Pediatric Surgery Flashcards
Excessive salivation after birth or choking spells during first feed. What other potential abnormalities should be investigated before therapy is undertaken?
ESOPHAGEAL ATRESIA
VACTER: vertebral (xray), anal (imperforation), cardiac (echocardiogram), tracheal, esophageal, renal (sonogram), and radial anomalies
If primary surgical repair of esophageal repair must be delayed, what should be done to protect the lungs from acid reflux?
gastrostomy
What is the most common type of tracheoesophageal abnormality?
Esophageal atresia with distal TEF (between lower esophagus and tracheobronchial tree)
What is the approach to treating imperforate anus?
1) look for associated VACTER anomalies
2) look for fistula; if one is present, can delay repair until before toilet training
3) find where the pouch is:
- if high rectal pouch, colostomy (with later repair)
- if blind pouch almost at level of anus, can do primary repair right away
Congenital diaphragmatic hernia is always on the (right/left).
Left
Why must repair of congenital diaphragmatic hernia be delayed 3 or 4 days?
To allow maturation of hypoplastic lung that still has fetal-type circulation
How do you treat respiratory distress in infant with congenital diaphragmatic hernia?
intubation, low pressure ventilation, sedation, NG suction
ECMO for difficult cases
In (omphalocele/gastrochisis), the defect is to the right of the cord and the bowel looks angry and matted, requiring TPN for about a month before it can work well.
gastrochisis!
In omphalocele, cord goes to the defect (can see normal-looking bowel and a little slice of liver through the thin membrane covering the defect)
While small gastrochisis or omphalocele defects can be closed primarily, large ones require construction of a ___________ to house and protect the bowel. Contents are squeezed into the belly a little each day–takes about a week to replace.
silastic silo
Baby with an abdominal wall defect over the pubis (which is not fused), with a medallion of red bladder mucosa, wet and shining. Next steps?
Exstrophy of the urinary bladder! Must transfer immediately to specialized center to perform repair within 1-2 days (delayed repairs do not work)
What are 3 causes of green vomiting and double-bubble abdominal X ray in infants?
1) duodenal atresia
2) annular pancreas
3) malrotation
If in addition to a double bubble on AXR, there is a little normal gas pattern beyond, the chances of which diagnosis are higher?
malrotation
Green vomiting in new born with AXR showing multiple air fluid levels (and not a double bubble). What causes this condition?
Intestinal atresia, resulting from a vascular accident in utero
Premature infant with feeding intolerance, abdominal distention, and a rapidly dropping platelet count:
Treatment?
necrotizing enterocolitis
Treatment: stop all feedings, administer broad spectrum abx, IV fluids, IV nutrition
When is surgical intervention required in necrotizing enterocolitis?
1) abdominal wall erythema
2) air in the portal vein
3) intestinal pneumatosis (presence of gas in the bowel wall)
4) pneumoperitoneum (intestinal necrosis and perforation)
Feeding intolderance, bilious vomiting, X ray showing multiple dilated loops of small bowel and a ground-glass appearance in lower abdomen:
Next step?
meconium ileus (usually in CF infants) Perform gastrografin enema to diagnose (microcolon and inspissated pellets of meconium in the terminal ileum) AND for therapy (Gastrografin draws fluid in, dissolves the pellets)
**Note: “soap bubble” or “ground glass” appearance in lower abdomen is due to small air bubbles mixed with the meconium is diagnostic of meconium ileus
More commonly seen in firstborn boys, nonbilious projectile vomiting after each feeding, starting around age 3 weeks, palpable olive-size mass in RUQ (and sometimes visible gastric peristaltic waves!):
Diagnosis/therapy?
Diagnose with sonogram if mass can’t be felt
Therapy with rehydration, correction of hypochloremic, hypokalemic metabolic alkalosis, followed by Ramstedt pyloromyotomy or balloon dilatation
___________ should be suspected in a 6- to 8-week-old baby who has persistent progressively increasing jaundice (including a substantial conjugated fraction).
Biliary atresia
A HIDA scan should be performed after 1 week of __________ (a powerful choleretic) in babies for whom biliary atresia is suspected (after serologies and sweat test rule out other problems).
phenobarbital
What is the treatment of biliary atresia?
Surgical derivation. 1/3 of patients need liver transplant right away.
Constipation with X ray showing distended proximal distention and “normal-looking” distal colon:
How is the diagnosis made?
Hirchsprung disease
Diagnosis made with full-thickness biopsy of rectal mucosa. Surgery.
6–12-month old infant with colicky abdominal pain, currant jelly stools, “empty’ RLQ and potential palpable mass on the right side of the abdomen.
Next step for diagnosis/therapy?
barium or air enema is diagnostic and therapeutic
Subdural hematoma and retinal hemorrhages:
shaken baby syndrome, child abuse
What is an X ray finding that suggests child abuse?
multiple fractures in different stages of healing
Lower GI bleeding in children. Next step?
Potential Meckel diverticulum. Do technetium scan looking for ectopic gastric mucosa in lower abdomen
