Pediatric Flashcards
Operative steps in pyloromyotomy
- Begin incision 2mm proximal to pyloric vein 2. incise to see bulging of mucosa 3. Muscle on either side should move independently. 4. If perforation of duodenal mucosa, close in layers, including serosa, flip pylorus over and do myotomy on other side. 5. Insufflate the NG at end of case to check for leak.
Feeding after pyloromyotomy
- STart 4-6 hours post op with Pedialyte 2. If tolerates, advance 10-15 cc per feed until at 90cc 3. Transition to breast milk or forumla. 4. If emesis, hold for 3 hours and try again.
Differential diatnosis of bilious emesis
- malrotation
- duodenal stenosis/web/atresia
- jejunal atresia
- NEC
- GERD
- Meconium ileus
- annular pancreas
Timing of diagnosis of malrotation (% diagnosed at 3 days, 1 week, 1st month)
30%, 50%, 80%
Studies available to help diagnose malrotation if UGI negative
CT abdomen and pelvis
U/S looking for SMV to the left or anterior to SMA
Ladd’s procedure in newborn or infant
- Horizontal supraumbilical incision
- Counterclockwise rotation of bowel between 1 and 3 full roations.
- Take down Ladd’s bands - right colon to right abdominal wall
- Appendectomy
- May incise peritoneum over mesentery to move colon further left.
- Place duo and small bowel on right and colon on left.
Neuroblastoma stats
most common cancer of infants
Most common solid tumor of children (10% of childhood malignancies)
50% diagnosed by 2 years old
50% in adrenal gland
Imaging work up for neuroblastoma, biopsy?
- U/S
- CT scan
- MIBG scan
- Biopsy needed of mass and bone marrow for staging.
Treatment for neuroblastoma
Complex decision making - surgery for early or low stage disease, induction chemo (Carboplatin/etopiside) + / - surgery for mid stage disease.
Imaging work up for abdominal mass in children
- U/S
- CT with IV/PO contrast
- May need doppler U/S to analyze IVC involvement (Wilms)
Principles of surgical management of Wilms’ tumor
- Diagnosis
- Resection without tumor spillage
- Avoid resection of adjacent organs
If can’t obtain all these initially (or if have IVC tumor thrombi) need pre-operative Chemotherapy (Vincristin, dactinomycin)
If abdomina spillage, patient will also need abdominal radiation.
of note, chemotherapy is started in hospital before discharge.
In addiiton to U/S and CT, what imaing and labs necessary if concern for hepatoblastoma
- MRI
- CBC, lytes, liver profile, AFP, B HCG, urinalysis
If hepatoblastoma is metastatic or unresectalbe?
need biopsy, then neoadjuvant therapy
Diagnostic work up for RLQ pain in child (intussuception)
Ultrasound, target sign
Treatment: air contrast enema
Instructions for air contrast enema
- Rectal tube
- Insufflation up to 120 mm Hg under fluoroscopy.
- Air in small bowel is diagnostic of success.
- Need to keep for observation for several hours prior to discharge