Pediatric Surgery Flashcards
VACTERL
Vertebral abnormalities Anal (imperforate) Cardiac (echo) Tracheal Esophageal Renal (ultrasound) Limb (radial side, mostly thumb)
Symptoms of esophageal atresia
Choking with feeds, gurgling and bubbling. First day
How to diagnose esophageal atresia?
Failure to pass NG tube
How to treat esophageal atresia?
Surgery
How do patients with imperforate anus present?
They have an atretic colon and have no anus
How to diagnose imperforate anus?
Upside down babygram, colon will rise, will see distance.
How to treat imperforate anus?
If distance from anus to colon is small, treat now.
If distance from anus to colon is large, place colostomy now, then fix anus before toilet training.
How do patients with congenital diaphragmatic hernia present?
Bowel sounds in thorax and scaphoid abdomen. Left sided only, posterior more common than lateral
How to diagnose congenital diaphragmatic hernia?
CXR with bowel in lungs
Treatment for congentical diaphragmatic hernia?
Surgery. Hypoplastic lungs may require intubation and surfactant.
Gastroschisis?
Failure of abdominal wall to close. Bowel protrudes through abdominal wall.
How to treat gastroschisis?
Place a sterile silo, twist bowel daily. Close when reduced
Omphalocele
Failure of abdominal wall to close completely. Bowel is covered by peritoneum though.
How to treat omphalocele?
Place a sterile silo and rotate bowel until reduced, then close.
Omphalocele and gastroschisis can be confused for…
Bladder extrophy
How to tell if protuberance is gastroschisis/omphalocele vs bladder extrophy?
Bladder extrophy will appear red and shining, wet with urine, and there will be no bowel visible.
How to treat bladder extrophy?
Emergent surgery to fix.
Algorithm for bilious emesis?
If baby is vomiting bile, get a babygram and look at the bowel. If there are multiple air fluid levels, then baby has intestinal atresia caused usually by maternal cocaine use causing intrauterine infarctions. Treat with surgery. If baby just has a double bubble sign then baby has duodenal atresia or annular pancreas. Treat with surgery. If baby has double bubble sign AND normal air in bowel then malrotation has occured. Get an enema to reveal and an upper GI series if negative to confirm. If either or positive, it’s malrotation and emergency surgery must be done. If negative, urgent surgery.
Time course for necrotizing enterocolitis?
Within days of birth
Risk factor for necrotizing enterocolitis?
Prematurity. The earlier the higher the risk.
How does necrotizing enterocolitis present?
With bloody bowel movement after first feeding, abdominal distention, and decrease in platelets.
How to diagnose necrotizing enterocolitis?
With a babygram which will reveal pneumatosis intestinalis.
How to treat necrotizing enterocolitis?
With TPN and NPO.
What is patient with necrotizing enterocolitis also at risk for?
Interventricular hemorrhage, diagnose with brain US
Time course for development of meconium ileus?
Days after birth
Presentation of meconium ileus
Failure to pass meconium
What is a risk factor for development of meconium ileus?
Cystic fibrosis
How to diagnose meconium ileus?
Babygram showing ground glass and dilated loops of bowel.
How to treat meconium ileus
Gastrographin enema
Time course for development of pyloric stenosis?
1-2 weeks
Presentation of Pyloric stenosis? Electolyte abnormalities?
Hungry baby, projectile vomiting, olive shaped mass in abdomen.
Patient will be hypochloremic, hypokalemic, and have a metabolic alkalosis.
How to diagnose pyloric stenosis?
Abdominal ultrasound which shows donut shaped lesion
How to treat pyloric stenosis?
First IVF and antibiotics, then surgery.
Time course for development of biliary atresia?
6-8 weeks
Presentation of biliary atresia?
Persistant jaundice
Diagnosis of biliary atresia?
HIDA scan 1 week after phenobarbital injection
Treatment of biliary atresia?
Resection
Presentation of hischsprung’s disease?
Failure to pass meconium on day 1, or chronic diarrhea at any age.
How to diagnose hirschsprung’s disease?
Dilated colon followed by normal looking colon (which is lacking the neurons)
How to treat hirschsprung’s?
Resection of the bad segment.
Pathology of intussusception
Telescoping of bowel causes vascular compromise and necrosis.
Common finding with intussusception
Currant jelly stool
Presentation of intussusception?
Abdominal pain, fetal position
How to diagnose intussusception?
KUB shows a sausage shaped mass.
How to treat intussusception?
Air enema
