Pediatrics Flashcards
__ % of the population will get appendicitis
Peak age range
10
10-18
main intuss cause
3 others
peak age in kids`
Peyers
meckels, tumor, duplication
10m
50% of cases of malrotation volvulus occur before
1m
obstruction pain type
colic
peds LGIB ddg
milk allergy, hirch, intuss, infect, ibd, meckels
2 clinically significant GI polyps for peds
solitary juvenile hamartomatous (90%)
aden polyps—- FAP
MCC of LGIB in children after infancy
polyps
4 peds LGIB situations requiring intervention surgically
malro, meckels, intuss(multiple failed enemas), nec entero with free air
pathophys progression of intuss, complication?
venous obstruction, art obst, ishemia
currant jelly stool?
intuss
GS for intuss imaging
obsolete modality?
u/s with dopplar
contrast enema
intuss preferred tx
success rate?
air enema
80%
down side to auto appy for any peds exploration
inc cost, inc LOS and inc post op bowel obst
MC TEF
Esoph atresia w/ distal TEF
TEF associated abnormalities
VACTERYL needs these 4 imaging evals
renal us, spinal us, echo, babygram
Why is an assoc TEF with esoph atresia better than not
can have single stage repair
Which side is a TEF repair approached
right thoracotomy
Describe TEF repair
A right thoracotomy approach is made because the aortic arch is usually left-sided.
The incision is made at the fourth intercostal space.
Extrapleural dissection is used to gain access to the posterior mediastinum.
The azygous vein is ligated.
The distal fistula is identified at its insertion into the trachea and transected.
The tracheal opening is closed with interrupted sutures.
The upper pouch is mobilized from the thoracic inlet and anastomosed to the lower pouch using interrupted sutures.
Minimally invasive techniques of repair with thoracoscopy are being increasingly applied
most important preop eval before esoph atresia / TEF surgery
echo
What is a cloaca
malformation of urethra, rectum and vagina
10% of hirschsprung patients have _____ or _____
trisomy 21; family hx
what is a typical occurence for hisrch
no meconium for 48h
no meconium for 48h think….
HSD
first step in work up for hirsch
contrast enema then rectal bx if needed
bx features of HSD
Absence of ganglion cells
Presence of hypertrophic nerves
Abnormal pattern of cholinesterase staining
Absence of calretinin staining
What is the distance cutoff for esoph atresia primary delayed repair
if longer?
2 vert bodies or less
traction sutures
What is the next intervention for end ileostomy stenosis when they fail lax and softeners
local revision and maturation
treatment for small duodenal mucosal perforation during pyloromyotomy for child
sew SM and cover with patch
