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Pestana Surgery > Pediatric Surgery > Flashcards

Pediatric Surgery Flashcards

0
Q

What is the management of a tracheoesophageal fistula?

A
  • Rule out associated anomalies (VACTER) Vertebral, anal, cardiac, TE, and renal/radial
  • echocardiogram for the heart
  • sonogram for the kidneys
  • physical exam for the anus
  • Surgery
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1
Q

Within eight hours after birth, baby has excess salvation. And G-tube inserted with x-ray to have babygram done. Film shows tube coiled back on itself and upper chest. Air in G.I. track.

A

Tracheoesophageal fistula, the most common type, proximal blind esophageal pouch and distal TE fistula.

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2
Q

VACTER

A 
Vertebral
Anal
Cardiac
TE
Renal/radial
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3
Q

What is the management for imperforate anus and a newborn?

A

If fistula, repair later as the gastrointestinal tract is not obstructed
If pouch: x-ray while holding baby upside down with metal Marker tape to anal dimple.

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4
Q

Newborn baby found to be to tachypneic, cyanotic, and grunting. Bowel sounds heard over left chest. X-ray confirms bowel in the left thorax. Baby develops significant hypoxia and acidosis. What is it? What is the management?

A

Congenital diaphragmatic hernia.
The main problem is the hypoplastic lung.
Wait 36-48 hours to do surgery to allow transition from fetal circulation to newborn circulation
Endotracheal intubation, low-pressure hyperventilation, sedation NG suction

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5
Q

At the time of birth, it is noted that a child has a large abdominal wall defect to the right of the umbilicus. There is a normal cord, but protruding from the defect is a matted mass of angry looking edematous bowel loops.

A

Gastroschisis

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6
Q

A newborn baby is noted to have a shiny, thin, membranous sac at the base of the umbilical cord (The cord goes to the sac, not to the baby). Inside the sac, one can see part of the liver and loops of normal bowel.

A

Omphalocele

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7
Q

A newborn is noted to have a moist medallion of mucosae occupying the lower abdominal wall, above the pubis and below the umbilicus. It is clear that urine is constantly bathing this congenital anomaly.

A
  • Extrophy of the urinary bladder.
  • Transfer to highly specialized institution with necessary urological surgical skill so repair can be done within the first 48 hours.
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8
Q

Half an hour after the first feed, baby vomits greenish fluid. X-ray shows a double bubble sign. No gas in the rest of the bowel. Differential diagnosis?

A
  • duodenal atresia
  • annular pancreas
  • no gas, so malrotation less likely
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9
Q

Half an hour after the first feed, a baby vomits greenish fluid. X-ray shows double bubble sign: a large air fluid level in the stomach, and smaller one in the first portion of the duodenum. Air in the distal bowel, beyond duodenum, in loops that are non-distended.

A

Duodenal stenosis - incomplete obstruction
annular Pancreas
Malrotation

Contrast enema or upper G.I. study

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10
Q

Newborn with repeated green vomiting during the first day of life, no meconium. Abdominal distention. X-rays show multiple air fluid levels and distended loops of bowel. What Is it? Management?

A

Intestinal atresia – caused by vascular accident in utero

Surgery to reconnect bowel

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11
Q

Excessive salivation on the day of birth

A

Esophageal atresia (usually with tracheoesophageal fistula)

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12
Q

Trouble when a premature baby is first fed

A

necrotizing enterocolitis

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13
Q

Bilious vomiting, “ground glass” appearance on abdominal x-rays, and a family history of cystic fibrosis

A

meconium ileus

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14
Q

three-week old with projective vomiting, “olive size” mass

A

hypertrophic pyloric stenosis

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15
Q

Nine-month old intermittent colicky pain, “currant jelly” stools

A

intussusception

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16
Q

Green vomiting in a newborn

A

Serious problem
Do a babygram
“Double bubble sign” on babygram = duodenal atresia, okr annular pancreas or malrotation
Do barium studies

17
Q

Malrotation requires

A

immediate surgery

18
Q

Multiple dilated loops on babygram

A

Intestinal atresia

19
Q

Green vomiting in newborn. If during surgery all of the small bowel is present, what do you suspect? Next step?

