Pediatric Surgery Flashcards
Esophogeal atresia
Excesive salivation shortly after birth, choking at first feeding. Small NG tube coils in upper chest in CXR. IF normal gas pattern in bowel, baby has blind pouch in upper esoph and fistula in lower E and tracheobronch. Look for assoc anomalies (VACTER- vert w/ x-ray, anal for perf, cardiac w/ echo, tracheal, esoph, renal w/ sonogram, radial)
Primary surgical repair best, but if delayed, do gastrostomy to protect lungs from reflux
Imperf anus
Part of VACTER. If it’s there, rule out others. Look for fistula nearby to vag or perineum. IF present, delay repair until further growth but before toilet training. If not, do colostomy for high rectal pouches (repair later). Or do primary repair right away if blind pouch is almost at anus.
Do upside down x-ray to determine level of pouch w/ metal marker on anus?
Congen diaphragmatic hernia
Always on left, bowel up in chest
Probelm = hypoplastic lung w/ fetal circulation.
Repair after 3-4 days to allow for maturation
Babies need ET tube, low-pressure ventilation for one lung, sedation, NG suction
Might need ECMO, often dx before birth
Gastroschisis and omphalocele
Show up w/ ab wall defect in mid belly
Gastroschisis- cord normal, defect to right of cord, no protective membrane, angry bowel
Omphalocele- cord goes to defect, thin membrane w/ normal blowel + liver under
Close small defects primarily, large defects make a silo to house/protect bowel, then squeeze silo into belly day-by-day
W/ gastroschisis, baby needs vasc access for parenteral nutrition (bowel won’t work for 1 month)
Exstrophy of urinary bladder
Ab wall defect over pubis, medallion of red bladder mucosa wet w/ urine. Baby has to be repaired within first two days, no delay
Green vomiting + double-bubble in XR
Large air fluid in stomach, smaller one in first dudodenum = dudodenal atresia, annular pancreas, or malrotation. Malrot = most dangerous, bowel can twist on itself, strangle and die- worry if little normal gas pattern beyond..dx w/ contrast enema or upper Gi (more risky). Can show up any time in first few weeks
Intestinal atreasia
Green vomiting + multiple air-fluid levels. May be 1+ atretic areas, no other assoc congen b/c just a vascular accident in utero
Necrotizing enterocolitis
Premature infants when first fed => feeding intol, ab distention, dropping platelets (sign of sepsis in babies!). Tx = stop feeding, braod spec abx, IV fluid/nut. Surgery if ab wall erythema, air in portal vein or intestinal pneumatosis or penumoperitoneum (sign of necrosis/perf)
Meconium ileus
Babies w/ CF. Feeding intol and bilious vom in fist two months. XR w/ multiple dilated loops of SB + ground glass in lower ab. Gastrgrafin enema is dx (microcolon + inspissated pellets of meconium in terminal ileum) and tx (dissolves pellets!)
Hypertrophic pyloric stenosis
@ 3 weeks, in first born boys, nonbilious projectle vom post feeding. Baby hungry/wants to eat post vom. Dehydrated w/ visible gastric peristaltic waves + palpable olive size mass in RUQ, or seen on sonogram. Tx = rehydration + correct hypoCl, hypoK met alkalosis, then Ramstedt pyloromyotomy.
Biliary atresia
6-8 week old babies w/ persistent worsening jaundice (some conjugated). Serology + sweat test, then HIDA scan after 1 week phenobarb (choleretic ups bile). If no bile in duo, do surg exploration. 1/3 babies get longlasting surg derivation, 1/3 need liver transplant after some time, 1/3 need liver transplant right away
Hirschsprung disease
Aganglionic Megacolon! Can recog early or not see for years. Chronic constipation. IF short seg, rectal exam => explosive expulsion w/ relief. IN older kids w/ ddx of psychogenic problems, fecal soiling suggests psych. X-ray shows prox distended colon, and normal distal (angang part). Do full thick biopsy of rectal mucosa. INGENIOUS operation- preserve sensory (that has no motor) rectum and add propulsion of innervated colon
Intussusception
6-12 mo old chubby kids w/ colicky pain episodes that make em double up and squat. Pain for 1 minute, then kid happy, then colic. Mass on right side + empty RLQ + currant jelly stools. Barum/air enema = dx + tx. If reduction not achieved or recurs, do surgery
Child abuse
If injuries not properly accounted for. Subdural hematoma + retinal hemorraghes (shaken baby), multiple fractures in diff bones @ diff stages healing, scalding burns of both buttocks. Call police :(
Meckel diverticulum
Lower GI bleed in pediatrics. Do radioisotope scan (gastric mucosa in lower abdomen?)
