Pediatric Surgery review Flashcards
What drug can you give to keep ductus arteriosus patent in neonates?
- Prostaglandins
What drug can you give in an attempt to pharmacologically close a patent ductus arteriosus?
- Indomethacin
What procedure do you perform to close a patent ductus arteriosus in a neonate?
- left anterolateral thoracotomy, can be performed at bedside
- clip PDA
describe a Duhamel proceudre
aganglionic rectal stump is left in place, ganglionic colon is brought posterior to stump and a common channel is made between the two
what surgical options are available for Hirschsprung’s disease?
- Soave
- Duhamel
- Swenson
Describe the Soave procedure
submucosal endorectal dissection, resection of aganalionic rectum with pull through of ganglionic colon and end to end anastomosis…a muscular layer from the aganglionic rectum is left surrounding the colon pulled through
Describe the Swenson procedure
full thickness resection of aganglionic rectum and pull through of sigmoid colon to create end to end anastomosis with rectal stump
Air filled stomach and air filled duodenum on plain film in a neonate…what is this called and what is it associated with?
- double bubble sign
- duodenal atresia or a duodenal web
neonate with bilious emesis, plain film with double bubble sign and no distal air noted…next step?
- upper GI contrast study, will confirm Duodenal atresia but more importantly need to rule in or out midgut volvulus (lack of air distally)
3 month old with inguinal hernia presents to ED, bowel noted to be in hernia…next step?
- attempt reduction, if successful admit for 1-2 days of observation then repair the hernia (allows for edema to subside)
- if reduction fails take to OR for open reduction and repair
unable to pass an NGT in a neonate…what is first on the differential?
Esophageal atresia
most common form of esophageal atresia?
atresia with a distal tracheoesophageal fistula (you’ll see gas in GI tract distally from inspired air
VACTERRL syndrome
Vertebral Anal Cardiac Trachea Esophagus Renal Radial Bone Limb
- defects that are associated with each other
What is unicameral bone cyst?
- cyst in the bone filled with cytokines that cause bone resorption
- typically asx but can present with pathologic fracture
how do you treat a fracture from a simple bone cyst?
- cast and see if it heals
- if this fails can do methylprednisolone injection
Characteristics of a mesenteric Cyst?
- no solid component
- freely mobile and perpendicular to mesentery
8 year old with 1 cm mass on lateral neck, mom said it comes and goes with some fluid drainage…next step?
- total surgical excision likely a brachial cleft anomaly
Surgical treatment for thyroglossal duct cyst?
Sistrunk procedure
removal of cyst and its track as well as central portion of the hyoid bone
Fetal structural abnormalities that are associated with increased amniotic fluid?
esophageal atresia
intestinal atresia
craniofacial abnormalities
Cardiac abnormalities seen in Tertralogy of Fallot?
- pulmonary artery stenosis
- ventricular septal defect
- overriding aorta with deviation of origin to the right
- concentric right ventricular hypertrophy
Type III choledochal cyst
intraduodenal or intrapancreatic dilations, distal to CBD
treatment for Type III choledochal cyst
if < 3cm can get an ERCP and marsupialize the cyst
if > 3cm will need formal resection and reconstruction
Type I choledochal cyst
extra hepatic biliary dilation(s)
- some argue Type I and IV are a spectrum of the same entity
treatment for type I choledochal cyst
resection with roux-en-y hepaticpjejunostomy
Type IV choledochal cyst
extra-hepatic and or intra-hepatic cyst
treatment for type IVa and V choledochal cyst
orthotropic liver transplantation if diffuse, segmental resection if isolated
Caroli Disease
multi-focal intrahepatic biliary dilation, can be segmental or diffuse
AKA type V choledochal cyst disease
Type II choledochal cyst
singular diverticulum protruding from CBD
treatment for Type II choledochal cyst
resection of diverticulum, reconstruction is normally not needed
how much blood do you give in pediatric trauma
10 mL/kg
how much fluid do you give in pediatric trauma, what is your bolus dose?
20 mL/kg
child with multiple liver masses and elevated alpha-fetoprotein…what do they have?
hepatoblastoma
how do you test adequacy of pyloromyotomy
- edges should be freely mobile, independent of each other
most common intestinal atresia
jejunal atresia
most common cause of jejunal atresia
intrauterine vascular accident
new born male has an undescended testicle, with no other symptoms, when does this become a problem?
if it has not spontaneously descended in the first 4 months of life surgery will likely be needed
when do kids present with pyloric stenosis typically
2-8 weeks of age
