Pediatric Surgery Flashcards
1 cause of vomiting in infancy requiring surgery
pyloric stenosis
pyloric stenosis: incidence? most common at what age range? male to female ratio?
3 per 1000 live births; usually 4-8 weeks but can happen as young as 2 weeks; 4-1 ratio, usually firstborn male
what type of obstruction is pyloric stenosis? what does the emesis look like?
gastric outlet; non-bilious emesis
what acid base disturbances (2) do you get with pyloric stenosis?
alkalosis and dehydration
what is the best test to diagnose pyloric stenosis? pyloric sphincter muscle wall thickness should be more than ___ mm
US; 4 mm
treatment of pyloric stenosis?
pyloromyotomy
in pyloric stenosis, the hypertrophic smooth muscle is ________
fibrotic
when doing a pyloromyotomy, its important to not violate the _______
mucosa
what is the rule of 2’s for Meckel’s diverticulum?
1) . affects 2% of the population
2) . occurs about 2 feet away from ileocecal valve
Meckel’s diverticulum is more symptomatic in what gender? when does it typically present?
males (3:1); typically presents within the first few years of life
Meckel’s diverticulum: can present with what three things?
obstruction, inflammation or hemorrhage
what is an omphalomesenteric band? how does this create Meckel’s?
also called vitelline duct, remnant during fetal development; Meckel’s diverticulum develops when incomplete obliteration of the vitelline duct occurs (can create a small bowel obstruction)
what is Meckel’s diverticulum?
an outpouching or bulge in the lower part of the small intestine
what is a physical characteristic of Meckel’s?
painless bleeding
Meckel’s: __% of all lower GI bleeding in patients younger than 2
50%
what is bleeding in meckel’s due to?
acid secreting ectopic gastric mucosa leads to ulcer formation (90%)
what is used to diagnose Meckel’s? what has to be present to use this test?
technetium pertechnetate imaging; heterotopic gastric mucosa (HGM) is present
what is the severity of Meckel’s?
inflammation to frank necrosis
treatment of meckel’s?
depends on severity, could just staple/suture end off, or have to resect, especially if bleeding is present
what is Intussusception?
part of the intestine slides into an adjacent part of the intestine
Intussusception: peak presentation age range? what is the most common presentation?
5-10 months; cyclic crampy abd pain, abd distention, irritability, vomiting, currant jelly stools, lethargy
what type of test might be positive for intussusception?
hemoccult stool
how do you reduce an intussusception?
hydrostatic reduction with fluoroscopic control or surgery
what is one of the late physical signs of intussusception?
current jelly stools
appendicitis: at least __% present in perforated children
40%
describe appendicitis presentation in children
variability, must have high index of suspicion
when you have intussusception in a kid, what are three things you can also find there?
1) . mesenteric lymph nodes in terminal ileum
2) . duplication cyst near terminal ileum
3) . Meckel’s diverticulum
what comes first for appendicitis presentation?
anorexia
what 4 things of classic appendicitis presentation?
1) . vague periumbilical pain- awaken with pain**
2) . localizes to RLQ over 12-24 hrs
3) . associated symptoms: anorexia, fever (low grade), N/V
4) . pain almost precedes other symptoms
* *anorexia, pain, N/V- order Dr says**
