PEDIATRIC SURGERY Flashcards
Congenital diaphragmatic hernia
Always on the left
Worry about the hypoplastic lung - wait 3-4 days for lung maturation
Gastroschisis vs omphalocele
Gastroischisis - cord is normal and defect is to the right of the cord
Omphalocele - cord goes into the defect
Slowly push abdominal contents back in… Takes about a week
Need TPN for a month because the bowel is angry
Malrotation
Green vomiting
Double bubble on X-ray
Bowel can twist on itself and cut off the blood supply and die
Diagnose with:
Contrast enema (safe but not always diagnostic)
Upper GI study (more reliable but unsafe)
Necrotizing enterocolitis
Premature infants at first feeding
Feeding intolerance
Abdominal distention
Rapidly dropping platelet count
Meconium ileus
Firstborn boys at 3 weeks old
Non bilious projectile vomiting
Visible gastric peristaltic waves
Palpable olive
Diagnose with US
Treat with rehydration and fix hypochloremic hypokalemic metabolic alkalosis then surgery (Ramstedt pyloromyotomy)
Biliary atresia
6-8 weeks old
Progressive jaundice
Try to stimulate bile production with one week of phenobarbital
If it doesn’t work you need surgery and eventually a liver transplant
Diagnosis of hirschsprung
Full thickness rectal mucosa biopsy
Intussusception
6-12 months
Colicky abdominal pain that makes them double up and squat
Vague mass on right side of abdomen
Empty RLQ
Currant jelly stools
Barium or air enema
Pediatric abdominal mass that moves up and down with respiration
Malignant liver tumor - hepatoblastoma or hepatocellular carcinoma
Alpha fetoprotein will be elevated
Pediatric abdominal mass that is deeper and doesn’t move
Wilms tumor - comes from the kidney
Neuroblastoma - comes from adrenal