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ABSITE > Pediatric Surgery > Flashcards

Pediatric Surgery Flashcards

1
Q

Foregut

A

lungs, esophagus, stomach, pancreas, liver, gallbladder bile duct, and duodenum proximal to ampulla

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2
Q

midgut

A
  • duodenum distal to ampulla, small bowel, and large bowel to distal 1/3 transverse colon
  • rotates 270 degrees counterclockwise
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3
Q

hindgut

A

distal 1/3 of transverse colon to anal canal

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4
Q

low birth weight

A

< 2,500 g

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5
Q

premature

A

< 37 weeks

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6
Q

trauma bolus peds

A

20 cc/kg X 2, then give 10 cc/kg blood

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7
Q

tachycardia (peds)

A

best indicator of shock (neonate > 150, < 1 year > 120, rest > 100

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8
Q

urine out put

A

2-4 cc/kg/hr
children have poor concentrating ability
< 6 months 25 % capacity of adults

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9
Q

maintenance fluids

A

4 cc/kg/hr for 1st 10 kg
2 cc/kg/hr 2nd 10 kg
1 cc/kg/hr every kg after that

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10
Q

caloric need (kcal /day)

A

90-120 till age 1
70-90 1-12yrs
30-60 12-18 yrs

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11
Q

pulmonary sequestration

A

lung tissue has systemic arterial supply (aorta) and either systemic venous or pulmonary vein drainage BUT DOESNT COMMUNICATE with tracheobronchial tree
- can be intralobar or extra lobar
- PRESENTS WITH INFECTION
TX lobectomy

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12
Q

congenital lobar overnflation

A
  • cartilage fails to develop in bronchus, leading to air trapping with expiration
  • can develop hemodynamic instabiity (same mechanism as tension PTX) or respiratory compromise
  • LUL, RML most commonly affected
  • TX: lobectomy
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13
Q

congenital cystic adenoid malforamation

A
  • communicates with airway
  • alveolar structure not well developed although lung tissue is present
  • Sxs: respiratory infection or resp compromise
  • TX: lobectomy
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14
Q

Bronchogenic cyst

A
  • extrapulmoary cyts formed from bronchial tissue and cartilage wall
  • usually present with a mediastinal mass filled with milky fluid
  • can become infected or compress adjacent structures
  • TX: resect cyst
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15
Q

Neuorgenic tumors

A

exs. neurofirbroma, neuroganglioma, neuroblastoma

MOST common mediatinal tumor in children - usually posterior located

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16
Q

Mediastinal masses in children

A

present with respiratory symptoms and dysphagia
T cell lymphoma - can presnt anterior, middle or posterior
teratomas - ant and middle
thymomas, and thyroid cancer - middle

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17
Q

choledochal cyst

A

TX resect

  • risk of cholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice
  • thought to be caused by refux of pancreatic enzymes in to the biliary system
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18
Q

Types of choledochal cysts - TYPE I

A

MOST COMMON
fusiform dilation of entire common bile duct, midly dilated common hepatic duct
TX: hepaticojejunostomy

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19
Q

Types of choledochal cysts- TYPE V

A

Carolis disease - intrahepatic cysts

hepatic fibrosis

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20
Q

cystic hygroma

A

lymphangioma - found in lateral cervical and submandibular regions in neck
TX: resection

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21
Q

asymptomatic lymphadenopathy

A

ABX for 10 days

excisional bxif no improvement –> lymphoma until proven otherwise

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22
Q

fluctuant lymphadenopathy

A

FNA, CX, ABX may beed I&D

chronic causes: cat scratch fever, atypical mycoplasma

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23
Q

lymphadenopathy

A

usually caused by acute suppurative adenitis associated with URI, or phyaryngitis

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24
Q

diaphragmatic hernias

A

80% left sided
80% associated anomalies ( cardiac and neural tube defects, malrotation)
MOST COMMON - Bochdalk’s
TX: abdominal approach, reduce bowel, high frequency ventilation, prostacyclin (pulmonary vasodilator)

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25
Q

Bochdalek’s hernia

A

located posterior laterally

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26
Q

Morgagni’s hernia

A

diaphragmatic hernia - located anteriorly

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27
Q

eventration

A

failure of the diaphragm to fuse

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28
Q

pectus excavatum

A

(sinks in) sternal osteotomy, need strut

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29
Q

pectus carinatum

A

(pigeon chest) repair for emootinal stress

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30
Q

1st branchial cleft cyst

A

angle of mandible, may connect with external auditory canal, often associated with facial nerve

