Newborn

Question 1

Newborn: surgical congenital abnormalities

Answer 1

• diaphramatic hernia: if lung hypoplasia is compatible w/ life -oomph ocean +

Question 2

when is surgery contrainticated

Answer 2

congenital anomalies incompatible w/ life or that cannot be corrected

Question 3

VACTERL

Answer 3

• Vertabral,
• Ano-rectal
• Cardiac
• Tracheo-oesphageal
• Radial, renal
• limb

Question 4

Signs of diaphhramatic hernia

Answer 4

• resp distress
• dextrocardia , heart sounds more prominent oon the right
• bowel sounds in the chest
• scaphoid abdomen

Question 5

Dx of diaphhramatic hernia

Answer 5

• Ante-natal: U/S
• Chest X-ray: deviated mediastanum, air filled bowel in hemi-thorax
  *

Question 6

Mx of diaphramatic hernia

Answer 6

• Evaluate lung hypoplasia
  
  • trail of life
  • gastric decompression
  • resp support
  • constant obs for pneumothorax
• Surgery: after weaning off ventilator
  
  • reduction of abdominal contents
  • repair of defect (mabye patch)
• look for other abnormalities

Question 7

Exompholos classification

Answer 7

• minor: defect les than 4cm, only bowel
• major: defect > 4cm , bowel + liver

Question 8

Mx Exompholos?

Answer 8

• Decompress Stomach w/ NG tube
• Manage fluid/ keep warm
• Antibiotics
• Plastic bag
• Refer
  
  • Primary repair
  • large defct - non operative treatment w/ aseptic ointments and delayed repair

Question 9

Exomphalos + Macrogloassia?

Answer 9

• Think Beckwith - Wiedermann Syndrome
  
  • look for + correct hypo glycemia

Question 10

What is Gastroschisis?

Answer 10

• bowel through defect _to the righ_t of umbilicus w/ no membrane
  *

Question 11

Mx Exomphalos?

Answer 11

• Enclose viscera: plastic bag
• Surgery: primary closure
  *

Question 12

Cx Neonatal Intestinal obstruction?

Question 13

Clinical presentation of intestinal obstruction?

Answer 13

• Bile stained/ persistant non- bile stined vomiting
• High obstruction
  
  • antenatal: Polyhydramnios
  • vomiting presominates
• Low
  
  • Abdo distension
    
    • Delayed passage of meconium

Question 14

Investigastions Intestinal Obstruction?

Answer 14

• Antenatal U/S: polyhydramnios, associated anomalies
• X-Ray:
• Barium enema: distal obstruction
  *

Question 15

Mx Intestinal obstruction?

Answer 15

• Resus + Rehydrate
• NG tube +/- suction
• Refer
  
  • Define type + level
  • surgical correction

Question 16

Signs of Oesophageal Atresia

Answer 16

• Antenatal: Polyhydramnios
• persistant drooling
• reguge of feed immediatly
• cannot pass NG tube
  
  • X-Ray curled up in pouch

Question 17

Mx of oesophageal atresia?

Answer 17

• Replouge NG Tube with constant aspiration
• 15 degree head up position (prevent reflux through fistula )
• gastrostomy for feeds
• Manage other cogentital abnormataties
• treat aspiration pneumonia
• surgical
  
  • extrapleural thoractomy
  • closure of traceo-oesophageal fistula
  • repair of oesophagus: can be in stages

Question 18

% of oesophageal atresia w/ fistula

Answer 18

• >90 %

Question 19

Duodenal Atresia - signs ?

Answer 19

• vomiting soon after birth
• stomach aspirate > 20ml

Question 20

Dx Duodenal Atresia?

Answer 20

• Double bouble w/withoiut distal air
  
  • fenestration
  • stenosis

Question 21

Meconium ileus presentation?

Answer 21

• Abdo distension at birth w/ palpable bowel loops
• vomiting not significant early on - bile stained
• Abdo X-Tay: Ground glass abdomen w/ dilated loops
• barioum enema microcolon
• look for cystic fibrosis

Question 22

Meconium illieus Mx?

Answer 22

• Half-strength gastrograffin enema if no peritonitis / volvulus
• Surgery:
  
  • laparotomy if enemasa ae unsuccesful

Question 23

Hirshsprungs presentation?

Answer 23

• Neonatal intestinal obstruction
• Bowel Dysfunction e.g intermittent constipation w/ feed refusal + vomiting
• Abdominal Distention
• Explosive decompression on rectal rexamination

Question 24

Dx Hirshsprungs?

Answer 24

• Barium Enema: trasitional zone - dilated proximal bowel transitioning to narrow a ganglionic bowel
• Biopsy: absent ganglia

Question 25

Mx of Hirshsprung’s?

Answer 25

• decompress bowel w/ washouts
• surgery:
  
  • colostomy proximal to ganglionic owel
  • 6-9 months later : pull through
  • early neonatal presentation: pull through w/ot colostomy