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