Peds Flashcards
Oxygenated blood from placenta enters through ?
umbilical veins
Most of the blood bypass fetal liver via the _________ and mix with deoxygenated blood in _________
ductus venosus
inferior vena cava
Foramen ovale shunts blood from
right atrium (high pressure pressure) directly into left atrium (low pressure pressure)
Ductus arteriosus connects
pulmonary artery directly to aorta
Deoxygenated blood returns to placenta via
the umbilical arteries
Most of the oxygenated blood reaching the heart via the umbilical vein and inferior vena cava is
diverted through the foramen ovale and pumped out the aorta to the head.
Pathway of blood through fetal circulation
Umbilical vein-> ductus venosus -> inferior vena cava -> right atrium ->left atrium (through foramen ovale) -> left ventricle -> aorta -> body
Some blood does not pass to left atrium (through foramen ovale), but enters the right ventricle and pumped into the pulmonary artery. From pulmonary artery blood pass to aorta through ductus arteriosus by passing lungs that are solid rock (infinite pulmonary resistance) during fetal life
Blood in umbilical vein is ________ saturated with O2. Umbilical arteries have low O2 sat.
80%
Indomethacin helps______ PDA. Prostaglandins E1 and E2 helps ______ PDA.
Indomethacin helps close PDA. Prostaglandins E1 and E2 keep PDA open
Fetal blood
PaCO2 = ______
PaO2 = ______
48 mmHg
30 mmHg (+10 increase if mother is on 100% O2)
Ductus arteriosus closes in __________ period
2-3 weeks
Foramen ovale closes in _________period
takes months to close
Is right to left shunt normal?
Normally occur to a small extent because 2% of the cardiac output bypasses the lungs- physiologic shunt
Prematurity is defined as
Birth before 37 weeks
< 1000 g
What are the complications of prematurity
Hyaline membrane disease Apneic spells Bronchopulmonary dysplasia Respiratory distress syndrome PDA Retinopathy
What are the anesthetic considerations of prematurity
Avoid excessive inspired O2
Risk of post-anesthetic apnea
Gut herniate into thorax through ‘hole’ in diaphragm
Congenital Diaphragmatic Hernia
Foramen of Bochdalek or Morgagni is
Hole in diaphragm through which gut herniate into thorax in CDH
What is the incidence and mortality for patients with CDH
1:5,000
Mortality 40-50%
In a Congenital Diaphragmatic Hernia, hypoxia is due to?
R to L shunt, from persistent fetal circulation
Physical examination for a patient with CDH
Scaphoid abdomen
Bowel sound in chest
Pulmonary hypoplasia and hypertension
Severe retractions
What is the treatment for Congenital Diaphragmatic Hernia
Stabilization Postductal PCO2 < 65mmHg and preductal O2 saturation >85% ECMO is useful Surgical decompression Intrauterine surgery
Anesthetic consideration for CDH
NG tube Avoid high pressure PPV Pre-oxygenation Decrease conc. of VA, muscle relaxant Nitrous oxide (N2O) is contraindicated High risk of pneumothorax avoid barotrauma. Treat with chest tube
What are the 3cs of Tracheoesophageal fistula
Cyanosis, chocking and coughing with feeding
Esophagus is a blind pouch attached by a fistula to the trachea in this congenital abnormality
Tracheoespophageal Fistula
What other defects are associated with Tracheoespophageal fistula
VATER syndrome
Vertebral defect, Anal atresia, TE fistula, Esophageal atresia, Radial dysplasia
Cx findings in a patient with Tracheoespophageal fistula show
NG tube coiled in esophagus
Surgical repair is must for petients with Tracheoespophageal fistula because?
