PEDS Flashcards
Bolus for peds
20 cc/kg
Easy way to determine fluid status of baby (in history)
Ask about wet diapers
Special notes on laparoscopic surgery in kids
Bladder decompression
Lower pneumoperitoneum (8-10) and slowly insufflate abdomen
Shorter lap instruments
Enter via hassan
Air enema - what pressure for intussusception?
should not exceed 120 mmHg
Pre tx for pyloric stenosis
20 mL/kg bolus NS d5 1/2 NS + 20K 1.5 X maintenance (4:2:1) UOP >1.5 cc/kg/hr pediatric ICU
Electrolyte goals in pyloric stenosis
Bicarb <30
Cl <100
K+ normal
Inguinal hernia repair in peds
R inguinal dissection
Locate hernia sac on anteromedial side of spermatic cord
Separate sac from cord contents (ID and preserve ilioinguinal nerve, vas deferens and testicular vessels)
Separate sac from cord structures and free it all the way to external inguinal ring
Perform double high ligation of sac with silk suture
Finally remove any excess sac from distal cord including any non communicating hydroceles
During inguinal hernia repair in child, find testicle is very mobile
Orchiopexy
During inguinal hernia repair in child, inadvertently divide vas deferens
Intraop urology consult to help with repair
Reduction of groin hernia in pediatrics
Intranasal fentanyl
Firm constant pressure in groin - part of this pressure includes elongation of herniated bowel
Repair of strangulated inguinal hernia (pediatrics)
Open skin overlying incarcerated bowel and dissect down to ext inguinal ring
Release ext fascial ring to free bowel - if appears necrotic, convert to transverse laparotomy and perform bowel resection + primary anastomosis vs discontinuity & open abdomen
If not necrotic, high ligation of sac and possible suture repair of inguinal floor if defect is particularly large
Intussuception (peds) - OR
ID intussusception and reduce it by gently pushing on large bowel and pulling on small bowel
Look carefully for pathologic lead point
If unable to reduce, resect and perform primary anastomosis
Intussusception in adolescent - recurrent
More concerned about pathologic lead point
Proceed to OR for reduction and ID of lead point
Henonch Schonlein Purpura
Small bowel intussusception
Purpura on extremities
Biliary emesis in an infant - critical fail if this is NOT considered
malrotation
Malrotation - OR
Detorse bowel by turning counterclockwise and ensure reperfuses nicely
ID any Ladds bands or scar tissue holding colon over duodenum or causing duo to twist in RUQ
Take down all those bands in order to fully mobilize colon and straighten duodenum
Make mesentery as wide as possible by leaving small bowel in right abdomen and large bowel in left abdomen
Appendectomyngui
Meckels diverticulum - description
True diverticulum
Arises from antimesenteric surface of distal ileum
Rule of 2s for meckels
Male:female 2:1 2 in in length 2 feet from ileocecal valve 2% of population 2% of chances of complications over lifetime
Gastric mucosa is present in how many of meckels
25%
Bleeding meckels - OR
Small periumbilical incision
Extracorporalize small bowel
Run small bowel to verify no other lesions present
SBR removing meckels + adjacent ulcers
Lap appy - appy appears normal but inflamed Meckels
Leave appy alone
Stapled excision of diverticulum if base appears healthy
Lap appy - inflammed appendix + 6 cm non inflamed Meckels
Perform appy
D/w family re: Meckels and if they consent stapled diverticulectomy during same operation
Lap pyloromyotomy - OR
Establish pneumoperitoneum
Longitudinal myotomy via seromuscular incision that runs across entire pylorus
Spread muscle to visualize submucosa and ensure complete myotomy
Look carefully for any injury to mucosa
Air leak test
Lap pyloromyotomy - full thickness injury to submucosa
Convert to open
Close mucosal injury with absorbable suture
Close pyloric muscle over top of injury also w/absorbable
Flip pylorus over and perform new pyloromyotomy 180 degrees from original
