Pediatric Flashcards
What is the most common complication after a TEF repair?
GERD (30-60%) then stricture (5-40%)
Which TEF type is most likely to have long gap atresia?
A: pure atresia. No fistula component
B: atresia + upper esophagus to trachea fistula
C: atresia + lower esophagus to trachea fistula
D: atresia with upper AND lower esophagus to trachea fistula
E: pure fistula with no atresia
A is most likely
When inserting an NGT in a TEF baby, the ng will stop advancing in all 5 types except which type?
Type E
A: pure atresia. No fistula component
B: atresia + upper esophagus to trachea fistula
C: atresia + lower esophagus to trachea fistula
D: atresia with upper AND lower esophagus to trachea fistula
E: pure fistula with no atresia
Which TEF type will have air in the GI tract on kub?
A: pure atresia. No fistula component
B: atresia + upper esophagus to trachea fistula
C: atresia + lower esophagus to trachea fistula
D: atresia with upper AND lower esophagus to trachea fistula
E: pure fistula with no atresia
Type C&D
What is the ultrasound criteria for pyloric stenosis?
7mm radius or 4mm wall thickness
14mm long
Which type of atresia is the most common?
Pyloric/duodenal/jejunoileal/colonic
Jejunoileal
What is the double bubble?
Stomach one bubble
Duodenal bulb is the second bubble
Duodenal atresia
Treatment for duodenal atresia vs annular pancreas?
Duodenal atresia: duodeno-D
Annular pancreas: duodeno-J
Proximal vs distal jejunoal atresia. Which one will you see distended abdomen?
Proximal: decompressed belly
Distal: distended abdomen
During fetal development, intestines leave the abdomen at how many weeks?
They return inside at how many weeks?
8 weeks
Returns at 10 weeks
Baby’s plain xr shows obstruction without air fluid levels. What’s the diagnosis?
What is the initial treatment? What if this doesn’t work?
Meconium ileus
Treatment: gastrografin enema to clear as much meconium as possible. Works 60% of the time
If this doesn’t work, then double barrel colostomy
Gene mutation associated with hirschsprung dzs?
RET
When you do a rectal exam on hirschsprung kids, do you usually have stool in the rectal vault?
Usually not because the stool never makes it down there
Baby doesn’t pass meconium.
First diagnostic test you’re going to do?
What do you expect the rectum and sigmoid sizes to be?
Barium enema is the first thing
In hirschsprung: rectum «_space;sigmoid
Normal kids: rectum»_space; sigmoid
What is a leveling colostomy?
For hirschsprung’s you go in laparoscopically and keep biopsying the sigmoid until you get normal ganglion. Then you do a colostomy at that level. Then you go back and do a pull through later
Describe the pull through operations
Which one has the smallest risk of disrupting the pelvic nerves?
Swenson: just cut it out and anastomose
Duhamel: do that weird side to side thing
Soave: do that telescoping thing after mucosectomy
Soave is better than swenson because during swenson you can actually affect the pelvic nerves. Soave you’re doing it all inside the rectum so no risk for that
Most common Gu anomaly associated with imperforate anus?
Absence of the left kidney
Most common age group you see intussusception in?
Most commong age group for pyloric stenosis?
Intussusception < 2 years
Pyloric stenosis < 6 months
What is the mecekl scan actually looking for? What type of tissue?
Gastric mucosa
Most common extracranial tumor in kids?
Most common intra-abdominal tumor in infants and children?
Common presentation of this tumor?
What mutation is associated with this? And if this mutation is present is it good or bad prognosis?
Neuroblastoma
Neuroblastoma
Commonly from bony Mets and bone pain
N-myc. It’s bad prognosis
Most common organ associated with neuroblastoma?
Adrenal
What stage is most common when neuroblastoma is diagnosed?
What is the 5yr survival?
~50% (+) mets (stage IV)
Actually good prognosis. 80% 5yr prognosis
Diaphragmatic hernias are thought to be secondary to failure of what structure to close?
Pleuroperitoneal canal.
Bochdalek (posterolateral)»_space; morgagni (anteromedial)
Failure in the development of bronchus cartilage results in what?
Over 90% of cases involve which lobes?
Congenital lobar emphysema
Left upper of right middle lobes
Esophageal foreign body that’s stuck can cause perforation within how many hours?
8-12 hrs
T/F: primary repair of TEF through thoracic approach is preferred for the repair of H-type TEF
False. H-type is done via cervical approach
T/F: presence of isotope in the intestine immediately excludes the diagnosis of biliary atresia
T/F: in biliary atresia, there will be an elevation of direct bilirubin, not indirect
True
False. Both direct and indirect is elevated
Males or females?
