Pediatric Surgery Flashcards
baby has excessive salivation noted shortly after birth or choking spells when first feeding is attempted. next steps?
small NG tube is passed and it will be seen coiled in upper chest when X-rays are done. esophageal atresia! before therapy is undertaken, rule out VACTER. surgical repair is preferred, but if it has to be delayed, do a gastostomy to prevent lungs from acid reflux.
MC type of esophageal atresia
blind pouch in upper esophagus, fistula bw lower esophagus and tracheobronchial tree.
baby has imperforate anus with a fistula nearby (to vagina or perineum)
rapair can be delayed until further growth but before toilet training time
baby has imperforate anus without nearby fistula
determine level of pouch by X-ray taken upside down (so gas in pouch goes up), with a metal marker taped to the anus. colostomy for high rectal pouch and later repair, or a primary repair can be done right away if the blind pouch is almost at the anus
baby is in respiratory distress. sonogram shows congenital diaphragmatic hernia. describe sonogram. next steps?
hernia on left and bowel up in chest. real problem is hypo plastic lung that still has fetal type circulation. repair must be delayed 3-4 days to allow maturation. babies are in respiratory distress and need endotracheal intubation, low pressure ventilation, sedation, and NG suction. difficult cases may need extracorporeal membrane oxygenation (ECMO).
baby has medallion of red wet and shining organ sticking through lower abdomen. next steps?
exstrophy of the urinary bladder. transfer baby to specialized where a repair can be done in 1-2 days of life. delayed repairs do not work.
baby wit green vomiting and double bubble picture in X-rays. what can it be (3)? most dangerous? next steps.
duodenal atresia, annular pancreas, malrotation. all require surgery. malrotation is the most dangerous because it can twist on itself, cut off blood supply, and die. dx malrotation with contrast enema or upper Gi study.
baby has green vomiting and multiple air fluid levels through the abdomen.
intestinal aresia. may be more than one atretic area but no other congenital anomalies have to be suspected because this condition results from a vascular accident in utero.
premature infant is first fed-> feeding intolerance, abdominal dissension, rapidly dropping platelet count.
NEC! stop all feedings, give IV fluids, IV nutrition. surgical intervention needed if infant gets abdominal wall erythema, air in portal vein, intestinal pneumatosis, or penumoperitoneum.
baby gets feeding intolerance and bilious vomiting. X-ray shows multiple dilated loops of small bowel and a ground glass appearance in lower abdomen. next steps to dx?
meconium ileum in cystic fibrosis! dx with gastrograffin enema-> microcolon, inspissated pellets of meconium in the terminal ileum. it is also tx: draws fluid in and dissolves the pellets.
first born 3 week old gets non bilious projectile vomiting after each feeding. baby is hunger and eager to eat after he vomits. olive size mass in right quadrant.
pyloric stenosis! sonogram or palpating olive size mass is diagnostic. therapy begins with rehydration and correction of hypochloremic, hypokalemic metabolic acidosis. then amsted pyloromyotomy or ballon dilation.
6-8 year old with persistent progressively increasing jaundice that is conjugated. next steps? dx? outcome?
biliary atresia! do serology and sweat test to rule out other causes. tx: do HIDA scan after 1 week of phenobarbital ( a powerful chloretic). if no bile reaches duodenum even with phenobarbital stimulation, surgical exploration is needed. outcome: 1/3 get long lasting surgical derivation, 1/3 need liver transplant after surgical derivation, and 1/3 need transplant right away.
kid has chronic constipation. rectal exam leads to explosive expulsion of stool and flatus with relief of abdominal distention.
hirschprung disease (no fecal soiling- that suggest psychogenic problem). X-rays show distended proximal colon (normal colon), and normal looking distal colon (aganglionic part). dx: with full thickness bx of rectal mucosa.
6-12 month old chubby healthy looking kid with episodes of clicks abdominal pain x1 minute that makes him double up and squat. physical exam shows vague mass on right side of ambomen, empty right lower quadrant, current jelly stools.
intussusseption! barium or air enema is both diagnostic and therapeutic. if reduction is not achieved radiologically or if there are any recurrences, surgery is done.
lower GI bleeding in peds. next steps?
meckel diverticulum! do radioisotope scan looking for gastric mucosa in the lower abdomen.
