Pediatric Flashcards
what Ig in milk vs placenta
IgA milk
IgG placenta cross
child bolus
20 cc/kg
child transfusion
10 cc/kg
tachycardia in child
neonate > 150
1 yr > 120
otherwise > 100
UOP child goal
2-4 cc/kg/hrc
congenital cystic disease of lung causes
- pulmonary sequestration from anomalous systemic arterial supply (aorta via pulmonary ligament) and drainage thru azygous (EXTRALOBAR) vs pulmonary vein (INTRALOBAR)… need to ligate arterial supply then lobectomy (can bleed)
- lobar overinflation/emphysema from cartilage failure in bronchus (air trap) (can cause tPTX) mostly LUL… lobectomy
- cystic adenoid malformation CCAM communciated with airway causing resp compromise/infection… lobectomy
bronchiogenic cyst mgmt
resect, malignant potential
bronchiogenic cyst location
mediastinum; posterior to carina; filled with milky
LAD unknown
10 days antibiotics suspect from infection
then excisional bx (to r/o lymphoma)
cystic hygroma LYMPHANGIOMA
found in lateral cervical POSTERIOR regions in neck; gets infected & multiloculated…… lateral to the SCM muscle
can connect to IJ
RESECT!
congenital diaphragmatic hernia
sx: both lungs dysf(x)l, hypoplastic and pulm HTN
mgmt diaph hernia
high freq ventilation, inhaled NO, ECMO
look for anomalies (cardiac, neural tube defects, malro)
bochdalek’s hernia
mC diaph hernia… located posteriorly
morgagni hernia
rare diaph hernia… located anteriorly
pectus excavatum
sinks in…
mgmt: sternal osteotomy with strut= Nuss or Ravitch procedure
pectus carinatum
pushes out…
mgmt: repair if emotional stress
1st branchial cyst
angle of mandible; poss connect to external auditory canal
ass’d with facial nerve
tx: resect
2nd branchial cyst MCMCMCMCMCMCM
MC**
anterior border of mid-SCM muscle
thru carotid bifurc into tonsillar pillar
tx: resect
3rd branchial cyst
lower neck, MEDIAL to/lower SCM to the piriform sinus
tx: resect
thyroglossal duct cyst
MIDLINE.
goes thru hyoid bone;descends thru foramen cecum
mgmt: excise cyst, tract, hyoid (at least central portion) = SISTRUNK POCEDURE
hemangiomas in kids
usually involte after 1YO… resolve at 7-8 YO
can resect after steroids if uncontrollable growth/impairs function
sx of neuroblastoma (MC abd malignancy solid in children)
secretory diarrhea, raccoon eyes (orbital met), HTN, opsomy-oclonus syndrome (unstead)
usually < 2 YO (Wilms older)
mgmt neuroblastoma
resect adrenal and kidney
if uresectable, doxorubicin chemo…need tissue dx first (n-myc vs no mutation) will change chemo
poor Px: neuron specific enolase, LDH, HVA, diploid, MYCN amplification
neuroblastoma staging
I: excised
II: incomplete excision does not cross midline
III: crosses midline +/- nodes
IV distant mets
wilms tumor = nephroblastoma
3 YO dx
prognosis wilms tumor based on?
GRADE LIKE SARCOMAS
wilms met to?
bone. &. LUNG (whole lung XRT)
sx wilms
asx»_space;» hematuria, HTN (mostly unilateral
mgmt wilms
nephrectomy withotu rupture
pull tumor out of renal vein
and LN SAMPLING*
stage II+ (not fully resected) needs actinomycin and vincristine
wilms staging
I; limited to kidney, excised
II: beyodn kidney but excied
III: residual nonhematogenous tumor
IV: heme mets
V: b/l renal involvement (needs nephron sparing surgery)
bone & lung mets need RADIATION
hepatoblastoma
AFP**
b-hCG release: fractures, precocious puberty
<3 YO
beckwith wiedemann syndrome
ass’d with hepatoblastoma and Wilms
mgmt hepatoblastoma
resect
doxorubicin if unresectable
plastinum chemotherapy if positive margin and then watch & wait
best prognosis for hepatoblastoma
FETAL HISTOLOGY
MC chid malignancy overall
ALL
MC solid tumor classs
CNS tumors
MC cause of duo obstruction <1wk old
duodenal atresia
MC duo obstructuion >1wk old
malrotation
MC cause LBO
Hirschsprungs
MC lung tumor child
carcinoid
MC painless lower GI bleed
Meckels
meckels location
antimesenteric border of small bowel
meckels path
persistent vitelline duct
meckels tissue MC
pancreatic > gastric (more likely to be sx-ic tho) – picks Meckels scan pertechnetate scan
mgmt meckels
resect if sx (gastric tissue = bleeding)….
