Pediatric Surgery Flashcards
Esophageal atresia
Birth thru 1st 24h
Excessive salivation right after birth w/ choking spells on 1st feeding
NG tube put in and seen coiled in upper chest
Most common type: blind pouch in upper esophagus w/ fistula b/t lower esophagus & tracheobronchial tree
Check for other abnormalities- VACTER
Primary surgical repair preferred; if delayed, gastrostomy done to protect lungs from acid reflux
Imperforate anus
Birth thru 1st 24h
May be part of VACTER abnormalities
Look for fistula- repair before potty training OR do colostomy for high rectal pouches
Level of pouch determined w/ upside down xray with metal marker taped to anus
Congenital diaphragmatic hernia
Birth thru 1st 24h
Always on left
Bowel will be up in chest
Due to hypoplastic lung w/ fetal type circulation
Repair delayed 3-4d to allow maturation
Need intubation w/ low pressure ventilation sedation and NG suction
Difficult cases req ECMO
Gastroschisis
Birth thru 1st 24h
Abdominal wall defect in middle of belly
The cord is normal- defect to RT of cord
No protective membrane- bowel is angry & matted
Small defects can be closed primarily
Large defects req silastic silo to protect bowel
Silo squeezed in over days until back in
Also req vascular access for PTN b/c angry bowel won’t work for a month
Omphalocele
Birth thru 1st 24h
Abdominal wall defect in middle of belly
The cord goes to the defect
Has thin protective membrane- underneath is normal looking bowel w/ slice of liver
Small defects can be closed primarily
Large defects req silastic silo to protect bowel
Silo squeezed in over days until back in
Exstrophy of Urinary Bladder
Birth thru 1st 24h
Abdominal wall defect- pubis not fused
Medallion of red bladder mucosa, wet & shiny
Baby taken to specialized center for repair- FIrst 1-2 days of live
Repaired delays do not work
Green vomiting and double bubble
Large air fluid level in stomach and smaller one in 1st part of duodenum
Seen in duodenal atresia, annular pancreas, or malrotation
Malrotation most dangerous b/c bowel can twist on itself & cutoff blood supply
If double bubble followed by normal gas pattern, malrotation risk higher-> dx w/ contrast enema or upper GI study
Intestinal atresia
Birth thru 1st 24h
Shows up w/ green vomiting w/ multiple air-fluid levels thruout abdomen
Results from vascular accident in utero (no other congenital abnormalities)
Necrotizing enterocolitis
First few days to first 2 months of life
Seen in premature infants when 1st fed
Feeding intolerance, abdominal distention, & rapidly dropping platelet count (sepsis)
Tx: stop feedings, antibiotics, IV fluid & nutrition
Surgery if abdominal wall erythema, air in portal vein, intestinal pneumatosis, or pneumoperitoneum
Meconium ileus
First few days to first 2 months of life
Seen in babies w/ Cystic fibrosis
Develop feeding intolerance & bilious vomiting
Xray shows multiple dilated loops of small bowel w/ ground glass appearance in lower abdomen
Gastrografin enema is diagnostic- microcolon & inspissated pellets of meconium in terminal ilium
Gastrografin also therapeutic b/c draws fluid in
Hypertrophic pyloric stenosis
Shows up at age 3wk
More common in 1st born boys
Nonbilious projectile vomiting after each feeding- but still hungry and eager to eat again
Dehydrated, visible peristaltic waves, palpable olive size mass in RUQ
Tx: rehydration, correct hypokalemic metabolic alkalosis; then Ramstedt pyloromyotomy or balloon dilation
Biliary atresia
6-8wk old w/ persistent progressive jaundice
Sweat test & serology to r/o other causes
HIDA scan 1wk after phenobarbital- if no bile in duodenum, req surgical exploration
1/3 get long-lasting surgical derivation
1/3 need liver transplant after surgical derivation
1/3 req immediate liver transplant
Hirschsprung Disease
aganglionic megacolon
May dx early life or may go on many years
Chronic constipation
Rectal exam may lead to explosive expulsion of stool & flatus with relief of distention
Xray shows distended proximal colon (actually normal) and ‘normal’ looking distal colon-actually aganglionic part
Dx w/ full thickness biopsy of rectal mucosa
Surgery to preserve sensory input of motor impaired rectum while adding propulsion of colon
Intussusception
Seen in 6-12mo old w/ colicky abdominal pain
Vague mass on RT side of abdomen; ‘empty’ RLQ
Current jelly stools
Barium or air enema dx and tx
If no reduction radiologically, then surgery
Child abuse
Suspected when injuries cannot be properly accounted for
Subdural hematoma w/ retinal hemorrhages (shaken baby syndrome)
Multiple fx in different stages of healing
Scalding burns, esp both buttocks (held in boiling water)
Refer to authorities