high risk of aspiration leading to aspiration pneumonia
Tracheoespophageal Fistula is associated with polyhydramnios T/F
True
What are the anesthetic considerations for Tracheoespophageal Fistula
Need frequent suction due to high secretion
Avoid PPV
Awake intubation
Hypertrophy of pyloric smooth muscles
Pyloric Stenosis
Features of pyloric stenosis
Palpable ‘olive’ shaped mass
Projectile vomiting resulting in metabolic alkalosis and shock
Loss of Na+, K+, H+, Cl-
Paradoxic aciduria -Trading off sodium with hydrogen
Present in the first two weeks to four months
1:1000 birth
‘String sign’ on barium study
Treatment of pyloric stenosis
Correct dehydration
NaCl and K+ supplement
Avoid Ringers lactate as lactate is metabolized to bicarb by liver
Surgical correction
Anesthetic consideration for patient with pyloric stenosis
Fix fluid and lytes first
Suction
High risk of aspiration
High risk of respiratory depression due to prolonged alkalosis
Awake intubation and rapid induction
Urinary output 1-2 ml/kg/hour
Assessment findings in a patient with acute epiglottitis
High grade fever Inspiratory stridor Tachypnea SOB Cyanosis Drooling Respiratory acidosis Sore throat leading to dysphagia then obstruction
Acute epiglottitis is caused by
Haemophilus influenzae type B
Acute epiglottitis is commonly seen at what age
2-6 year of age
Edema of supraglottic structures
Acute epiglottitis
Describe the treatment of Acute epiglottitis
ET and antibiotics are life-saving
Ampicillin
Vaccination
Anesthesia consideration in a patient with Acute epiglottitis
Lateral neck X-ray to determine extent of obstruction
Prepare for tracheostomy
Avoid laryngoscopy
Inhalation induction in sitting position
Intubation with smaller size tubes
Child in ER prefers to sit and appears anxious. The child assumes the characteristic sniffing position to maximize the patency of her airway. What is the diagnosis
epiglottitis caused by Haemophilus influenzae type B
Features of Laryngotracheal bronchitis
Low grade fever Less airway obstruction Barking cough RSV 3 months to 3 years
Treatment of Laryngotracheal bronchitis
Oxygen and mist therapy
Nebulized epi
IV dex
Intubate if signs of respiratory depression appear
Anesthetic consideration in Laryngotracheal bronchitis
Usually no intubation
What is the onset of epiglottitis compared to croup and tracheitis
Epiglottitis: rapid onset
Croup: develops in 2-3 days
Tracheitis: gradual onset
What is the age group of epiglottitis compared to croup and tracheitis
Epiglottitis: 2-7 yrs
Cropup: 3m-5y
Tracheitis: any age
What is the response to recemic epi of epiglottitis compared to croup and tracheitis
Epiglottitis: no response
Croup: Stridor improves
Tracheitis: no response
What is the severity of respiratory distress in epiglottitis compared to croup and tracheitis
Epiglottitis: Severe respiratory distress
Croup: Mild to moderate
Tracheitis: Severe respiratory distress
What is the xr finding of epiglottitis compared to croup and tracheitis
Epiglottitis: Subglottic narrowing (steeple sign) on AP neck
Croup: Thumbprint sign on Lateral neck
Tracheitis: Subglottic narrowing
What is the severity of fever in epiglottitis compared to croup and tracheitis
Epiglottitis: High grade
Croup: Low grade fever
Tracheitis: High grade fever
What is the causative microorganism in epiglottitis compared to croup and tracheitis
Epiglottitis: Haemophilus influenzae B
Croup: Parainfluenza virus
Tracheitis: Staph aureus
Pierre-Robin Syndrome and Treacher-Collins Syndrome present with difficult intubation and awake intubation is recommended. Differentiate between the two.
Pierre-Robin syndrome patient has: Cleft palate, Small face and glottis
Treacher-Collins syndrome patient has: Small lower jaw and Absent or malformed ear. It’s More severe than Pierre-Robins
Patient has Small lower jaw and Absent or malformed ear.
Treacher-Collins syndrome
Patient has Cleft palate, Small face and glottis
Pierre-Robin syndrome
What is the incidence of Omphacele compared to gastroschisis
Ompacele 1:5000
Gastroschisis: 1: 15000
What are the features of Omphacele compared to gastroschisis
Omphalocele is associated with other congenital anomalies e.g. Down’s whereas gastroschisis is not
Omphalocele have a hernia sac whereas gastroschisis do not
Omphalocele results from herniation of abdominal contents into umbilical cord, covered with peritoneum whereas; gastroschisis extrusion of abdominal contents through abdominal folds
Omphalocele occurs at the base of umbilicus, whereas gastroschisis occurs as a result of failure of lateral body folds to fuse
Failure of lateral body folds to fuse leading to extrusion of abdominal contents through abdominal folds
Gastroschisis
Persistence of herniation of abdominal contents into umbilical cord, covered with peritoneum
Omphalocele
Anesthetic consideration for Omphalocele and Gastroschisis
NG decompression
Awake intubation
Nitrous oxide (N2O) is contraindicated ; avoid further distension
Muscle relaxation for reduction
Staged closure if:
Intragastric pressure > 20 cm H2O
Peak inspiratory pressure > 35 cm H2O
End-tidal CO2 > 50 mmHg
Replace third space fluid loss with salt solution and 5% albumin
Intubation for 1-2 days postop
Staged closure of Omphalocele and Gastroschisis is performed if?
