Pediatric Surgery Flashcards
Choking spell on first feed, drooling
Coiled NG in upper chest on xray
Tx?
Esophageal atresia
Primary surgical repair or gastrostomy if delay
Check other VACTER anomalies
Components of VACTER anomalies
Vertebral Anal Cardiac Tracheal Esophageal Renal, radial
Tx of imperforate anus
What if fistula present?
Primary repair
Colostomy if blind rectal pouch without fistula
With fistula, can delay repair
Tx for congenital diaphragmatic hernia
Primary repair 3-4 days after birth (lung maturity)
Meanwhile ET tube, NG suction, sedation, low-pressure ventilation
Where does umbilical cord reach in gastroschisis versus omphalocele
Gastroschisis: cord reaches baby, defect goes around
Omphalocele: cord goes to defect
Tx of gastroschisis and omphalocele
Small: primary closure
Large: silastic silo while contents squeezed back in over a week before closure.
TPN for gastro as bowel wont work for 1 month
Medallion of moist, shiny mucosa projects through abdominal wall over pubis
Tx?
Exstrophy of urinary bladder
Need immediate repair
Possible causes of green vomiting, double bubble in a newborn (3)
Duodenal atresia
Annular pancreas
Malrotation
How is malrotation diagnosed
Contrast enema- safe
or Upper GI- riskier but more reliable
Etiology and signs of intestinal atresia
Vascular accident in utero
Multiple air-fluid level bubbles and green vomiting
Premature infant, first feed
Feeding intolerance, abdominal distention, thrombocytopenia, signs of sepsis
Tx?
Necrotizing enterocolitis
NPO, broad spectrum antibiotics, IV fluids, IV nutrition
Surgical indications in NEC
Abdominal wall erythema, air in portal vein
Intestinal pneumatosis or pneumoperitoneum
Newborn with feeding intolerance, bilious vomiting
Xray shows ground glass appearance in lower abdomen
Dx? Tx?
Meconium Ileus
Gastrografin enema is diagnostic and therapeutic
3-4 weeks old
Nonbilious projectile vomiting
Olive mass in RUQ
Tx?
Hypertrophic pyloric stenosis
Rehydrate, correct hypochloremic, hyperkalemic metabolic alkalosis
Ramstedt pyloromyotomy or balloon dilatation
6-8 week old with persistent increasing jaundice
Serology, sweat test negative
Dx? Tx?
Biliary atresia
1 week phenobarbital (choleretic) then HIDA scan
If no bile, surgical exploration and derivation or liver transplant