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31
Q

2nd branchial cyst

A

MOST COMMON

ant border of SCM, goes through carotid bifurcation into tonsillar pillar

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32
Q

3rd branchial cyst

A

lateral neck

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33
Q

thyroglossal duct cyst

A

from the descent of the thyroid gland from the foramen cecum
may be only thyroid tissue pt has
presents as a midline cervical mass
TX excision of cyst, tract, and hyoid bone

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34
Q

hemangioma

A

rapid growth during first 6- 12 months of life, then involutes
TX: observation, UNLESS uncontrollable growth, impair function, persists after age 8, tx with steroids, laser, resection

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35
Q

neuroblastoma

A

1 solid abdominal malignancy in children

most common location - adrenals
most common 1st 2 yrs of life
SXS: diarrhea, raccoon eyes (orbital metastases), HTN, unsteady gate (opsomyoclonus)
derived from neural crest cells

TX: chemotherapy, resect

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36
Q

diagnosing neuroblastoma

A
  • abdominal xray - may show stippled calcifications in the tumor
  • Increased cateholamines, VMA, HVA, metanephrines
37
Q

neuron specific enolase

A

increased in neuroblastomas with mets

rare mets to lung and bone

38
Q

high risk neuroblastoma

A

> 1 yr, N- myc, diploid, LDH, shimada classification

39
Q

Wilms tumor

A

nephroblastoma
mean age at diagnosis - 3 years
frequent mets to bone and lung
PROGNOSIS BASED ON TUMOR GRADE

40
Q

Wilms tumor associations

A

Beckwith - Wiedmann syndrome (hemihypertrophy, cryptorchidism, Drash syndrome, aniridia)

41
Q

Treartment of Wilms tumor

A

NEPHRECTOMY
ALL stage < 500 g actinomycin and vincristine (except stage I)
Stage II or greater > 500g add doxorubicin
Stage III or greater add XRT

42
Q

Stage V Wilms tumor

A

Bilateral renal involvement

10%

43
Q

Hepatoblastoma

A

MOST COMMON MALIGNANT liver tumor in children
AFP - increased in 90%
prefetal histology has best prognosis

44
Q

TX of hepatoblastoma

A

RESECTION

doxorubicin cisplatin based chemotherapy to downstage tumors and allow resection

45
Q

Leukemia (ALL)

A

1 childrens malignancy overall

46
Q

CNS tumors

A

1 solid tumor class

47
Q

Neuroblastoma

A

1 general surgery tumor

48
Q

duodenal atresia

A

1 cause of duodenal obstruction in newborns

49
Q

malrotation

A

1 cause of duodenal obstruction after newborn period (> 1 week)

50
Q

Hirschsprungs disease

A

1 cause of colon obstruction

51
Q

painless lower GI bleeding in peds

A

meckels diverticulum

52
Q

upper GI bleeding <1 yr

A

gastritis

53
Q

Meckels diverticulum

A 
persistent vitelline duct
found on antimesenteric border 
rule of 2s
2 feet from ileocecal valve, 2%population, 2 % symptomatic, 2 tissue types (pancreatic, gastric), 2 presentations - diverticulitis and bleeding
TX: resect
54
Q

pyloric stenosis

A

projectile vomiting
firstborn males @3-12 weeks
olive mass in stomach
hypochloremic, hypokalemic metabolic alkalosis

55
Q

Diagnosing pyloric stenosis

A

US- pylorus > 4mm thick, > 14 mm long

56
Q

Pyloric stenosis TX

A

pyloromyotomy (RUQ incison), circular muscles of the stomach

57
Q

intussesception

A

invagination of one loop of intestine into another
3 months to 3 years
lead points: enlarged Peyers patches (MOST COMMON), lymphoma, Meckels
15 % recurrence after reduction

58
Q

Intussesception symtoms

A

currant jelly stools ( from vascular congestions, not an indication for resection), sausage mass, abdominal distension, RUQ pain, and vomiting

59
Q

Intussesception treatment

A 
AIR CONTRAST ENEMA 
max pressure:120 mm HG
max column if barium: 3 feet
80% successful, 
peritonitis, free air, unable to reduce --> OR reduce via distal limb
60
Q

intestinal atresia

A

result from intrauterine vascular accidents
sxs: bilious emesis, distension, most do not pass meconium
get barium enema to r/o hirschprungs before surgery – > resection

