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Surgery > Pestana- 5. Pediatric Surgery > Flashcards

Pestana- 5. Pediatric Surgery Flashcards

1
Q

What do you expect if a baby shows up with excessive salivation noted shortly after birth or choking spells when first feeding is attempted?

A

esophageal atresia

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2
Q

What can be done to make the diagnosis of esophageal atresia?

A

pass an NG tube and see it coiled up in the chest on CXR

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3
Q

What is the sign that a baby has the most common form of esophageal atresia (blind pouch in upper esophagus and fistula between lower esophagus and tracheobronchial tree)?

A

normal gas pattern in the bowel

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4
Q

What must you also look for in a patient with esophageal atresia?

A

VACTERL

imperforate anus, cardiac anomalies, renal anomalies, vertebral anomalies

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5
Q

What must you do in a patient with esophageal atresia if surgery has to be delayed?

A

gastrostomy (protects lungs from acid reflux)

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6
Q

What should you look for if your patient has an imperforate anus?

A

nearby fistula (to vagina or perineum)

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7
Q

If a fistula is nearby, what does this mean for surgery?

A

it can be delayed (but needs to be done before toilet training)

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8
Q

How do you determine the level of the rectal pouch?

A

x-ray taken upside down with metal marker taped to the anus

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9
Q

Congenital diaphragmatic hernia is always on what side?

A

left (bowel up in chest)

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10
Q

What is the major problem in CDH?

A

hypoplastic lung that still has fetal-type circulation

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11
Q

How long must you wait before you repair CDH?

A

3 or 4 days

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12
Q

What is the treatment for pre-op CDH?

A
  • Endotracheal intubaiton
  • Low pressure ventilation
  • Sedation
  • NG suction
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13
Q

What may you have to do for difficult cases of CDH?

A

Extracorporeal Membrane Oxygenation

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14
Q

When is CDH usually diagnosed?

A

before birth (sonogram)

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15
Q

What side is gastrochisis on?

A

right

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16
Q

Is there a cord in omphalocele?

A

not really, the cord goes to the defect

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17
Q

What all is in the omphalocele membrane?

A

normal-looking bowel and a little slice of liver

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18
Q

How long does silo closure usually take?

A

about a week

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19
Q

How long does it take gastrochisis bowel to start working?

A

around a month (baby needs vascular access for TPN)

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20
Q

How quickly must you repair exstrophy of the bladder?

A

within 1-2 days of life

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21
Q

In what 3 conditions may you see “double-bubble” and bilious vomiting?

A
  • Duodenal atresia
  • Annular pancreas
  • Malrotation
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22
Q

WHy is malrotation very dangerous?

A

volvulus can occur and the bowel can become ischemic and die

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23
Q

If you see double bubble with little normal gas pattern beyond, what should you think of?

A

malrotation

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24
Q

How do you diagnose malrotation?

A
  • Contrast enema (safe but not always diagnostic)

- Upper GI study (risky but more reliable)

25
Q

When will malrotation typically present?

A

within the first few weeks of life

26
Q

What do you expect with bilious vomiting and multiple air-fluid levels?

A

intestinal atresia

27
Q

What leads to intestinal atresia?

A

vascular accident in utero

28
Q

What do you suspect in a premature infant who develops feeding intolerance, abdominal distention, and a rapidly dropping platelet count after their first feed?

A

necrotizing enterocolitis

29
Q

How do you treat necrotizing enterocolitis?

A
  • Stop feedings
  • Broad spectrum Abx
  • IVF
  • IV nutrition
30
Q

When is surgical intervention required for necrotizing enterocolitis?

A
  • Abdominal wall erythema
  • Air in portal vein
  • Intestinal pneumatosis
  • Pneumoperitoneum (necrosis + perf)
31
Q

What should you suspect in a baby with CF who develops feeding intolerance and bilious vomiting?

A

meconium ileus

32
Q

What does an x-ray of meconium ileus look like?

A

multiple dilated loops of small bowel and ground-glass appearance in lower abdomen

33
Q

What is the diagnosis/treatment for meconium ileus?

A

Gastrografin enema

34
Q

What condition typically presents around 3 weeks in firstborn boys?

A

hypertrophic pyloric stenosis

35
Q

How does hypertrophic pyloric stenosis present?

A

nonbilious projectile vomiting

36
Q

What is the physical exam for pyloric stenosis?

A
  • Dehydration
  • Gastric peristaltic waves
  • Palpable olive-like mass in right upper quadrant
37
Q

If you cannot feel the olive, how do you diagnose pyloric stenosis?

A

ultrasound

38
Q

What electrolyte abnormality is seen with pyloric stenosis?

A

Hypochloremic, hypokalemic metabolic alkalosis

39
Q

What are the two most common operations performed for pyloric stenosis?

A

Ramstedt pyloromyotomy

Balloon dilatation

40
Q

What do you expect in a 6 to 8 week old baby with progressively increasing jaundice (mostly conjugated)?

A

biliary atresia

41
Q

What is the diagnostic test for biliary atresia?

A

HIDA scan after 1 week of phenobarbital showing no bile reaching the duodenum

42
Q

What are the three paths for infants with biliary atresia?

A
  • 1/3 get long-lasting surgical derivation
  • 1/3 need liver transplant after surgical derivation
  • 1/3 need transplant right away
43
Q

What is the cardinal symptom of Hirschsprung disease?

A

chronic constipation

44
Q

What happens during the rectal exam in a patient with Hirschsprung disease?

A

explosive expulsion of stool and flatus

45
Q

What does an x-ray show with Hirschsprung disease?

A

distended proximal colon with “normal looking” distal colon

46
Q

Which part of the colon on x-ray is aganglionic?

A

the distal colon that is skinny

47
Q

How do you diagnose Hirschsprung disease?

A

full-thickness biopsy of the rectal mucosa

48
Q

What do you expect in a 6-12 month old child with episodes of ~1 minute colicky abdominal pain that makes them double-up and squat?

A

intussusception

49
Q

What is the classic physical exam finding with intussusception?

A

currant jelly stools

50
Q

What is the diagnosis and treatment of intussusception?

A

barium or air enema

51
Q

What do you think of in a child with SDH and retinal hemorrhages?

A

shaken baby syndrome

52
Q

What do you always expect in lower GI bleeding in the pediatric age group?

A

Meckel diverticulum

53
Q

What do you do to diagnose Meckel diverticulum?

A

radioisotope scan (look for gastric mucosa in the lower abdomen)

54
Q

By what age does an orchiopexy need to be done for an undescended testicle?

A

by one

55
Q

What do you call a testicle that is in the canal at birth but can be pulled down where it belongs?

A

overactive cremasteric muscle

56
Q

What do you expect if a baby has an abdominal mass that moves up and down with respiration?

A

malignant liver tumor (hepatoblastoma or hepatocellular carcinoma)

57
Q

What hormone is elevated in liver tumors?

A

AFP

58
Q

True or false: neuroblastomas can involute and revert to benign forms

A

true!

Surgery (13 decks)

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