PEDIATRICS Flashcards
3 week firstborn baby presents with projectile vomiting of milk, palpable “olive” in RUQ. The child is dehydrated seen by sunken fontanelles and dry mucous membranes. The child vomits, then feeds again, vomits, feeds again, etc. Dx and tx
Pyloric stenosis, check with US- tx is to correct electrolytes, replace intravascular volume, and pyloromyotomy
Most common surgical disorder of infancy
pyloric stenosis
Pyloric stenosis causes …
hypertrophy of the circular and longitudinal muscles of the pylorus (separates stomach from duodenum)
Bilious emesis in baby with pyloric stenosis
EMERGENCY
15 year old patient presents with RLQ pain over the last 24 hours. Pain has been getting worse. N/V. No rectal bleeding. Pain precedes nausea. PE indicates tenderness at McBurney’s point, unilateral guarding, and Rovsing’s sign (referred pain). Dx and Tx?
Acute appendicitis seen with CT contrast. Tx- urgent surgery
1 year old wakes up crying and screaming at night, then falls back asleep. These episodes repeat throughout the night. Infant often lifts legs up. There is pallor, sweating, and dehydration. Mass palpable on exam in abdomen. Child may also have vomiting and Currant jelly stools later on. Dx?
Intussesception
What are the late findings of intussusception if you do not treat right away?
Currant jelly stools and vomiting
What is the most common cause of obstruction in children between 6 months and 2 years of age?
intussusception
what occurs in intussusception
a part of the intestine invaginates over in another part of intestine- may cause restriction of vascular flow and bowel necrosis (obstruction that limits blood flow to that area)
Tx of intussusception
Correct electrolytes, volume, BARIUM OR AIR ENEMA used to diagnose and treat
How does Hirschprung’s disease work
lack of innervation of distal colon causing constipation- failure of cephalocaudal migration of the parasympathetic myenteric nerve cells into the distal bowel
Is obstruction in hirschprung’s disease functional or structural?
functional- affected area fails to relax in response to distention, causing backup- constipation
Newborn presents with bilious emesis, distension, irritability, chronic constipation. Xray shows dilated loops of bowel. Barium enema shows change in calibur from normal to aganglionic bowel segments
Hirschprung’s disease
Dx and tx of Hirschprung’s disease
MUCOSAL BIOPSY needed to establish diagnosis- look for aganglionosis in mucosa. Xray shows dilated loops of bowel. Barium enema can also confirm- change from normal to aganglionic segments. Tx- surgery to remove affected segment (single stage laparoscopic procedure)
Rectal exam in infant with Hirschprung’s disease
Passage of flatus and stool and decompression
PE in older children with Hirschprung’s
CHARACTERISTIC- abdominal pain and chronic constipation. passage of stool reuires more effort. rectum typically empty, sigmoid palpable across lower abdomen
Most common and serious GI disorder of premature infants
Necrotizing enterocolitis
What is Necrotizing enterocolitis characterized by?
mucosal necrosis, ulceration, sloughing of intestinal mucosa
Premature newborn presents with bloody stools, abdominal distension, lethargy, apnea, bradycardia, abdominal wall erythema. Xray shows dilated bowel, pneumatosis, air in portal vein, and free air. thrombocytopenia, and low or high WBC count. Dx?
Necrotizing enterocolitis
What diagnostic study should NOT be performed in NE?
contrast studies
Absolute indication of surgery in NE
Pneumoperitoneum
Tx in NE
bowel resection with exteriorization of the ends of the bowel. Infants less than 1500g, RLQ irrigation and drainage
Patient presents with painless rectal bleeding, purulent discharge from umbilicus, peritonitis. Obstruction occurs 2 ft. of ileocecal valve. Dx?
Meckel’s diverticulum with Technetium 99 scan and CT
Abnormality of omphalomesenteric or vitelline duct is
Meckel’s diverticulum
Meckel’s diverticulum, remnant of…
embryonic yolk sac
What is the main problem with getting Meckel’s diverticulum
may contain ectopic tissue (gastric, pancreatic) which can lead to ulceration
Tx of meckel’s diverticulum
surgical
Most common reason for obstruction in infancy:
small bowel volvulus or adhesive bands (Ladd’s bands)
different types of malrotatin that can occur
nonrotation, incomplete, reversed rotation, or anomalous fixation of the mesentery
Ladd’s bands present or absent in which malrotations?
Absent in Nonrotation, Ladd’s bands in others (except reversed)
Infant presents with bilious vomiting. Xray shows double bubble sign. UGI shows duodenum on R and obstruction with duodenal distension. Dx?
Malrotation
SMA in different malrotations
Nonrotation-midgut is suspended from SMA/V. Incomplete- cecum fixed near SMA. Reversed- Duodenum is anterior to SMA. anamalous fixation of mesentery- SMA syndrome- compression of third part of duodenum by AA
Which malrotation causes obstruction of right colon and rotates in clockwise direction
reversed
which malrotations are prone to volvulus d/t short, narrow mesentery
incomplete and nonrotation
Complications of malrotation
obstruction, peptic ulceration, malabsorption
tx of malrotation
ladd’s bands are divided, intestine twisted, appendix removed, cecum placed in LLQ, duodenum straightened
abdominal wall defect- viscera covered in a sac of peritoneum and amnion
Omphalocele
Omphalocele associated with…
genetic abnormalities, CHF, beckwith-wiedmann, pentaology of cantrell, prune belly syndrome
Tx of omphalocele
bowel returned to abdomen slowly in “silo”, defect is repaired. NOT emergency or urgency
Abdominal wall defect through which uncovered viscera protrude
Gastroschesis
Location of gastroschesis
To the right of the umbilicus
Tx in gastroschesis
URGENT REPAIR d/t loss of domain. Silo applied
Important to save umbilical cord in…
both gastroschesis and omphalocele
chest indented inwards
pectus excavatum
bird chest outward
pectus carinatum