61
Q

Duodenal atresia

A

usually distal to ampulla of vater, causes bilious vomiting, feeding intolerance
associated with cardiac, renal, and other GI anomalies
20% have down syndrome
AXR: double bubble
TX: duodenostomy

62
Q

Tracheoesophageal (TE) fistulas

A

Type C - most common; promximal esophageal atresia (blind pouch) and distal TE fistula
Sxs: newbors spit up feeds, excessive drooling, respiratory sxs.`

63
Q

VACTERL

A

vertebral, anorectal, cardiac, TE fistula, radius/renal, limb anomalies
TX: right extrapleural thoracotomy
complications: GERD, LEAK, empyema, stricture, fistula

64
Q

Malrotation

A

sudden onset of bilious vomiting (Ladds bands from right retroperitoneum attached to cecum cause duodenal obstruction)
compromise of SMA
failure of the normal 270 counterclockwise rotation

65
Q

Malrotation treatment

A

UGI diagnosis

resect LAdds bands, counterclockwise rotation, cecopexy LLQ, appendectomy`

66
Q

meconium ileus

A

distal ileal obstruction, abdominal distension, bilious vomiting
sweat chloride test or PCR for cl channel defect
(cystic fibrosis 10%)
AXR: soap suds appearance
TX. gastrograffin enema
alt: N-acetlycysteine enema

67
Q

Necrotizing entercolitis

A

bloody stools after 1st feeding in premature infant
risk factors: hypoxia, hypotension, anemia, polycythemia, sepsis
Sxs: lethargy, resp decompression, abdominal distension, vomiting blood PR

68
Q

Diagnosing NEC

A

AXR: pneumatosis intestinalis, free air, portal vein air

69
Q

NEC - TX

A

resuscitation, NPO, ABX, TPN, orogastric tube

OR–> free air, peritonitis, clinical deterioration, needs barium enema first r/o distal obs, then ostomies

70
Q

congenital vascular malformation

A

surgery for hemorrhage, ischemia, chf, nonbleeding ulcers, fuctional impairment and limb discrepancy
embolization

71
Q

imperforate anus

A

high (above levators) - meconium in urine of vagina(fistula to bladder/vagina/prostatic urethra)
TX: colostomy, later anal reconstruction with posterior sagittal anoplasty
low (below levators) - perform sagittal anoplasty

72
Q

gastroschisis

A

intrauterine rupture of umbilical vein; does not have a peritoneal sac
herniates to the right of umbilicus
TX: saline soaked guaze, TPN NPO, repair when stable, silo

73
Q

omphalocele

A

failure of embryonal developement, midline defect,
increased congenital anomalies (50%) , peritoneal sac with cord attached
TX: silo, later closure

74
Q

cantrell pentology

A 
cardiac defects
pericardium defects 
sternal cleft
diaphragmatic septum transversum absence
omphalocele
75
Q

hirschprungs

A

infants fail to pass meconium in 1st 24 hrs
dx rectal bx (absence of ganglion cells in myenteric plexus)
failure of neural crest cells to progress in craniocaudal direction

76
Q

hydrocele

A

transluminates

TX: surgery at 1 if not resolved or if thought to communicate

77
Q

umbilical hernia

A

failure of closure of linea alba; most close by age 3

TX: surgery if not closed by age 5 or incarceration

78
Q

inguinal hernia

A

persistent processus vaginalis M>F, R>L

79
Q

cystic duplication

A

most common in ileum, often on mesenteric border

resect

80
Q

biliary atresia

A

most common cause of neonatal jaundice requiring surgery

81
Q

jaundice persisting > 2 weeks after birth

A

biliary atresia

82
Q

liver bx showing periportal fibrosis, bile plugging

A

biliary atresia

83
Q

TX of biliary atresia

A

hepaticoportojejumostomy

preform before age 3 months

84
Q

teratoma

A

AFP, beta HCG

neonates - sarcococcygeal

85
Q

sarcococcygeal teratomas

A

90% benign at birth

if presents > 2 months –> malignant

86
Q

associated with bilateral cryptochidism

A

prune belly syndrome

87
Q

laryngomalacia

A

most common cause of airway obstruction in infants
outgrow by 12 months
caused by immature epiglottis cartilage with intermittent collapse

88
Q

choanal atresia

A

obstruction of choanal opening by either bone of mucus membrane, usually unilateral
intermittent resp distress, poor suckling

89
Q

laryngeal papillomatosis

A

most common tumor of the peds larynx
involutes after puperty
possible HPV form mom

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