Intragastric pressure > 20 cm H2O
Peak inspiratory pressure > 35 cm H2O
End-tidal CO2 > 50 mmHg
What are the anesthesia considerations of Prune Belly Syndrome
Risk of aspiration; cannot cough
Awake intubation
Treat as full stomach
No muscle relaxant
Bad kidneys
Congenital deficiency of abdominal muscles with thin weak abdominal wall. Will have mass of wrinkled skin on abdomen
Prune Belly Syndrome
A remnant of the omphalomesenteric duct that can contain ectopic (usually gastric or pancreatic mucosa)
Meckel’s Diverticulum
Features of Meckel’s Diverticulum (Rule of 2’s)
2 time male as often as female 2 years and under for symptoms 2 cm long 2 feet proximal to ileocecal valve 2 types of ectopic tissues 2% of population
PE findings of Meckel’s Diverticulum
Unremarkable
Rectal bleeding
Abdominal pain
Umbilical cellulitis
Treatment of Meckel’s Diverticulum
surgical resection
Abnormal rotation of the midgut around mesentery (SMA)
Intestinal Malrotation and Volvulus “twist”
Midgut volvulus can cut the blood supply leading to infarction that is a surgical emergency. What are the signs and symptoms
Billious vomiting
Progressive abdominal distension and tenderness
Metabolic acidosis
Bloody diarrhea is indicative of infarction
What is the incidence and mortality of Intestinal Malrotation and Volvulus “twist”
1:500 incidence
High mortality
Symptoms of acute or chronic bowel obstruction
A patient with Intestinal Malrotation and Volvulus “twist” May develop “bowel compartment syndrome” which may (4)
Impair ventilation
Obstruct venous return
Impair renal functions
High mortality
Anesthetic considerations for patient with Intestinal Malrotation and Volvulus “twist” include?
Preop stabilization, NG, fluid/lyte balance, antibiotics
Rush to OR
Preoxygenation , awake intubation, rapid induction
Hypovolemia
Poor tolerance to GA
Ketamine may be agent of choice
Fluid resuscitation
Blood products
May develop “bowl compartment syndrome”
Telescoping of a segment of bowl into itself
Intussusception
MCC of bowel obstruction in first 2 years
Intussusception
Risk factors of Intussusception are?
Meckel’s diverticulum
Intestinal lymphoma
Viral infection
H&P for a patient with Intussusception
Abrupt onset of abdominal pain in a healthy child
Colicky pain, vomiting, blood in stool “current jelly stool”
Pallor , sweating
“Sausage-shape abdominal mass”
Treatment for a patient with Intussusception
Correct fluid and electrolyte
Air contrast enema is diagnostic and
curative
Surgical resection
Hereditary disease of exocrine glands of lungs and G.I.T. Result from a defect in Cl- channels that is caused by mutation
Cystic fibrosis
Most common recessive disorder in Caucasians [defective CFRT gene on chromosome 7]
Cystic fibrosis
Features of Cystic fibrosis
Thick and sticky mucus builds up in lungs and intestine forming cysts.
Inability to clear secretions leading to bronchiectasis
Is associated with a deficiency of pancreatic enzymes resulting in malabsorption and steatorrhea
____________ is associated with a deficiency of pancreatic enzymes resulting in malabsorption and steatorrhea
Cystic fibrosis
Clinical presentation of cystic fibrosis
Low RV, high airway resistance, decreased VC, decreased expiratory flow rate
Recurrent resp. infections , pneumonias
Fat malabsorption leading to deficiency of A,D,E, K
Fluid and electrolyte imbalance due to malabsorption
Failure to thrive
Death in early adulthood
Elevated Sweat chloride test is diagnostic for?
