Pediatric Surgery Flashcards
What do you suspect in a newborn who presents with excessive salivation or choking spells during first feeding attempt?
Esophageal atresia- likely due to TE fistula
MC type of TE fistula
Proximal blind esophagus
Distal esophagus joins trachea
You insert a NGT in a baby and on XR it appears it has coiled back on itself in the upper chest…
Suspect TE fistula
You diagnose a baby with TE fistula, what are the first steps that need to be taken?
Rule out VACTERL abnormalities
- vertebral, anal, cardiac, TE and renal/radial
- once this has been R/O then you should proceed with surgery
A newborn baby is found to have an imperforate anus on PE- what is the next step?
Part of VACTERL group of abnormalities
Next step - XR while holding baby upside down and metal marker on anal dimple to assess level of blind pouch
Tx of imperforate anus
If fistula to vagina or perineum present, repair can be done later
If low blind pouch, repaired with simple operation
If high blind pouch, colostomy with reconstruction later
surgery for a baby with TE fistula must be delayed, what should be done in the meantime?
Gastrostomy to protect lungs from acid reflux
Newborn baby is tachypneic, cyanotic and grunting; bowel sounds are heard over the left chest - dx test? Dx?
Should do a chest XR: will show bowel in chest
- congenital diaphragmatic hernia
Tx of hypoplastic lung due to congenital diaphragmatic hernia
Surgery - but wait 36-48 hrs to allow transition from fetal circulation
In the meantime, intubation, low pressure hyperventilation, sedation and NGT suction
Bilious vomiting, ground glass appearance on abdominal XR and family history of CF
Meconium Ileus
3 week old baby with projectile vomiting following each feeding and on physical exam you see visible gastric persistaltic waves and a palpable olive mass
Hypertrophic pyloric stenosis
9 month old baby with intermittent colicky pain and currant jelly stool
Intussusception
Newborn with large abdominal wall defect to the right of the umbilicus - normal cord but protruding from the cord are edematous bowel loops
Gastroschisis
Newborn with shiny, thin membranous sac at the base of the umbilical cord; inside the sac you see part of the liver and loops of normal bowel
Omphalocele
Newborn with moist medallion of mucosa occupying the lower abdominal wall (above public and below umbilicus) that is constantly bathed in urine
Exstrophy of the urinary bladder
Tx of exstrophy of bladder
Emergent transfer to specialized institution
- requires rapid within 48 hrs
A baby with Down syndrome vomits green fluid. What study do you order?
X-ray
What can the double bubble sign on XR mean?
Annular pancreas
Duodenal atresia
What does a double bubble sign with no gas in the rest of the bowel mean?
Likely that complete obstruction is present and surgery is needed
- dx is most likely duodenal atresia in a new born with Downs
What does a double bubble sign with air in the distal bowel mean? What test should you do next?
Incomplete obstruction (duodenal stenosis, annular pancreas, malrotation) - order barium enema
A newborn baby has repeated episodes of green vomiting, it also didn’t pass meconium; XR shows multiple air fluid levels and distended loops of bowel
Intestinal atresia
- vascular accident in utero with loss of blood supply tons segment of bowel
You had suspected intestinal atresia based on XR and clinical findings, but when you operate you find all the bowel is there…
Consider aganglionic megacolon with involvement of entire bowel
- do frozen sections on appendix
What are the signs of sepsis in a newborn?
Rapidly dropping platelet count
Premature baby develops feeding intolerance, abdominal distention and rapidly dropping platelet count; baby is 4 days old and was treated with indomethacin for PDA - what do you suspect?
Necrotising enterocolitis
