Pediatrics Flashcards
How is esophageal atresia first noticed?
Excessive salivation shortly after birth or choking spells when first feeding is attempted. Small NG tube can be passed and seen coiled in the upper chest on x-rays.
Describe the most common type of esophageal atresia.
-Normal gas pattern in the bowel-Blind pouch the upper esophagus-Fistula between lower esophagus and the tracheobronchial tree
What needs to be done before therapy for esophageal atresia can be attempted?
Rule out associated abnormalities (VACTER)-Vertebral (check x-ray)-Anal (look for imperforation)-Cardiac (Echo)-Tracheal-Esophageal-Renal (Sono)-Radial (check x-ray)
What should be done if primary surgical repair for esophageal atresia has to be delayed?
Gastrotomy to protect the lungs from acid reflux
What can be done about an Imperforate Anus?
- Rule out VACTER2. Look for fistula (to vagina or perineum)a. If present, repair can be delayedb. If not present a colostomy is needed for high pouch/repair if pouch is close to the anus
How is the level of the blind pouch in an Imperforate Anus determined?
Upside down x-ray so the gas can be seen at the top of the pouch
What side of the chest is affected by Congenital diaphragmatic hernias?
Always the left side
what is the most concerning problem for Congenital diaphragmatic hernias?
Pulmonary hypoplasia with fetal-like circulation
When should repair for Congenital diaphragmatic hernias be attempeted?
3-4 days later to allow for lung maturation
What is immediate management of babies with Congenital diaphragmatic hernias?
Endotracheal intubation, low-pressure respiratory ventilation, sedation, and NG suction.(Difficult cases may need extracorporeal membrane oxygenation)
When are patients diagnosed with Congenital diaphragmatic hernias?
Many are diagnosed before birth via sonogram
How do Gastroschisis and Omphalocele present?
Both have an abdominal wall defect in the middle of the belly
Characteristics of Gastroschisis
-Cord is normal (reaches the baby)-Defect is to the right of the cord-There is no protective membrane-Bowel looks angry and matted
Characteristics of Omphalocele
-Cord goes to the defect-Defect has a thin membrane and normal-looking bowel and liver can be seen
How are Gastroschisis and Omphalocele defects managed?
-Small defects are closed primarily-Large defects require construction of a Silastic to protect the bowel. Contents of silo are squeezed into the belly a little bit every day for 1 week
What do babies with Gastroschisis need?
Vascular access for Total Parenteral Nutrition (PTA) because angry-looking bowel will not work for 1 month
What is Exstrophy of the urinary bladder?
Abdominal wall defect over the pubis (not fused) with medallion re bladder mucosa, wet and shining with urine.
What needs to be done for a baby with Exstrophy of the urinary bladder?
Transport to specialized center for repair within 1-2 days of life.. Delayed repairs do not work.
What does green vomit in a newborn mean? What does the presence of a “double-bubble” on x-ray indicate?
-Serious problems!!!-double-bubble: large air-fluid level in the stomach and smaller one in the first portion of duodenum-Seen in duodenal atresia, annular pancreas, malrotation
Which is the worst abnormality related to a “double-bubble”? and why?
Malrotation: bowel can twist on itself, cut off blood supply and die. Chances of malrotation are higher if a little normal gas pattern is seen beyond the double-bubble
How is malrotation diagnosed?
Contrast enema (safe, not always dx) or upper GI study (more reliable, risky)
When do the first signs of malrotation show up?
At any time within the first few weeks of life (not just in newborns)
What is the main cause of Intestinal Atresia?
Vascular accident in utero
How does Intestinal Atresia present?
Green vomit and multiple air-fluid levels throughout the abdomen seen on x-ray
What other congenital abnormalities can be suspected with Intestinal Atresia?
None. There may be more than one atretic area, but there’s no reason to suspect other congenital abnormalities
In which patients is Necrotizing Enterocolitis usually seen?
Premature infants when they are first fed
What are the signs and symptoms of Necrotizing Enterocolitis?
Feeding intolerance, abdominal distension, rapidly dropping platelet count (sign of sepsis).