A

Pancolonic aganglionic megacolon. Do frozen sections of the appendix.

20
Q

A very premature baby develops feeding intolerance, abdominal distention, rapidly dropping platelet count. Diagnosis?

A

Necrotizing enterocolitis

21
Q

Rx for necrotizing enterocolitis

A
  • Stop feedings
  • Broad spectrum abx
  • IVF, nutrition
  • Surgical intervention if baby develops abdominal wall erthema, air in portal vein, pneumoperitoneum
22
Q

Feeding intolerance in 3 day old, XR show multiple dilated loops of small bowel and a groundglass appearance in the lower abdomen. The mother has cystic fibrosis. What is the diagnosis?

A

Meconium ileus

23
Q

What is the treatment for meconium Ileus?

A

Gastrografin enema may be diagnostic and therapeutic

Surgery may be needed

24
Q

Three week old baby has had trouble feeding and not growing. Bilious vomiting. X-rays show double bubble with normal looking gas pattern in the rest of the bowel. What is it?

A

Malrotation. It can show up within the first few weeks of life. Proceed with urgent diagnostic studies.

25
Q

Three week old firstborn, began to vomit three days ago, vomiting is projectile, no bile. Dehydrated with visible gastric peristaltic waves and palpable olive sized mass. What is it?

A

Hypertrophic pyloric stenosis

26
Q

Management for hypertrophic pyloric stenosis

A

Check electrolytes; hypokalemic, hypochloremic metabolic alkalosis. Correct it, rehydrate, Ramstead pyloromyotomy or balloon dilatation

27
Q

Eight-week-old baby with persistent, progressively increasing jaundice. Bilirubin elevated two thirds conjugated direct. Normal serology sweat test normal. What is it?

A

Biliary atresia

28
Q

What is the management for biliary atresia?

A

HIDA scan after one week of phenobarbital is the best test. Surgical derivation will be tried, but two thirds of these kids and up with

29
Q

Two month old baby boy is brought in because of chronic constipation. Abdominal distention, dilated loops of bowel. Rectal examination followed by expulsion of stool with remarkable improvement distention. What is it?

A

Hirschsprung disease

Aganglionic megacolon

30
Q

How do you diagnose Hirschsprung disease?

A

Barium enema will define the normal looking aganglionic distal colon and the abnormal looking distended normal proximal colon.

Diagnosis is established with full thickness biopsy of the rectal mucosa showing that it is aganglionic.

31
Q

Nine-month old healthy boy with episodes of colicky abdominal pain. Physical exam shows a vague mass on the right side of the abdomen, an empty right lower quadrant, current jelly stools. What is it?
Management.

A

Intussusception

Barium enema or air anima are both diagnostic and therapeutic. Surgery

32
Q

A seven-year-old boy passes a large bloody bowel movement. What is it? Diagnosis?

A

Meckel’s diverticulum. Do a radioisotope scan looking for gastric mucosa in the lower abdomen.

33
Q

Diverticulum in the distal ileum with rectal bleeding in an infant.

A

Meckel’s diverticulum - remnant of the omphalomesenteric duct.

34
Q

Most frequent type of intussusception

A

ileum enters the cecum. Peristalsis pulls the proximal segment into the distal segment

35
Q

Best treatment for Hirschprung disease?

A

Diverting ileostomy and appendectomy – safest way to obtain tissue for the pathologist to confirm the absence of ganglia.

Definitive repair will be done when the child is older.

36
Q

How do you differentiate malrotation vs intestinal atresia?

A

Atresia - at birth, XR show MULTIPLE AIR FLUID LEVELS

Malrotation - “Double bubble sign” with little gas beyond.

Barium enema or contrast study from above must be done to confirm.

37
Q

3 week old iwth bilious vomiting. 2 large air fluid levels in upper GI, large left and smaller right. Small amount of distal gas.

A

Malrotation

Do barium enema or contrast study to diagnose immediately

38
Q

3 week old with projectile non-bilious vomiting. X-ray shows gastric distension.

A

Pyloric stenosis.

39
Q

At birth, bilious vomiting and x-ray films show multiple air fluid levels.

A

Intestinal atresia

Pestana Surgery (12 decks)

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