Peds GI Surgery - Opheim Flashcards
What are the steps in the evaluation of a pediatric patient with a GI complaint?
- History
- OPQRSTa
- Birth history, Feeding pattern, Activities
- Physical exam
- Face flushed, diaphoretic
- Interaction with others
- Position, wiggling around, curled up
- Head to Toe exam
- Abdominal exam
- bump table, use stethoscope
- Percuss, palpation
- Can patient sit up, take deep breath, cough, twist torso, etc. comfortably
Define “acute abdomen”.
“Signs and symptoms of abdominal pain and tenderness, a clinical presentation that often requires emergency surgical therapy.”
What conditions are associated with an “acute abdomen”?
- Causes
- Infection
- Obstruction
- Ischemia
- Perforation
- “often” requires surgery… not “always”
- Endocrine, metabolic, hematologic, toxins/drugs
- DKA, porphyria, lead poisoning, hypercalcemia, Addison’s disease, constipation
- Malrotation (after IV hydration)
What laboratory studies should be performed in the evaluation of abdominal problems?
- Complete blood count with differential
- WBC, hemoglobin, platelet
- Neutrophil %
- Basic metabolic profile
- CRP
- Sed rate
- Urinalysis
What are the symptoms of Pyloric Stenosis?
- Projectile, non-bilious vomiting
- May have recent history of “formula intolerances”
- curdled milk/formula, could have rust tint if delayed presentation
- Baby acts hungry
- Eventually will become dehydrated
- No tears when baby cries
- Infrequent wet diapers
- Lethargy
What is the diagnostic test of choice for Pyloric Stenosis?
Ultrasound
What is the most important part of treating pyloric stenosis?
Fluid resuscitation first
(surgery later)
What is the clinical triad of symptoms in Intussusception?
- Colicky abdominal pain
- Bilious emesis
- “Currant jelly” stools
How does intussusception lead to ischemia and necrosis?
- Lymphatic obstruction
- Venous congestion
- Impaired arterial blood flow
- ISCHEMIA AND NECROSIS!
What abdominal condition shows a “target sign” finding on ultrasound and/or CT scan?
Intussusception
(colon with small bowel inside of it)
What is the most common cause of acute surgical abdomen in children?
Acute appendicitis
What are the three etiologies of acute appendicitis?
- Lymphoid hyperplasia
- Fecolith
- Foreign body
What is the basic pathophysiology of appendicitis?
- Obstruction of appendix traps bacteria within
- Bacteria multiply, appendix distends
- Distention impairs venous outflow
- Arterial inflow then becomes impaired
- Ischemia, gangrene, necrosis, perforation
What exam findings can guide and/or determine the position of appendix?
- Pain at McBurney’s point - RLQ
- Psoas sign– retrocecal appendix
- Obturator sign– pelvic location of appendix
- Rovsing sign – pain in contralateral abdomen after palpation
What is Meckel’s Diverticulum?
- Small bowel diverticulum— TRUE diverticulum
- All layers of bowel wall
- Embryology: persistent vitelline (omphalomesenteric) duct
What are the Rules of 2’s in Meckel’s Diverticulum?
- 2% of population
- Within 2 feet of ileocecal valve
- 2 types of heterotopic tissue: gastric (50%) and pancreatic
- 2 inches in length
- 2 year old
How does Meckel’s Diverticulum present?
- Painless lower GI bleed
- Obstruction
- Meckel’s Diverticulitis
Why is rectal bleeding common in Meckel’s Diverticulum?
- Painless lower GI bleed (20-30% of complications)
- Due to the gastric tissue contained in the diverticulum
- Bleeding occurs on wall opposite of the Meckel’s
- Meckel’s scan
- Technetium-99m pertechnetate scintigraphy
What is Hirschsprung’s Disease?
- Absence of Ganglion cells in the myenteric and submucosal plexus
- Aganglionosis always involves distal rectum
- Higher risk in patient’s with family hx and in Down syndrome patients.
How does a patient with Hirschsprung’s Disease present?
- Abdominal distention
- Bilious emesis
- Failure to pass meconium in the first 24 HRs
What is the gold standard test to diagnose Hirschsprung Disease?
Full thickness rectal biopsy
