Pediatrics Flashcards
Typical presentation of solid tumors in childhood
Most solid tumors present as painless, asymptomatic abdominal masses.
Presentation, work up and tx for Wilm’s tumor
Large painless mass in abdomen of the kidneys.
Investigations: basic labs +/- tumor markers, US of abdomen (first line imaging), biopsy for grading of tumor (requires architecture).
Stage 1-5.
Tx: surgery. Can do neoadjuvant therapy with chemo and adjuvant therapy with RT.
Overall survival 85%.
Common childhood cancers
Wilm’s tumor, neuroblastoma, lymphoma, rhabdomyosarcoma, hepatoblasoma/HCC, germ cell tumor
DDx for bilious vomiting based on age
Newborn (up to 30 days): congenital structural anomalies. GI atresia (complete interruption). Malrotation: volvulus or internal hernia. Meconium ileus. Hirschsprung's disease. Imperforate anus. Biliary atresia. Urinary obstruction.
Infant (up to 1yr):
Intussusception.
Malrotation: volvulus or internal hernia.
Hirschsprung’s disease of a short segment.
Incarcerated hernia.
Child (>1 yr): Intussusception. Appendicitis. Adhesions. Malrotation.
What is the provisional diagnosis for bilious green vomit in a child?
Malrotation with volvulus until proven otherwise.
Bile implies obstruction is beyond the apulla of vater.
Acute tx: IVF, decompress stomach.
Duodenal atresia: what, SS, characteristic imaging, mgmt
Failure of vacuolization of the duodenum.
Associated with T21, CHD, polyhydramnios.
Will show ‘double bubble’ sign on AXR. With high colonic obstruction may see gastric and duodenal distension.
Mgmt: duodeno-duodenostomy
Adhesive bowel obstructions: presentation, imaging results, mgmt
Abdominal pain and intermittent vomiting of green bile in an older child.
On Hx, previous surgeries.
Imaging: AXR shows dilation, air-fluid levels, absence of colonic gas.
Mgmt: resuscitation. Drip and suck (IVF and NG tube), serial P/E and recognize if conservative management has failed- i.e. 24-48 hrs with no resolution or vascular compromise. If medical mgmt fails, surgery for lysis of adhesions.
Presentation, imaging and mgmt of pyloric stenosis
Pylorus hypertrophies, resulting in progressive obstruction.
Presentations:
3-8 wks of age, 1st born male.
Persistent, projectile, progressive emesis with every feed.
Palpable olive in RUQ (deep, firm).
Hypochloremic hypokalemic metabolic alkalosis.
US: look for thickened pylorus.
Tx: pyloromyotomy.
Intussusception: what, presentation, tx
Telescoping of intestine into adjacent intestine.
Presentation: 3 months to 3 years age. Crampy, intermittent 'knees up' abdo pain. Red current jelly stools. Sausage shaped abdominal mass.
Tx: enema reduction, surgery if needed.
Initial mgmt and Ddx for child with rectal bleeding
Support pt: resuscitate, transfuse and prevent shock if needed .
Order INR/PTT and cross match.
DDx: malortation with volvulus, Meckel’s
Malrotation with volvulus: what, presentation, invetigations, mgmt
Incomplete bowel rotation during 7-12th wk of gestation results in rotation of portion of bowel about a focal point of mesentery that results in obstruction.
Presentation:
Newborn to older child with abdominal pain and green, bilious vomiting.
BRBPR due to blood supply cut off from intestine.
Labs: INR/PTT, cross match.
US: look for spiral sign.
Tx: resuscitation + urgent laparotomy.
Meckel’s diverticulum: what, presentation, investigation, tx
Congenital true diverticulum in intestine but lined with gastric mucosa. Thus, parietal cells are present and secrete acid which can contact SI and cause marginal ulcer and bleeding.
Presentation: painless bleeding PR. Typically dark blood or melena.
Meckel’s radionuclear scan: substance is taken up by parietal cells seen the stomach and in the diverticulum.
Tx: resuscitation and Meckel’s diverticulectomy.
Define fistula
Connection between 2 epithelial surfaces. May be pathologic or iatrogenic.
Describe spontaneous pneumothoracies
Not associated with underlying lung pathology. Bleb ruptures and air enters the pleural space and as a result, there is no ventilation into that lung.
More common in tall, slender, men.
High recurrence rate. May need to staple bleb if unremitting leakage of air
Appendicitis: presentation, investigations, treatment
Presentation: diffuse abdominal pain that migrates to RLQ. Pain is intense, continuous.
Atypical pain is common.
N/v, AN, may have peritonitis if perforated.
PEx: tender at McBurneys, Rovsing’s (sign of peritonitis), psoas and obturator sign. Can present in children atypically with absence of many signs.
Investigations: elevated WBC, normal AXR in most.
US: visualize appendix, hyperechoic mesenteric fat, fluid collection and tenderness.
CT: sensitive but causes radiation exposure.
Tx:
Staging: acute vs gangrenous non-perforated vs perforated.
Resusitation.
Lap appendectomy. However, if perforated then conservative mgmt with interval appendectomy. If abscess present, drain percutaneously.
