphoid abdomen
DX: UGI (gold standard)
Cardinal Signs of Hirschprung
• Failure to pass meconium
within 24 hours of birth
• Abdominal distension
• Vomiting (bilious)
How to treat umbilical granuloma
Silver nitrate
How long can eat/drunk before surgery
2 Clear, sweet liquids
4 Breast milk
6 Infant formula, fruit juices, gelatin
8 Solid food
When should a umbilical hernia be repaired
if it persists to age 4-5 yr
causes symptoms
becomes strangulated
becomes progressively larger after age 1-2 y
When should a hydrocele be repaired
If still present at 12-18 mo (probably communicating)
Cryptorchidism
- when to refer
- when is surgery
Refer at 9 months
Surgery by 9-15months
Gastroschisis
- Defect to RIGHT of umbilicus
- NO covering membrane
- usually isolated defect
- associated with NEC
Omphalocele
- Defect THROUGH umbilicus
- Covering membrane present
- can have defects in bowel, liver, and less often stomach