Cystic fibrosis
Anesthetic consideration for cystic fibrosis
Anticholinergic drugs are controversial
Prolong inhalation induction
Deep anesthesia for intubation
Avoid hyperventilation; may lead to shallow postop respiration
Respiratory therapy: Bronchodilators, incentive spirometry, postural drainage and proper antibiotics
Lateral curvature of vertebra and deformity of rib cage
Scoliosis
Anesthetic considerations of scoliosis
Peop PFTs, ABG and ECG
Significant blood loss and risk of paraplegia during surgery
Monitor sensory and motor EP
Predispose to MH, arrhythmia, and adverse effects of sux i.e. hyperkalemia, myoglobinuria and sustained muscle contraction
Anesthetic consideration for Tonsillectomy and Adenoidectomy
No surgery if infection or clotting defects
Give preop atropine to dry-up secretions
Use reinforced or preformed ET tube
Awake intubation
Post op vomiting is common
Rapid-sequence induction with cricoid pressure
Anesthetic consideration for Tonsillectomy and Adenoidectomy
No surgery if infection or clotting defects
Give preop atropine to dry-up secretions
Use reinforced or preformed ET tube
Awake intubation
Post op vomiting is common
Rapid-sequence induction with cricoid pressure
Features of patient undergoing Tonsillectomy and Adenoidectomy
Enlarged tonsils leading to mouth breathing, obstruction, pulmonary hypertension
Perioperative airways problems
Pathophysiology of patient undergoing Myringotomy and insertion of Tympanostomy Tubes
Recurrent otitis media
Hemophilus influenzae, streptococci, pneumococcus, mycoplasma are common pathogens
Myringotomy is making a hole for drainage of any fluid in middle ear cavity
Tubes provide long term drainage
common pathogens that cause recurrent otitis media
Haemophilus influenzae
Streptococcus
Pneumococcus
Mycoplasma
Anesthesia concerns of patient undergoing Myringotomy and insertion of Tympanostomy Tubes
Inhalation induction with nitrous oxide (N2O) is safe due to short duration (10-15 min)
47 chromosomes with 3 copies of chromosome 21 seen in 1 in 700 births
Down’s Syndrome
Signs and symptoms of down syndrom
Flat face
Short neck, Upslanting eyes
Brushfield spots- dark lines in iris
Epicanthal folds
Protruding large tongue
Irregular dentition
hypotonia
Associated with mental retardation, TE fistula, subglottic stenosis, pul infections
Anesthetic consideration for down syndrome
Difficult airways
Smaller ET tubes are required
Watch for post op apnea and stridor
Atlanto-axial dislocation
Paradoxical embolism due to ‘hole’ in heart ; VSD
Patient presents with facial muscle and shoulder girdle weakness and AD. Likely diagnosis is?
Facioscapulohumeral dystrophy
Characteristic facies, cataract, testicular atrophy and muscle weakness and wasting
Myotonic dystrophy
X-linked disorder similar but less severe to Duchenne
Becker muscular dystrophy
X-linked disorder due to deficiency of dystrophin- a cytoskeletal protein (like glue)
Duchenne Muscular Dystrophy
Most common and most lethal muscular dystrophy
Duchenne Muscular Dystrophy
Duchenne Muscular Dystrophy occurs____ of age; death by _____ age
2-6 years
20 years
What are the presenting features of Duchenne Muscular Dystrophy
Progressive clumsiness
Fatigability
Difficulty in standing, waking, proximal muscle weakness
Respiratory insufficiency
Possible mental retardation
Evaluation of Duchenne Muscular Dystrophy shows?
Elevated CK
Degeneration seen in biopsy
Physiological jaundice is seen when?
after first day of life and within 3-5 days of birth
Jaundice in first day of life in NOT ?
physiological
fetal deposition of bilirubin in basal ganglia with bilirubin > 20 mg/dl
Kernicterus
In neonatal Jaundice, Bilirubin rises to _______ then falls
9 mg/dl
Diagnosis and Differentials of neonatal jaundice
Physiological jaundice Breast milk jaundice Crigler-najjar syndrome Gilbert’s syndrome Hemolysis Neonatal hepatitis Biliary atresia Alpha-1 antitrypsin deficiency Metabolic disorders Hypothyroidism
The most common motor disability in childhood is
Cerebral palsy
A non-progressive, non-hereditary disorder of impaired motor function and posture
Cerebral palsy
Cerebral palsy Most commonly results from
a perinatal neurologic insult
Risk factors of Cerebral palsy include?
