Pediatrics Flashcards
Choledochal cysts tx
Always excise
25% risk of cancer
30% risk of pancreatitis
Type I choledochal cyst tx
whole CBD involved
tx: excise and do hepatico-j
Type II choledochal cyst tx
diverticulum that hangs off CBD
tx: do diverticulectomy
Type III choledochal cyst tx
distal dilation involving sphincter of Oddi
tx: resection or marsupialization
Type IV choledochal cyst tx
intra- and extrahepatic cysts
tx: resection, lobectomy, transplant
Type V choledochal cyst tx
intrahepatic cysts (Caroli's disease) tx: resection, lobectomy, transplant
congenital lobar emphysema
massive hyperinflation of a single lobe (usually upper/middle)
1/3 have respiratory distress at birth
CXR: radioluceny of affected lobe, compression of other lobe
M:F ratio is 2:1
tx: severely symptomatic - lobectomy, good prognosis
cystic hygroma (lymphangioma) tx #1 complication?
resect #1 complication = infection
1st sign of CHF in children?
hepatomegaly
Strawberry hemangioma
appear in 1st few weeks of life. leave alone, most involute by age 7.
Neuroblastoma
- markers its associated with?
- origin cells?
MC solid peds malignancy
- high VMA, high HVA associated with worse prognosis, N-myc
- neural creast cells
1 peds malignancy overall
Leukemia
Wilms tumor
nephroblastoma
80% cure with nephrectomy
Biliary atresia tx
Kasi procedure (before 3 months age) hepatoportoenterostomy
Meckel’s diverticulum
on anti-mesenteric border 2ft from ileocecal valve 2% population 2% symptomatic 2 types of tissue: pancreatic, gastric 2 common presentations: diverticulitis, GIB
1 cause of GIB in children
Meckel’s diverticulum - persistent omphalomesenteric duct
Intussusception tx
reduce with air/contrast enema
IV glucagon can help (relaxes smooth muscle)
Usually presents in < 3 yo
peritonitis = ex lap
(if adult, automatically go to OR due to high risk of malignancy)
Intestinal atresia caused by
Intra-uterine vascular events
10% atresias are multiple
Duodenal atresia sx
Bilious vomiting
Double bubble sign
#1 cause of neonatal duodenal obstruction
associated w/ trisomy 21, 1/3 have cardiac defects
TE fistulas MC type and sx
90% are type C (most “common”): blind esophagus, distal TEF
spits up feeds and NG tube won’t pass
Type A TE fistula
Blind esophagus, no fistula
No air seen in entire GI tract
VATER
Vertebral Anorectal (imperforate anus) TEF Radial Renal anomalies
Ladd’s procedure
For malrotation - appendectomy, take down bands, counterclockwise rotation
Meconium ileus dx and rx
associated with cystic fibrosis
Dx and rx: gastrografin enema
1 cause of colon obstruction
Hirschsprung’s
no BM in 1st 24hrs
dx: rectal biopsy
necrotizing enterocolitis sx and tx
presents AFTER initiating feeds in neonate with blood in stool
tx: peritonitic, free air - OR for resection with ostomy
do contrast eval weeks later to evaluate for stenosis before reconnecting bowel
Imperforate anus tx
if high, need colostomy
Gastroschisis
Intrauterine rupture of umbilical cord
No associated defects, lateral defect, no sac
associated w/esophageal atresia
Omphalocele
Midline defect, may contain liver or other non-bowel contents
Frequently associated with other anomalies - cardiac, pericardium, sternum, diaphragm, has peritoneal sac covering
Process vaginalis
Present at 12 weeks gestation - peritoneal diverticulum that extends as testis descends in the 7th/8th month of gestation
Patent process vaginalis causes inguinal hernia
Inguinal hernia risk of incarceration in infants
exceeds 60% in 1st 6 months
Repair should be performed before infant discharge
MC tumor that develops from undescended testis
Nonseminomatous germ cell tumor
Lymphadenitis
enlarged LN in the neck
Can progress to suppurative lymphadenitis - requires I&D
Peritonsillar abscess
Complication of tonsillitis, pharyngitis or dental infection
Sx: hoarse voice, medial displacement of tonsils, edematous deviated uvula, inflamed soft palate, fever, chills
Tx: abscess present - I&D
Cause: MC pathogen is beta-hemolytic Strep
Thyroglosal duct abnormalities
midline fluctuant cystic mass superior to thyroid - mobile and painless, moves with swallowing
tx: surgical excision
Branchial cleft anomalies
presents as cysts, sinuses, or cartilaginous nests in lateral neck
tx: excision
Torticollis
Hard mass in SCM in first 2-4 weeks of life
a/w breech delivery, vertebral anomalies
tx: surgical division of SCM and fascia
Trachea foreign body removal tx?
