Pediatric surgery Flashcards
Operative management of CDH
- Presence of pulmonary hypertension that results in right to left shunting across the patent formation ovale or the ductus arteriosus and the degree of pulmonary hypoplasia are the leading cause of cardiorespiratory insufficiency
- Cureent management:
- manage pulmonary hypertension
- seen within 7 to 10 days
Consistent biochemical profile with pyloric stenosis
Hypochloremic, hypokalamic metabolic alkalosis
- The urine pH is high initially, but eventually drops because hydrogen ions are preferentially exchanged for sodium ions in the distal tubule of the kidney as the hypochloremia becomes severe (Paradoxical aciduria)
- Typical of olive in thr RUQ and the presence of visible gastric waves on the abdomen
- UTZ criteria
- channel length over 16mm and pyloric thickness over 4mm
An infant presents to the emergency room with billous emesis and irritability. PE is notable for abdominal tenderness and erythema of the abdominal wall. Abdomina X-ray demonstrates dialted proximal bowel with air-fluid levels. What is the most appropriate next step after resusictation
Laparotomy
- Billous vomiting is usulaly the first sign of volvulus
- If left untreated, vascular compromise of the midgut initially causes bloody stools, but eventually results in circulatory collapse
Hirschprung disease
- 20% of cases are diagnosed beyond he newborn period
- The underlying apthology is characterized by an absence of ganglion cells in Auerbach plexus
- Constipation and abdominal distention are classic symptoms
- Decompressive stoma
- placed in the ganglion-containing bowel
- the hypertrophied, dilated portion of the intestine in Hirschprung disease contains normal ganglion cells
- It is the narrow segment of the colon distal to the dilated portion that ganglion cells are absent
The most common form of esophageal atresia is _________
EA with distal tracheoesophageal fistula
- Type C - 85% of cases
- Type A (pure EA) - 8 to 10% of patients
- Type E (TEF without EA)/H type - 8% of cases
- Type D (EA with fistula between both proximal and distal ends of the esophagis and trachea) - 2%
- Type B (EA with TEF between proximal esophagus and trachea) - 1%
The predicted 4 year survival rate of a child with a Wilms tumor that is condined to one kidney and is grossly excised
97%
A premature infant boy has been started on enteral feed shortly after birth, but develops feeding intolerance 2 weeks postnatally. He displays abdominal tenderness, distention, and bloody stools. An abdominal radiograph is obtained and reveals pneumatosis intestinalis, What should be the next step in management?
Nasogastric decompression, parenteral nutrition, broad spectum antibiotics
- Bell stage II necrotizing enterocolitis
- Intubation and mechanical ventialtion may be required to maintain oxygenation
- Serial PE are performed looking for the development of diffuse peritonitis, a fixed mass, progressive abdominal wall cellulitis or systemic sepsis
- If Abdominal xray show fixed intestinal loop, consideration should be given to exploratory laparotomy
An infant girl is found to have persistent jaundice after birth. A metabolic screen is normal, ultrasound demonstrates an absent GB and a technetium 99m imidoacetic acid scan shows radionucleid that is concentrated in the liver but not excreted into the intestine.
Surgery should be performed within 60 days of life
- Biliary atresia - fibroproliferative obliteration of the biliary tree which progresses toward hepatic fibrosis, crirrhois and end-stage liver failure
- Kasai procedure
- creation of a hepatoportoenterostomy
The leading cause of death for children older than 1 year of age is
Injury
A double bubble sign on an abdominal radiograph in an infant is characteristic of ___________
Duodenal atresia
- Whenever the diagnosis of duodenal obstruction is entertained
- malrotation and midgut volvulus
- duodenal atresia
- duodenal web
- stenosis
- annular pancreas
- duodenal duplication cyst
The defect in gatsrochisis is
- To the right of the umbilicus
- no overlying sac and the sie of the defect is usually <4cm
- omphalocoele the umbilical cord inserts into the sac
The initial treatment of pure EA (no fistula) is
Gastrotomy alone
- upper and lower ends are too far apart for an anastomosis to be created
- performing serial bougienage to increase the length pf the upper pouch
- when the two ends cannot be brought safely togetherm esophageal replacement is required, using either a gastric pull-up, reverse gastric tube or colon interposition
The most common branchial cleft fistula originates from the
Second branchial cleft
- Paired branchial clefts and arches develop early in the 4th gestational week
- the 1st cleft and the 1st, 2nd, 3rd, and 4th pouches give rise to adult organs
- 2nd branchial cleft which normally disappears, and extends from the anterior border of the SCM superiorly, inward through the bifurcation of the carotid artery and enters the posterolateral pharynx just below tonsillar fossa
- 3rd branchial cleft fistula passes posterior to the carotid bifurcation
Characteristic of congenital lobar emphysema
- commonly invovles the upper lobes of the lungs (left greater than right)
- Condition manifested during the first few months of life as a progressive hyperexpansion of one or more lobes of the lung
- caused by increased bronchial obstruction from poor bronchial cartilage development or extrinsic compression
An infent is referred to your clinic for evaluation of a neck mass. On PE, the patient has a left lateral neck mass with his head rotated to the opposite side, Which of the following is the most likely diagnosis?
Torticollis
- fibrosis of the SCM and is histologically cahracterized by the deposition of collagen and fibroblast around atrophied muscle cells
- Midline masses:
- thyroglossal duct remnants, thyroid masses, thymic cysts, or dermoid cysts
- Lateral lesions
- branchial cleft remnants, lymphatic malformations (cystic hygroma), vascular malformations, salivary gland tumors, torticollis and lipoblastoma
