Peds GI Surgery- Opheim

Question 1

What is the first step in managing an infant with pyloric stenosis?

Answer 1

Optimize the infant’s medical status

****resuscitation before surgery!!!!!!!

• correct electrolytes
• IV hydration
• NPO

Question 2

What type of vomiting is associated with pyloric stenosis?

Answer 2

Projectile NON-BILIOUS

Question 3

Rule of 2’s for Meckel Diverticulum?

Answer 3

• 2 feet from ileocecal valve
• 2 inches long
• 2% of population
• first 2 years of life
• 2 types of tissue (gastric and pancreatic)

Question 4

What is the main presentation of meckel’s diverticulum?

Answer 4

** PAINLESS LOWER GI BLEED

• due to gastric tissue contained in diverticulum
• Bleeding occurs OPPOSITE of the Meckels

Question 5

What is the triad for Hirschsprungs Disease?

Answer 5

Adominal distention
Bilious emesis
Failure to pass meconium in the first 24 hours

Question 6

What lab finding is an ominous sign in kids?

Answer 6

Hyponatremia

Question 7

What lab is used in the ER as a sign of bacterial infection?

Answer 7

Calcitonin

Question 8

What does “acute abdomen” mean?

Answer 8

Signs and sx of abdominal pain and tenderness that often requires emergency surgery

Question 9

What are Ladd’s bands?

Answer 9

Attachment between cecum and duodenum in malrotation that causes duodenal obstruction

Question 10

Diagnostic test of choice for pyloric stenosis?

Answer 10

US

Question 11

What does the vomit look like in pyloric stenosis

Answer 11

NON-BILIOUS

Curdled milk/formula

Question 12

First thing you do for a child with pyloric stenosis???

Answer 12

RESUSCITATION

Correct electrolytes, IV hydration, NPO

Question 13

When is the “Ramstedt procedure” done?

Answer 13

Pyloric stenosis

Pyloromyotomy

Question 14

Cause of pyloric stenosis?

Answer 14

Hypertrophy of circular muscle due to improper innervation

Question 15

Currant jelly stools

Answer 15

Intussusception

Question 16

Common site for intussusception?

Answer 16

Ileocolic region

Question 17

Triad of sx for intussusception?

Answer 17

Colicky abdominal pain
Bilious emesis
Currant jelly stools

Question 18

What is the typical finding of intussusception on US or CT?

Answer 18

Target sign in transverse orientation

Question 19

What do you try first to diagnose and treat intussusception?

Answer 19

Barium enema

Question 20

How many times can you try the BE?

Answer 20

2 times…3rd time recurrence means you gotta go to the OR

Question 21

most common cause of acute surgical abdomen in children

Answer 21

Appendicitis

Question 22

Fecolith

Answer 22

stool ball gets stuck in appendiceal orifice

Question 23

Gold standard test for Hirschsprung’s Disease?

Answer 23

Full thickness rectal biopsy

Question 24

Common presentation of Hirschsprungs?

Answer 24

failure to pass meconium in first 24 hours

Question 25

Baby with intestinal protrusion covered by peritoneum

Answer 25

Omphalocele

Question 26

Beckwith-Wiedemann Syndrome

Answer 26

Omphalocele
Hyperinsulinemia
Macroglosia (huge tongue)

Question 27

Baby who comes out with protruding abdominal contents that are red and angry

Answer 27

Gastroschisis (red and angry due to contact with amniotic fluid)
No sac covering abdominal contents

Question 28

Who is most at risk for gastroschisis?

Answer 28

Small for gestational age

Question 29

30 % of omphaloceles are associated with what?

Answer 29

Trisomies