Rigid bronch with forceps retrieval of foreign body
MC levels of foreign body lodgement in esophagus?
Sites of esophageal narrowing:
- cricopharyngeal muscle
- arch of aorta (level of carina)
- GEJ
Esophagus foreign body removal tx?
- level of cricopharyngeus and carina: rigid or flexible esophagoscopy with mechanical retrieval by forceps
- GEJ: obs
Risks of esophageal foreign body removal?
- esophageal perf
2. aspiration - prevent by placing patient prone
Diaphragm eventration
lack of normal muscular component of the diaphragm
intact, yet elevated diaphragm
Causes of diaphragm eventration
Congenital
Acquired: phrenic nerve injury
Sx of diaphragm eventration
Asymptomatic
Respiratory distress, especially infants
Tx of diaphragm eventration
asymptomatic - nothing
symptomatic - plication and stabilization of the diaphragm in the expiratory position
Surgical management of intussusception
Should be managed surgically if there are signs of necrotic bowel, incomplete reduction, or after 2+ recurrences
Bowel reduced by squeezing mass distal to proximal, if resection is necessary ileocectomy can be done with primary anastomosis
Immunity at birth from
IgA - breastmilk
IgG - crosses the placenta
Umbilical vessels
2 arteries
1 vein
pulmonary sequestration cause
lung tissue has anomalous systemic arterial supply that does not communicate with tracheobronchial tree
MC - thoracic aorta or abdominal aorta through inferior pulmonary ligament
extra-lobar vs intra-lobar pulmonary sequestration
extra lobar: more likely to have systemic venous drainage
intra lobar: more likely to have pulmonary vein drainage
pulmonary sequestration treatment
ligate arterial supply first, then lobectomy
bronchiogenic cyst
most common cyst of mediastinum
tx: resect cyst
Most common mediastinal tumor in children
neuorgenic tumors - neurofibroma, neuroganglioma, neuroblastoma
anterior mediastinum mass differential
T-cell lymphoma
teratoma
thyroid cancer
middle mediastinum mass differential
T-cell lymphoma
teratoma
cyst (cardiogenic or bronchiogenic)
posterior mediastinum mass differential
T-cell lymphoma
neuroblastoma
neurogenic tumor
diaphragmatic hernia treatment
stabilize these patients before operating on them
need to reduce bowel and repair defect +/- mesh
run the bowel and look for visceral abnormalities
Bochdalek’s hernia
MC, located posteriorly
Morgagni’s hernia
rare, located anteriorly
Pectus excavatum
sinks in
sternal osteotomy, need strut
performed if causing respiratory symptoms
Pectus carinatum
chest juts out
strut not necessary, repair for cosmetic reasons if wanted
Wilms tumor treatment
nephrectomy
tumor thrombus from vein can be extracted
frequent mets to bone/lung
Hepatoblastoma
MC malignant liver tumor in children
Elevated AFP in 90% of cases
Tx: resection is optimal option, or downstage with chemo until resectable
Fetal histology has best prognosis
Ultrasound findings for pyloric stenosis
> 4 mm thick
>14 mm long
Bilious vomiting in infant - first study
UGI to rule out malrotation
