PEDS Flashcards
Meckel’s workup
Put in NG tube first to rule out upper gastrointestinal bleed.
Technetium 99 – Meckel’s scan
Increased sensitivity with H2 blocker, glucogon, tinted Gaston stimulation
angeo and tagged red blood cell not as good.
If failed to diagnose:
diagnostic laparoscopy
Consider non-umbilical sight of trocar because of risk of vitelline duct attachement.
Meckel’s diverticulectomy
right peri Median incision(or laparoscopy)
Incidental appendectomy.
Ligate a large mesenteric vessel at tip of diverticulum.
If a acute hemorrhage:
Wedge resection of diverticulum and adjacent ilio alteration
Control sites of bleeding of ileal mucosa
Closed transversely handsewn
(may close with stapler if narrow base)
If an intestinal ischemia, extensive inflammation, irreducible intussusception, very wide diverticulum, or palpable ectopic mucosal tissue near the diverticulum:
Segmental RESECTION of involved illium
If significant alteration and bleeding opposite to the diverticulum on the mesenteric side:
Segmental RESECTION.
Omphalocele define
midline anterior abdominal wall
fascial defect > 4 cm.
The rectus muscles are present and normal but insert widely on the costal margins and do not meet in the middle at the xiphoid.
allows for herniation of the midgut and other abdominal viscera.
The herniated organs are contained within a membranous sac that consists of peritoneum, Wharton’s jelly, and amnion.
The umbilical cord inserts on the apex of this membrane.
Small omphalocele contains small bowel with or without stomach and has a fascial defect 5 cm.
Ruptured omphalocele is the third presentation of omphalocele where the sac has ruptured in utero or during birth.
Gastroschisis defined
is a full-thickness abdominal wall defect that occurs just to the RIGHT
of a normally inserted umbilical cord.
The herniated bowel and abdominal viscera are not covered by a membrane.
The viscera are subjected to exposure to amniotic fluid during gestation.
An umbilical hernia defined
abdominal wall defect caused by a persistent umbilical ring and is covered by skin.
Pentalogy of Cantrell defined
is a rare congenital
omphalocele,
anterior diaphragmatic hernia,
malformation or absence of the pericardium,
sternal cleft,
and cardiac malformations.
Ectopia cordis thoracis defined
partial or complete failure of midline fusion of the sternum resulting in the heart protruding from the chest through a split sternum.
In contrast to the Pentalogy of Cantrell, the heart is not covered by a membrane in ectopia cordis thoracis.
prune belly syndrome
constellation of anomalies including deficient or absent abdominal wall muscles,
bilateral cryptorchidism,
dilated dysmorphic urinary tract.
work up of omphalocele
Chest x-ray, echocardiogram, renal ultrasound, and skeletal radiography are performed and note no abnormalities.
omphalocele associations
(Beckwith-Wiedemann, OEIS [omphalocele, exstrophy, imperforate anus, and spinal
anomalies],
Gershoni-Baruch, Donnai-Barrow)
or
with an associated chromosomal abnormality (trisomy 13,14, 15, 18, or 21 DOWNS).
Fifty percent to seventy percent of patients with an omphalocele will have at least one associated anomaly.
Cardiac defects represent the most frequent anomaly occurring in 30% to 50% followed by
musculoskeletal,
gastrointestinal,
genitourinary
Chromosomal abnormalities occur in 30%.
Omphalocele has also been seen with Turner’s syndrome and triploidy.
Beckwith-Wiedemann syndrome is
umbilical defect,
macroglossia,
hyperinsulinemia,
organomegaly,
increased risk of
Wilms’ tumor,
hepatoblastoma,
neuroblastoma.
Omphalocele is also part of the OEIS complex, which involves
bladder exstrophy,
imperforate anus,
spinal defects.
Lower midline syndrome includes exstrophy of the bladder or cloaca, vesicointestinal fissure, colon atresia, imperforate anus, sacral vertebral defects, lipomeningocele or meningomyelocele.
Management of sick kids with omphalocele
Immediate D 10/0.25 normal saline IV
150 mL per kilogram per day
Then reduce to a maintenance of 100 mL per kilogram per day
If sac ruptured needs immediate surgical intervention.
Given antibiotics and VITAMIN K
Close on Felicio with plastic wrap to maintain body heat
Glucose monitor
(asso with Beckwith- Wiedemann)
Fluid resuscitation for pyloric stenosis
D5 half normal saline
or
1/2 NS
20 mL per kilogram
AND
Maintenance:
4:2:1 with D5
What a electrolyte marker is used for adequate fluid resuscitation
Bicarbonate
What is normal bicarbonate level
22 – 26
What is normal sodium
135 – 145