if >1/3 size of bowel OR IF diverticulitis (panc tissue) at base, need to SBR
pyloric stenosis age
3-12 wks
pyloric stenosis metabolic derangement
hypochloremic hypokalemic metaboic alkalosis
paradoxical aciduria
US pyloric stenosis
muscle is >3 mm thick
muscle is >14 mm long
3.14 PIloric stenosis
mgmt pyloric stenosis
Ramstedt pyloromyotomy; proximal extent should be circular mm of stomach
need to visualize mucosa
fluid reuscitate with NS til UOP ok, then switch to D5NS with 10mEq K.. beware of hyperK, hypoNa, and hypogly
intussusceptionage
3 mo to 3 yr
mgmt intussusception
air contrast enema 120 mm Hg (max pressure)
OR if fails
PUSH on distal limb (don’t pull on proximal)
don’t rly need to resect in kids (adults = ca)
repeat air enema if it keeps working
4 hours obs, PO challenge, and DC
intussuscipiencs
intussusceptum
intussusceptum goes INTO intussuscipiens
duodenal atresia
MC obstruction in newborn
due to failure of recanalization unlike jejunal
distal to ampulla (bilious)
ass’d polyhydramnios, cardiac/renal/GI anomalies/Down syndrome
dx: double bubble
mgmt: DD or DJ
r/o volvulus with UGI series (crosses midline)
intestinal atresia (nonD)
usually jejunum
from vascular accidents in utero
mgmt: resect after r/o Hirschsprungs
type C TEF **MC
blind proximal esophageal atresia and distal TEF
spits food, drools, can’t NGT
XR: huge gas bubble
mgmt: R thoracotomy, primary repair, G tube, divide azygous
type A TEF
esophageal atresia no fistula
same sx but no gas in abdomen
VACTERL
vertebral
anorectal imperforate
cardiac
TE fistulaa
radius/renal
limb anomalies
malrotation
sudden bilious emesis from Ladd’s bands (causing obstruction)
can cause SMA compromise… infarction
failed 270 degree counterclockwise rotation by right RP ladds bands
dx: upper GI emergently; duo does not cross midline; DJ junction on the right.
mgmt: resect Ladd’sbands, coutnerclokwise place cecum in LLQ with cecopexy, place duo in RUQ and appy.
abnormalities associated with midgut volvulus?
diaphragmatic hernia 20%
omphalocele
gastroschisis
meconium ileus dx
see on XR: feculent small bowel without air fluid levels
do PCR for Cl channel defect, sweat chloride test
meconium ileus mgmt
gastrografin enema (dx and tx), vs NAC enema
or OR decompression, plus vent for antegrade enema
NEC necrotiszing enterocolitis
bloody stool after 1st feeding premies <37
+thrombocytopenia (=sepsis in infants)
XR: pneumoatosis, free/portal air (on lat film)
mgmt NEC
resusc, NPO, abx, TPN, OGT, and POSSIBLY PERC DECOMPRESSION IF FREE AIR (SCORE)
OR if peritonitis/free air/abdominal wall erythema… resect & ostomy
when reconnect, get fluoro study first (make sure no distal stenosis)
imperforate anus HIGH above levator mgmt
fistulizes to vag/bladder so need:
1. colostomy
2. eventual anal recon with posterior sagittal anoplasty
imperforate anus LOW below levators mgmt
fistulizes to perineal skin so need:
posterior sagittal anorectoplasty PSARP no colostomy with postop anal dilation
gastroschisis pathophys
intrauterine rupture of umbilicla vein; NO SAC
gastroschisis association
intestinal atresia (cuz vascular accident!)