Prematurity- strongest risk factor Mental retardation Low birth weight Fetal malformation Neonatal cerebral hemorrhage / leukomalacia Perinatal hypoxia- Reduce umbilical or uterine blood flow Advance maternal age ( >35 years) Metabolic / endocrine disorders Malnutrition Perinatal hypoxia Alcohol and tobacco use during pregnancy Trauma Infections (TORCH)
Identify TORCH infections
Toxoplasmosis Others (syphilis, chicken pox. listeria) Rubella Cytomegalovirus Herpes
Signs and Symptoms of cerebral palsy
Tone abnormality – hyper or hypo tonic ; fluctuating
Signs of upper motor neuron lesions ??
Reflex abnormality:
- Enhanced reflexes(hyperreflexia), clonus
- Absence of primitive reflexes e.g. stretch reflex, asymmetrical tonic neck reflex (ATNR), grasp reflex
Atypical posture
-Spasticity of upper and lower extremities
Delayed motor development
-Inability to sit or crawl
Atypical motor performance
Ataxia
The most common form of cerebral palsy is?
Spastic 80%
Cerebral palsy caused by lesion of cerebral cortex
Spastic
Presents as an Upper motor neuron type lesions and
Contractures
Spastic cerebral palsy can be categorize further into
Spastic hemiplegia (one entire side of the body)
Spastic diplegia (both lower extremities with lordosis or kyphosis)
Spastic quadriplegia (entire body)- Associated with scoliosis
3 types of cerebral palsy
Spastic
Athetosis
Ataxia
Athetosis (dyskinesia) cerebral palsy presents with what symptoms
Slow, writhing involuntary movements
Choreiform
Dysarthria
Difficult eating
Cerebral palsy caused by lesions of basal ganglia
Athetosis (dyskinesia)
Cerebral palsy caused by lesions of cerebellum
Ataxia
Ataxia type cerebral palsy presents with what symptoms
Wide based, staggering and unsteady gait
Intentional tremors
Cognitive impairment associated with CP
Most common in spastic quadriplegic
Spastic CP is associated with normal IQ
Seizure disorders associated with CP
Occurs in 25 to 60% of cases
Most common in spastic hemi/quadriplegic
Partial seizures
Visual (strabismus/nystagmus) and hearing impairment
is associated with CP
True
Oral motor disorders associated with CP
Leads to difficulty in eating and talking
Drooling
Tooth decay
Periodontal diseases
G.I.T pathologies
GERD
Constipation
Malnutrition
Dehydration
Pulmonary pathologies associated with CP
Shortness of breath
Poor cough reflex leading to aspiration
Diagnosis of CP
Is Mainly clinical
Treatment for CP
Muscle relaxants e.g. Diazepam, Dantrolene, Baclofen for spasticity
Physical therapy
Orthotics and splinting to prevent contractures
Bracing, surgical release
The most common congenital heart disease is?
VSD
Large ASD will result in which symptoms
SOB Hyperdynamic pericardium RV heave Systolic ejection murmur Fixed splitting of S2 Paradoxical embolism
Large VSD will result in which symptoms
Pulmonary HTN
Growth failure
CHF
Infection
Childhood ASD will have no symptoms. T/F
True
Avoid the following during repair of VSD
Arrhythmia
RV dysfunction
Pulmonary vascular obstructive disease
Paradoxical embolus
Mechanical obstruction ‘kink’ between proximal and distal aorta, usually after the origin of left subclavian artery
Coarctation of aorta
Most Coarctation of aorta patients are asymptomatic, ______% will lead to CHF in infancy
10%
Male: female ratio in patients with Coarctation of aorta
2:1
Physical exam finding in patient with Coarctation of aorta
Weak or absent femoral pulse. Always compare radial and femoral pulse
Upper extremity hypertension; lower extremity hypotension
Cold extremities, claudication with exercise, leg fatigue
Rib notching, “3” sign
EKG normal or LVH
Compare type of hypertrophy in different Congenital abnormalities
ASD: RVH VSD: CHF PDA: LVH, CHF CoA: LVH ToF: RVH TA: Biventricular Hypertrophy
Continuous murmur “machinery” is heard on?
