Peds Surgery -Safoui Flashcards
What things are associated with esophageal atresia?
- polyhydramnios in pregnancy
- VACTERL (veretebral, anorectal, cardiac* (most common), trachoesophageal, renal, limb)
What is the most common type of esophageal atresia? How is EA diagnosed?
Type C
(proximal atresia with distal fistula)
can be diagnosed prenatally with MRI and US
How does a baby with an EA present?
- newborn with excessive drooling w/in first few hours
- choking when attempting feeding
- cyanosis/resp distress
- Type C=abdominal dissension when crying (air into stomach)
- failure to pass NG tube (will coil in mouth or esophagus)
If there is a pure atresia, will there be air in the abdomen?
NO!
there is no fistula to get air into the abd
What is the treatment for a esophageal atresia?
1: rule out the VACTERL anomalies (esp cardiac=most common)
- NG tube in proximal pouch to prevent aspiration
- elevate the head (prevent reflux)
- surgical consult and do the ECHO
What vessel will be in the way in an esophageal atresia repair?
Azygous vein
What is an omphalocele?
- Defect in abdominal wall at the site of the umbilical ring in which bowel and solid viscera protrude (lateral folds do NOT close)
- Covered by peritoneum and amniotic membrane=protected.
- Umbilical cord inserts into sac.
- associated with congenital anomalies
- can see on US
What is the most common anomaly seen with omphaloceles?
cardiac
10-50% premature
What is the temporary treatment for an omphalocele?
maintain body temp and cover omphalocele to reduce fluid loss (silo)
-normally 4 cm+
What is the difference between omphalocele and gastroschisis?
- gastroschisis has NO overlying sac on the intestinal contents
- also it is normally to the RIGHT of the umbilicus (instead of through it with omphalocele)
- Gastroschisis is also < 4 cm while omphalocele is > 4 cm
- no anomalies associated with gastrocschisis
What anomalies are associated with gastroschisis? How large are they normally?
NONE
–> can be seen 10% of the time with esophageal atresia
What is the treatment for gastroschisis?
resuscitate if need and then urgent surgery because NOT covered
close surgically within 1-2 weeks
if atresia, will have to close first then go back to correct the atresia
What is the most common cause of vomiting in childhood?
acute viral gastroenteritis
What does bilious emesis in a child indicate? What has to be ruled out?
an intestinal obstruction (dark green)
most important to rule out=malrotation with midgut volvulus =surgical emergency
What is pyloric stenosis? What is the typical presentation?
postnatal muscular hypertrophy of the pylorus –> gastric outlet obstruction
- often seen in newborn male with projectile postprandial non bilious emesis
- palpable “olive:” in the RU abd
- Hypochloremic hypokalemic metabolic alkalosis with a paradoxical aciduria
What US finding is diagnostic of a pyloric stenosis?
channel length of >16 mm and pyloric thickness of >4 mm
What is the treatment for pyloric stenosis?
*Must fluid resuscitate and correct the metabolic alkalosis first!
- Once electrolytes are normal, then surgical intervention.
- -> Ramstedt pyloromyotomy (small cut to allow it to open the obstruction)
How will a proximal vs distal obstruction present in a newborn with bilious emesis? What has to be ruled out in proximal obstructions?
Proximal:
- emesis first, no distension
- r/o malrotation with midgut ovules
Distal:
- abd distension and then emesis
- absent/delayed stool (>24 hours)
What is the most common cause of malrotation?
nonrotation
What is the gold standard for malrotation diagnosis without vovulus? Who should this NOT be performed on?
upper GI =corkscrew appearance “whirlpool sign”
do NOT perform on a pt in shock or with midgut volvulus*
What is an annular pancreas? What is it associated with?
Due to incomplete rotation of the ventral pancreatic bud resulting in the pancreas encircling the 2nd part of the duodenum.
annular=ring
Associated with trisomy 21.
What is the most common cause of obstruction in newborns < 1 week? What is the most common embryological cause of this?
Duodenal atresia
*failure to recanalize
What are the x ray findings seen with duodenal atresia? What is this associated with?
“double bubble” on x ray
-if distal air–> r/o midgut volvulus
associated with trisomy 21
What is the most frequent cause of intestinal obstruction in the first 2 years of life (6-24 months)? When does this normally occur?
Intussusception
normally after a viral illness
terminal ileum telescopes into the colon
What is the clinical presentation of intussusception?
waves of abd pain then diarrhea with currant jelly stools (bloody bowel movements with mucus)
-may palpate a sausage mass in the upper abd.
What are most pts with meconium ileus associated with? How is this treated?
Cystic fibrosis
water-soluble enema then surgery if needed
ground glass appearance on x-ray
What is the most frequent and lethal GI disorder in preemies? What area is most commonly involved?
Necrotizing enterocolitis (NEC) =bowel distention with patchy areas of thinning, pneumatosis, gangrene, and frank perforation.
most commonly involves the terminal ileum and the colon
What plain film finding is pathognomonic for NEC?
pneumatosis intestinalis –> invasion of the ischemic mucosa by gas-producing microbes
What is short gut syndrome? what is the most common cause of short gut syndrome?
- Removal of more than 50% of small bowel length.
- Ranges from 150 to 300 cm in a newborn
- Need at least 30 cm with ICV
- Without ICV need at least 70 cm
*most common cause=neonatal intestinal resection (most reason for it is NEC)
What is the most common cause of death in short gut?
liver failure from TPN
What is Hirschsprung disease? What is the clinical finding associated with this?
Congenital Aganglionic Megacolon
- Absence of ganglion cells in the submucosal and muscular layers of the colon
- failure to pass meconium within 48 hours of life
- can be associated with trisomy 21
What will happen to a kiddo with biliary atresia that is not corrected?
Biliary cirrhosis, hepatic failure, and death occur uniformly by age 18–24 months without surgical correction or transplantation
want to diagnose before 3 months or will need a liver transplant