- pyloric stenosis
- meckel’s diverticulum
- pyloric stenosis: males > females (5:1)
- meckel’s: males > females (2:1)
Bilateral absence of the iris
Hypospadias
What tumor?
Wilms.
WAGR - Wilms, aniridia, GU, Retardation
Duodenal vs jejunal atresia
Which one is associated with down syndrome and annular pancreas?
Duodenal
Soap bubble sign
Meconium ileus
What is the most commonly used esophagus substitution in children?
Colon
Chemo can turn an unresectable hepatobladtoma into a resectable one. What is the chemo agent of choice?
Cisplatin or vincristine
Not vinblastine
What is the most common gene associated with Hirschsprung’s disease?
What is the pathophys of Hirschsprung disease?
During which weeks week of gestation do the neural crest cells migrate?
Intestines go out of belly at which wk and come back at which wk?
RET proto oncogene
Neural crest fail to migrate because they mature or differentiate too early before reaching the destination.
4-7 weeks of gestation
Leave at 8 wks, return at 10 wk
T/F: post-op intussusception is usually asymptomatic
T/F: post-op intussusception is usually ileocolonic
T/F: post-op intussusception is usually self limiting
F. Usually causes SBO
F. Usually ileo-ileal. Primary intussusception is usually ileo-colic
F. usually needs surgry
During a pyloromyotomy you divide until you can see which layer?
Serosa Muscularis propria Muscularis mucosa Submucosa Mucosa
Submucosa needs to be visible. That means muscularis is divided
Treatment for hepatoblastoma for resectable vs unresectable dzs
Resectable: surgery + adj chemo
Unresectable: neoadj + surgery
Can you radiate neuroblastoma?
Yes. Generally not indicated unless tumor progression. Given as adj therapy along with chemo
What is the recurrent rate for intussusception after successful reduction?
5%
In CDH, what is the primary cause of respiratory distress? Is it pulmonary vascular hypertension or atelactasis secondary to lung compression? Pulmonary hypoplasia?
Pulmonary hypoplasia.
Pulmonary vascular hypertension happens often but is not the primary cause of early respiratory distress
What is the most common congenital anomaly of the GI tract?
Meckels
Incidentally found mesenteric cyst in kids. What do you do with it and why?
Cut it out. It can twist and cause ischemia
What is the deal with pediatric umbilical hernias? When do you repair? How?
For hernias > 2cm or hernias that persist after age 4
First line is primary repair
Recurrence rate only 0.27-0.44%
How does swallowed battery cause injury?
T/F: button batteries are hard to distinguish from coins on plain x-rays.
What is the most common complication from swallowed button battery?
They produce hydroxyl radicals in the mucosa causing a caustic injury, not pressure/electrical/thermal effects
False. Button batteries have the halo appearance
TE fistula (47.9%) > esophageal strictures (38.4%) > esophageal perforation (23.3%)
Ladd’s procedure laparoscopic vs open: is there a difference in outcome?
Incidence of recurrent volvulus is higher in laparoscopic
8mo baby bilious vomiting. First imaging to get? Why?
Plain film to rule out free air. If free air -> surgery
if no free air-> then can do UGI
Are there two umbilical veins or two umbilical arteries?
Two umbilical arteries
1 umbilical vein
Kids >5yr umbilical hernia first line is primary repair. When would you use a mesh?
Defect >3cm
When would you repair a pediatric umbilical hernia for kids <5yrs of age
For kids >2 yrs of age + symptomatic
What is the adequate port placement for lap pyloromyotomy?
Umbilicus, RUQ, LUQ
Imaging of choice when you’re suspecting pancreas divisim?
MRCP, CT not as sensitive as mrcp
Chemo agents for hepatoblastoma?
Radiation yes or no?
Cisplatin or vincristine (not vinblastine) can be combined with 5FU, doxorubicin
Usually not. Usually neoadj -> surgery
Radiation requires attenuated doses due to the limited ability if the liver to regenerate after radiation exposure
What is the recurrence rate of intussusception immediately after successful reduction?
5% within 48hr
10% total recurrence rate in a few months
Most commonly affected part of the GI tract for atresia?
Ileum.
Intussusception. Air or hydrostatic enema? Reason for not using the other?
Difference in rate of perforation between the two?
When perforation occurs, is it more common in the intussupien or intussusceptum?
Hydrostatic uses barium. Not recommended due to risk of barium peritonitis, infection, and adhesions when perforation occurs
actual perforation rate is the same
More common in intussupien