PDA
Symptoms of large PDA include
CHF
Delayed growth
Infections
Treatment of PDA
Surgical ligation
COX-1,COX-2 inhibtors and indomethacin “medical ligation”
Preductal (right hand) and Postductal (foot) O2 saturation difference =
3%
High >10% in Increase right to left shunt (Pulmonary hypertension)
MC congenital heart disease causing cyanosis
Tetralogy of Fallot
Four features of Tetralogy of Fallot
Pulmonary stenosis – RV outflow obstruction
Overriding aorta (aorta comes out both from left ventricle and right ventricle ( BIG AORTA)
Large VSD
Right ventricular hypertrophy
Clinical presentation of a patient with ToF
Cyanosis
Squatting
Dyspnea
Hypercyanotic and hypoxic spells ( TET spells) PO2 < 50 mmHg during feeding or crying unresponsive to supplemental O2.
PO2 < 50 mmHg during feeding or crying unresponsive to supplemental O2 in ToF refers to?
Hypercyanotic and hypoxic spells ( TET spells)
PE findings in ToF
RV heave
Harsh systolic ejection murmur
EKG findings in ToF
Right axis deviation
RVH
Conditions that increase R to L shunt
Increase in pulmonary vascular resistance OR decrease in SVR
Acidosis
Hypercarbia
Hypotension
X-ray findings in ToF
Boot shaped heart
Decreased pulmonary markings
Squatting is preferred in patients with ToF because?
It is a position that increases systemic vascular resistance and aortic pressure, which decreases right-to-left ventricular shunting and thus increase arterial O2saturation.
Treatment of ToF
For symptomatic patient , PGE1 infusion
ForTETspells, knee-chest positioning, calming, O2, and vasoconstrictors
ToF surgery
Blalock-Taussing shunt; connects subclavian artery to pulmonary artery
Closing VSD
Resecting obstruction
Anesthetic management for ToF
Maintain intravascular volume and SVR
Avoid high in pulmonary vascular resistance (e.g. by N2O)
Ketamine is used because it maintains or increases SVR and therefore does not aggravates R to L shunt
VA and histamine-releasing drugs lower SVR and increase shunt
Phenylephrine increases SVR and decreases shunt
Missing tricuspid valve
Tricuspid atresia
Missing tricuspid valve
Tricuspid atresia
Blood flow in a patient with Tricuspid atresia
Blood can flow out of right atrium only via PFO or ASD
PDA is necessary for blood to flow from LV into pulmonary circulation
__________ is needed for survival in a patient with Tricuspid atresia
PGE1
Treatment of a patient with Tricuspid atresia
Septostomy
B.T. shunt
Fontan procedure: Anastomosis of right atrium with right pulmonary artery
Glen shunt: SVC to pulmonary artery
Heart transplant
Conotruncal separation does not occur, one trunk
Truncus Arteriosus
In a patient with Truncus Arteriosus, When pulmonary resistance falls it leads to _______ flow to lungs causing ____________
increase
CHF , tachypnea
EKG findings in a patient with Truncus Arteriosus
biventricular hypertrophy
Surgery for Truncus Arteriosus
close VSD with trunk in LV, connect RV and pulmonary artery
Blood flow in a patient with Transposition of great vessels
RV flows to the aorta
LV flows to the pulmonary artery
Patient with Transposition of Great vessels must have mixing to survive. This can be in the form of?
ASD
VSD
PDA
Infuse PGE1 to keep open
Egg shaped heart on CXR
Transposition of Great vessels
3 sign on cxr
Coarctation of aorta
Boot shaped heart on CXR
ToF
Surgery for Transposition of Great Vessels ( TGV)
atrial septostomy if no connection, whole atrial switch in neonatal period
Pulmonary veins drains into RA instead of going to left atrium
Total Anomalous Pulmonary Venous Return(TAPVR)
Blood flow in Total Anomalous Pulmonary Venous Return(TAPVR)
Coronary sinus to RA Innominate to SVC Portal vein to IVC Combination of routes R to L shunt across ASD
Clinical presentation of a patient with Total Anomalous venous return
Cyanosis
Tachypnea
Dyspnea
Snowman shaped heart on XR
Total Anomalous venous return
Surgery for Total Anomalous venous return
redirection of veins
Hypoplastic left heart syndrome
Hypoplasia of left ventricle, mitral valve and ascending aorta
Mixing of pulmonary and systemic blood in single ventricle
Systemic flow is dependent on PDA. Give PG-E1 infusion to keep the duct open*
High or low pulmonary vascular resistance lead to cardiovascular collapse
String sign on barium study
Pyloric stenosis
Incidence of pyloric stenosis
1:1000
Pyloric stenosis occurs at what age
First 2 weeks to four Months