gastroschisis gross
RIGHT of midline; no sac; stiff bowel from amniotic fluid
gastroschisis mgmt
saline soaked gauze, resuscitation, TPN, NPO repair when stable
place bowel back in, silastic mesh silo if needed (squeeze over time)
primary after silo is done
gastroschisis association
1: intestinal atresia > midgut volvulus
omphalocele pathophys
embryonal development with SAC and cord attached
MIDLINE MIDLINE MIDLINE
omphalocele associations
Down
malrotation
Cantrell pentalogy: cardiac, pericardium defect, sternal cleft/absent sternum, diaph septum trasnversum absence, omphalocele
Beckwith Wiedemann, Trisome 13 18 and 21
mgmt omphalocele
saline soaked gauze and resusciation, TPn, NPO, repair when stable
OR: place back in if needed, silo and delayed closure if needed
extrophy of urinary bladder
mucosa thru walld efect over pubis (not fused)
mgmt: close defect and repair bladder
hirschsprung pathophys and dx
absence of ganglion cells in myenteric plexus; faiure of crest cells ganglion cells to progress in caudad direction
must dx with full thickness rectal bx
RET+ (think MEN2A)
mgmt hirschsprung
leveling biopsies (larparoscopic): resect rectum and colon until proximal to where ganglion cells appear
Soave or Duhamel procedure (connect colon to anus after colostomy possibly)
endorectal pullup without ostomy (SCORE)
emergent colectomy and rectal irrigation if COLITIS (can cause sepsis)
umbilical hernia repair
close by 5 (earlier if incarcerated or VP shunt)
indirect inguinal hernia repair
M>F
R>L>b/L
elective with high ligation <1 YO AT THE INTERNAL RING(earlier if sx; witin 24 hr of reduction)
explore other side if female, < 1 YO, or lef sided
hydrocele
transilluminate…
OR at 1 YO (resect and ligate processus vaginalis)
duplication cyst
mostly ILEUM; on MESENTERIC border
mgmt: resect
biliary atresia
@ wks after birth… progressive jaundice
MC cause of neonatla jaundice requiring surgery & liver txp
dx: bx (fibrosis, bile plug, cirrhsois, ductal proliferation)
mgmt: kasai hepaticoportojejunostomy1/3 improve) before 3 mo old otherwise irreversible
teratoma presenation in neonates
sacrococcygeal
high AFP and bHCG
if >2 mo persist, need coccygectomy and surveillance
undescended testicle
wait 6 mos to treat
risk for SEMINOMA even if u treat it
if b/l, chromosomal studies
mgmt: bring it down yourself, no OR
if can’t bring down, orchiopexy thru inguinal incision may need to divide spermatic vessels (vas def blood supply will collateralize) to bring it down
tracheomalacia dx
wheezing… see bronch: elliptical fragmented tracheal rings instead of C shaped
tracheomalacia mgmt
indication: dying spell (MC), ventilator prolonged, many infection
mgmt: aortopexy (aorta to the sternum (open trachea)
laryngomalacia
MC airway obstruction in infants
sx: stridor /intermittent distress in supine
= immature epiglottis cartilage
mgmt: trach if doesn’t improve by 1 YO (it may)
choanal atresia
unilateral bone/membrane obstructing nasal passage
sx: can’t suckle/can’t breathe
mgmt choanal atresia
reconstrcut
larygneal papillomatosis
MC tumor of larynx in kids.. .goes away at puberty
HPV from mom
mgmt layngeal papillomatosis
endoscopic/laser but will probably come back
pyloric stenosis surgical technique
fredet ramstedt pyloromyotomy
dividespyloric muscle until mucosa is visualized; 1-2 mm prox to duo and extending to nonhypertrophied antrum
pyloric stenosis abnormality
hypoK hypoCl met ALKALOSIS
meckel scan
tech-99m pertechnitate scintigraphy for GASTRIC mucosa
Wilms vs neuroblastoma on CT scan
Wilms replaces parenchyma; neuroblastoma displaces it
how to find testicle in EMPTY SCROTUM?
laparoscopy to find
MC child malignancy overall
ALL
MC solid tumor class in kids
CNS
MC abd solid tumor in kids
<2 YO: neuroblastoma
>2 YO: Wilms nephroblastoma
MC lung tumor in kids
carcinoid! (MC benign is hemangioma)
MC duo obstruction in kids
<1 wk: duo atresia
>1 wk : malro
