Pestana Pediatric Surgery Flashcards
Congenital anomalies that require surgical intervention between birth - 24 hours
- esophageal atresia
- imperforate anus
- congenital diaphragmatic hernia
- gastroschisis/omphalocele
- exstrophy of urinary bladder
- green vomit +/- double bubble (duodenal atresia, annular pancreas, malrotation)
- intestinal atresia
Congenital anomalies that require surgical intervention between first few days - 2 months of life
- necrotizing enterocolitis
- meconium ileus
- hypertrophic pyloric stenosis
- biliary atresia
- hirschsprung disease (aganglionic megacolon)
Congenital anomalies that require surgical intervention between later during infancy
- intussusception
- child abuse
- meckels diverticulum
a newborn infant begins to choke after his mom tries to breast feed him for the first time after birth; excessive drooling is noted.
esophageal atresia
what is the next best step in management for a newborn with suspected esophageal atresia?
- pass an NG tube and image - it will be seen coiled in the upper chest.
- If there is normal gas pattern in the bowel, then the infant likely has the most common type of esophageal atresia (blind pouch in upper esophagus with fistula between lower esophagus and tracheobronchial tree)
most common type of esophageal atresia?
blind pouch in upper esophagus with fistula between lower esophagus and tracheobronchial tree
once you establish that a newborn infant has esophageal atresia, what is the next best step in management?
rule out other associated anomalies (VACTERL: vertebral defects, anal atresia, cardiac defects, tracheal-esophageal fistula, renal defects, limb defects) BEFORE doing surgical repair
- *note these structures are of mesodermal origin*
if there is a delay in surgical repair of a esophageal atresia, what is the next best step in management?
gastrostomy (creation of an external opening into the stomach for nutritional support/GI compression) has to be done in order to protect the lungs from acid reflux
how is an imperforate anus with a fistula at the vagina or perineum managed?
repair is delayed until further growth of the infant
how is an imperforate anus without evidence of a fistula at the vagina or perineum managed?
- colostomy (for high rectal pouches with subsequent repair when the infant is older)
- primary repair (for rectal pouches that are close to the anus)
when is a congenital diaphragmatic hernia repaired? rationale? what should you do in the interim?
3-4 days after birth to allow for maturation of the hypoplastic lung must give endotracheal intubation, low pressure ventilation, sedation, and NG suction since the infants are usually in respiratory distress
where is a congenital diaphragmatic hernia usually located?
always on the L
when are most congenital diaphragmatic hernia diagnosed?
in utero via sonogram
∆ btwn gastroschisis and omphalocele? What are they caused by?
- gastroschisis - not covered by peritoneum with angry looking bowel
- omphalo”cele” - “sealed” by peritoneum; normal looking bowel
both caused by abdominal wall defect in the middle of the belly
management of newborn infant with gastroschisis? 2
construction of a silastic “silo” to house and protect the bowel. Contents of the silo are then squeezed into the belly a little bit everday until complete closure can be done (~1 week)
vascular access for parenteral nutrition because the bowel function usually takes ~1 month to return
What is exstrophy of the urinary bladder and what is it caused by?
caused by abdominal wall defect over the pubis
results in a medallion of red bladder mucosa, wet and shining with urine
management of an infant with this
exstrophy of the urinary bladder
surgical repair within the first 1-2 days of life, otherwise delayed repairs do not work
of these, which one is the most dangerous?
duodenal atresia, annular pancreas, or malrotation
How is it diagnosed?
malrotation - bowels can twist on itself and cut off its blood supply, and die
diagnosis:
- if there is little gas beyond the double bubble seen on x-ray
- contrast enema or upper GI study
note: malrotation can show up at any time within the first few days of life
What is this pathology?
intestinal atresia
How does intestinal atresia occur? how does it present?
aka “apple peel atresia” - result of a vascular accident in utero
green vomit + multiple air fluid levels throughout the abdomen seen on x-ray (ø double bubble)
premature infant is fed for the first time develops abdominal distension, thrombocytopenia, and feeding intolerance
<strong>feeding intolerance - </strong>inability to digest enteral feedings; gastric residual volume >50%, abdominal distention, emesis, and disruption of the patient’s feeding plan.
necrotizing enterocolitis
meconium ileus occurs in which patient population?
how do these patients present?
cystic fibrosis
feeding intolerance + bilious vomiting
Xray shows multiple dilated loops of small bowel and ground-glass apperance in the lower abdomen
how are infants with hypertrophic pyloric stenosis managed? 3
- rehydration with IVF
- correction of hypochloremic, hypokalemic metabolic alkalosis
- ramstedt pyloromyotomy or balloon dilation
how do infants with biliary atresia present?
6-8 wk infants with persistent, progressively increasing jaundice with
- substantial conjugated bilirubin fraction
- acholic stools
- dark urine
- FTT due to malabsorption and ADEK deficiencies