What is the treatment for Necrotizing Enterocolitis?
Stop all feedingBroad spectrum antibioticsIV fluids and IV nutritionSurgery if there’s abdominal wall erythema, air in the portal vein, intestinal pneumatosis (gas in the bowel wall), or pneumoperitoneum (sign of interstitial necrosis and perforation)
In which patients is Meconium Ileus seen?
Babies with cystic fibrosis
What are the signs and symptoms of Meconium Ileus?
Feeding intolerance, ambiguous vomiting, x-ray with dilated loops of small bowel and ground-glass appearance in lower abdomen,.
How is Meconium Ileus diagnosed?
Gastrografin enema showing microcolon and inspissated pellets of meconium in terminal ileum
What is the treatment for Meconium Ileus?
Gastrografin enema draws fluid in, dissolves the meconium pellets
When does Hypertophic pyloric stenosis show up in a patient? In which patients is most common?
Shows up at age 3 weeksCommon in firstborn boys
What are the signs and symptoms of Hypertophic pyloric stenosis?
Nonbilious projectile vomiting after each feeding, hunger and eagerness to eat again after vomiting. Most patients are dehydrated at the time they are seen with visible peristaltic waves and a palpable olive-size mass in the RUQ
How is Hypertophic pyloric stenosis diagnosed?
By SSx and feeling the olive-size mass in the RUQ (pyloric sphincter). Ultrasound used if mass cannot be felt.
How is Hypertophic pyloric stenosis treated?
Rehydration and correction of hypochloremic, hypokalemic metabolic alkalosis and Ramstedt pylorotomy or balloon dilation
In what patients should Biliary atresia be suspected?
In 6-to-8-week-old babies with persistent, progressively increasing jaundice
What should be done if Biliary atresia is suspected?
Serologies and sweat test to tule out other problems. HIDA scan after 1 week of phenobarbital
When is surgical exploration needed in suspected Biliary atresia?
If no bile reaches the duodenum even with phenobarbital stimulation
What is the prognosis for patients with Biliary atresia after surgical intervention?
1/3 of patients can get long-lasting surgical derivation1/3 need a liver transplant after they survived for a while with surgical derivation1/3 need liver transplant right waway
What is the cardinal symptom of Hirschsprung disease (aganglionic megacolon)?
Chronic constipation. It can be recognized early in life or go undiagnosed for many years
What do x-rays show in Hirschsprung disease?
Distended proximal colon (normal portion) and “normal-looking” distal colon (aganglionic)
What can rectal exam show in Hirschsprung disease?
With short segments of aganglionic colon rectal exam can result in explosive expulsion of stool and flatus, with relief of abdominal distention.
How is Hirschsprung disease diagnosed?
With full-thickness biopsy of rectal mucosa
What is the goal of surgical treatment in Hirschsprung disease?
To preserve the unique sensory input of the motor-impaired rectum, while adding the normal propulsive capability of the innervated colon
What are the signs and symptoms of Intussusception?
Episodes of colicky abdominal pain lasting about 1 minute that makes the baby double up and squat. The baby looks normal until another colic begins. Physical exam shows a vague mass on the right side of the abdomen, an empty RLQ and currant jelly stools.
How is Intussusception diagnosed? How is it treated?
Barium or air enema is both diagnostic and therapeutic
In what patients is Intussusception seen?
6-to-12 month-old chubby, healthy-looking kids
When is surgery considered for Intussusception?
IF reduction is not achieved radiologically or if there are recurrences
When should child abuse be suspected?
When injuries cannot be accounted for
What are classical presentations of child abuse?
Subdural hematoma plus retinal hemorrhages (shaken baby syndrome), multiple fractures in different bones at different stages of healing, scalding burns of both buttocks ( child dipped into boiling water).
What should be done if child abuse is suspected?
Refer to the proper authorities
What should be suspected in lower GI bleeding in the pediatric age group?
Meckel Diverticulum
what should be done when Meckel Diverticulum is suspected?
Radioisotope scan looking for gastric mucosa in lower abdomen
