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Paediatric surgery > GI > Flashcards

GI Flashcards

1
Q

Most common type of tracheo esophageal fistula

A

Esophageal atresia with fistula between trachea and distal esophagus( Type 1a and 3 depending on classifn system)

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2
Q

Reason for enlarged gastric bubble in TEF

A

Fistula between trachea and distal esophagus leading to air entering stomach (not usually seen in types 1b and 1e)

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3
Q

Syndrome associated with TEF

A

VACTERL

Verterbal
Ano-rectal malformations
Cardiac abnormalities
Tracheo
Esophageal fistula
Renal, Radial aplasia
Limb

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4
Q

Investigation of choice for TEF

A

Flexible bronchoscopy looking
- presence of fistula to proximal segment
- presence of fistula to distal segment

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5
Q

Incision for TEF

A

4th of 5th intercostal space

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6
Q

Steps for TEF ligation and repair

A

Isolate azygos vein

Interrupted sutures
1. Posterior first
2. Then anterior

Check whether NGT is able to pass thru patent repair
- on POD5 inject dye to check for leak and whether feeds can be started

Place chest tube to drain saliva leak

Monitor in NICU

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7
Q

What does double bubble sign with absent distal colonic and rectal suggest

A

Duodenal atresia or annular pancreas

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8
Q

Part of pregnancy duodenal atresia usually occurs

A

1st trimester: Failure of recanalization

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9
Q

Windsock appearance suggests?

A

Duodenal webs/intraluminal duodenal diverticulum

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10
Q

syndrome associated with duodenal atresia

A

T21

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11
Q

Suspicion in newborn with NBNB projectile vomiting

A

Hypertrophic pyloric stenosis

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12
Q

First steps for newly diagnosed duodenal atresia

A
  1. Order TTE tro cardiac abnormalities
  2. Drip and suck the neonate
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13
Q

Direction umbilical vein catheter usually goes in

A

Superiorly

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14
Q

Why duodenal atresia usually p/w bilious vomiting

A

Usually distal to ampulla of vater

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15
Q

How duodeno-duodenostomy is usually performed for duodenal atresia

A

side to side anastomosis b/w D1 and D3, D2 often too atretic

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16
Q

Radiological invx to confirm small bowel atresia

A

Barium enema

Barium follow through would be too dilated

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17
Q

Most common types of duodenal atresia and the etiology

A

Type 1 and 3a, usually due to vascular accident/ischemia

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18
Q

Part of pregnancy where jejunal and ileal atresia tend to occur

A

2nd and 3rd trimester due to ischemia

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19
Q

Risk factor for short gut syndrome

A

DJ flexure to ileocecal valve <60cm

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20
Q

Options for jejunal and ileal atresia mx

A
  1. Stoma
  2. Bowel resection
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21
Q

How suction rectal biopsy is done

A

3 biopsys starting 3cm from rectum, 3cm apart

22
Q

Mx of hirschsprung

A

Non surgical: rectal washout 2-3x a day

Surgical

1) Transverse colon colostomy as temporizing

2) Definitive is pull through eg Duhamel, Swensen

23
Q

Invx for hirschsprungs disease

A
  1. Suction rectal biopsy to confirm diagnosis
  2. Barium enema to delineate anatomical segment
  3. XR to look for dilated bowel segments
23
Q

What to check for intraop in Pull through

A

intraop frozen section to check for ganglion cells present at dentate line via pull through

24
Q

Common cx of anorectal malformations in boys

A

Fistula to genito urinary system
- check intra op if present, needs to be ligated

25
Q

Reason for double barrel stoma with division in ARM for boys

A

Reduce entry of fecal output into distal segment that may cause UTIs/ fecaluria

26
Q

Mx of Ano rectal malformations

A

LAARP/PSARP

Laparoscopic/ Posterior sagittal AnoRecto Plasty

27
Q

Side of umbilical cord that gastroschisis usually comes out of

A

Almost always on the right side of the umbilical cord

28
Q

Syndromes predisposing to omphalocele/exomphalos

A

T13,18,21 edwards patau downs

Beckwith Wiedemann syndrome

29
Q

Temporizing measure for closing large omphalocele

A

A silo sutured to the skin to help reduce heat and fluid loss

30
Q

Common organs involved in omphalocele

A

Stomach, small intestine, liver and spleen

31
Q

How to monitor for excessive intra abdominal pressure when replacing an omphalocele

A
  1. Intra vesical pressure management
  2. Looking for desaturation
32
Q

Types of congenital diaphragmatic hernia

A
  1. 80% bochdalek foramen left posterolateral
  2. 10% right sided
  3. 5% morgagni foramen anterior
33
Q

Cx of Congenital diaphragmatic hernia

A
  1. Pulmonary hypotension
  2. Pulmonary hypoplasia
    3.
34
Q

Acute medical Mx of CDH

A

Intubation and ventilatory support
1.High frequency oxygen ventilation
2. Nitric oxide to help with pulmonary vasodilation
3. extra corporeal membrane oxygenation for severe cases

35
Q

Signs and Sx of Hypertrophic Pyloric stenosis

A

Sx
1. NBNB projectile vomiting

Signs
1. Olive shaped mass at the LUQ

36
Q

Invx for Hypertrophic Pyloric Stenosis

A

Biochemical
1. RP for electrolytes hypokalemia hypochloremia, low bicarb, BE less than -2
2. ABG for metabolic acidosis
3. Urine for paradoxical aciduria

Imaging
1. Transabdominal US

37
Q

US finding for Hypertrophic Pyloric Stenosis

A

Hypertrophied muscles around pylorus

Can include Dynamic study

38
Q

Mx of hypertrophic pyloric stenosis

A

Pyloromyotomy( open vs lap vs transumbilical)
- Split pyloric muscles without entering the lumen

trial of feeds 4hrs after

39
Q

Barium enema findings for Hirschsprungs disease

A
  1. Transition zone with funneling
  2. Reversal of rectosigmoid ratio
40
Q

Sign of HAEC

A

Hirschsprung associated enterocolitis

Sawtooth appearance from mucosal edema

41
Q

Age group where intussusception is common

A

6 months to 6 years

42
Q

Most common cause of intussuception

A

Infection causing hypertrophy of Peyer Patches or lymphadenitis

43
Q

First line management of intussusception

A

Air enema

44
Q

What to consent for in open reduction of intussusception

A

Appendicectomy so RUQ pain won’t lead to diagnostic dilemma

45
Q

Possible pathological lead points to expect in patients outside of 6m to 6y

A
  1. Meckel
  2. Polyps
  3. Hamartoma
  4. Masses eg lymphoma, GIST
  5. IgA Vasculitis/HSP
46
Q

Number of air enema reductions before converting to open reduction

A

3-4 attempts with high pressures not >120mmHg

47
Q

Mx of intuss with suspected pathological lead point

A

Open reduction with exploration

48
Q

Mx of indirect inguinal hernia in neonate/infant

A

Surgical herniotomy due to high risk of cx( incarceration, obstruction, strangulation and perforation)

49
Q

Age where hydrocele is

A
50
Q
A

Paediatric surgery (5 decks)

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