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Surg > Pestana5 (Peds) > Flashcards

Pestana5 (Peds) Flashcards

1
Q

Esophageal atresia (sxs 2)

A
  • Excess salivation at birth

- Choking spells w/ first feeding

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2
Q

Most common esophageal atresia

A

Blind pouch in upper esophagus, fistula bw lower esophagus and tracheobronchial tree (Type C)

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3
Q

Esophageal atresia (workup)

A
  • Look at anus for imperforation
  • Xray for vertebral and radial anomalies
  • Echocardiogram for cardiac anomalies
  • Sonogram for renal anomalies
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4
Q

Esophageal atresia (a/w)

A

VACTER

Vertebral, anal, cardiac, tracheal, esophageal, renal/radial anomalies

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5
Q

Esophageal atresia (mgmt)

A
  • Surgical repair

- If delayed, need gastrostomy to protect lungs

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6
Q

Imperforated anus (workup 2)

A
  • r/o VACTER

- Look for fistula nearby

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7
Q

Imperforated anus (mgmt)

A

Fistula (+): delay until further growth

Fistula (-): high rectal pouch, colostomy; low rectal pouch, repair

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8
Q

Imperforated anus (determining level of rectal pouch)

A

Upside down xrays w/ metal marker on the anus

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9
Q

Congenital diaphragmatic hernia (features 3)

A
  • Always on left
  • Bowel in the chest
  • Respiratory distress
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10
Q

Congenital diaphragmatic hernia (major complication)

A

Hypoplastic lung

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11
Q

Congenital diaphragmatic hernia (mgmt 5)

A
  • Delay repair for 3-4 days to allow lung maturation
  • Endotracheal intubation
  • Low-pressure ventilation
  • Sedation
  • NG suction
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12
Q

Congenital diaphragmatic hernia (dx)

A

Sonogram before birth

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13
Q

Gastroschisis vs omphalocele

A
  • Gastroschisis: no membrane, cord is normal

- Omphalocele: thin membrane, cord defect

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14
Q

Gastroschisis, omphalocele (mgmt)

A
  • Small: primary closure
  • Large: protect w/ Silastic silo, then squeeze bowel into abdomen little by little over a week
  • Vascular access in gastroschisis for perenteral nutrition
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15
Q

Exstrophy of the urinary bladder (mgmt)

A

Repair w/in the first 1-2 DOL

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16
Q

Green vomiting and “double-bubble” sign on xray (ddx 3)

A
  • Duodenal atresia (newborn issue)
  • Annular pancreas (newborn issue)
  • Malrotation (can show up anytime w/in first few wks of life)
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17
Q

Malrotation (dx)

A

Contrast enema or upper GI study

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18
Q

Intestinal atresia (dx)

A

Multiple air-fluid levels throughout the abdomen

19
Q

Intestinal atresia (pathology)

A

Vascular accident in utero

20
Q

Necrotizing enterocolitis (dem, onset)

A

Premature infants when first fed

21
Q

Necrotizing enterocolitis (sxs 3)

A
  • Feeding intolerance
  • Abdominal distension
  • Rapidly dropping plt count
22
Q

Necrotizing enterocolitis (mgmt 3)

A
  • Bowel rest: stop all feeding, NG decompression
  • Broad-spectrum ABXs
  • IV fluids+nutrition
23
Q

Necrotizing enterocolitis (indications for surgery 4)

A
  • Abdominal wall erythema (cellulitis)
  • Air in portal vein
  • Intestinal pneumatosis
  • Pneumoperitoneum
24
Q

Meconium ileus (dem)

A

CF

25
Q

Meconium ileus (sxs 2)

A
  • Feeding intolerance

- Bilious vomiting

26
Q

Meconium ileus (xray 2)

A
  • Multiple dilated loops of small bowel

- Ground-glass appearance in the lower abdomen

27
Q

Meconium ileus (dx, mgmt)

A

Gastrografin enema

28
Q

Hypertrophic pyloric stenosis (dem, onset)

A

First-born boys, 3wks

29
Q

Hypertrophic pyloric stenosis (sxs 4)

A
  • Nonbilious projectile vomiting
  • Dehydration
  • Visible gastric persitalsis
  • Palpable “olive size” mass
30
Q

Hypertrophic pyloric stenosis (mgmt 3)

A
  • Rehydration
  • Correction of hypochloremic hypokalemic metabolic alkalosis
  • Ramstedt pyloromyotomy or balloon dilatation
31
Q

Biliary atresia (onset)

A

6-8wks old

32
Q

Biliary atresia (presentation)

A

Persistent, progressively increasing jaundice (conjugated/direct)

33
Q

Biliary atresia (workup)

A
  • Serologies, sweat test

- HIDA scan post 1wk of phenobarbital (if no bile reaches duodenum after 1wk, then surgical exploration: ELAP)

34
Q

Biliary atresia (prognosis 3)

A
  • 1/3 survive w/ surgical derivation
  • 1/3 need liver transplant after surgical derivation
  • 1/3 need immediate liver transplant
35
Q

Hirschsprung disease, aka aganglionic megacolon (sxs 2)

A
  • Chronic constipation

- Explosive expulsion of stool and flatus on rectal exam

36
Q

Hirschsprung disease (xray)

A

Proximally dilated colon, distally normal-looking colon

37
Q

Hirschsprung disease (dx)

A

Full-thickness biopsy of rectal mucosa

38
Q

Intussusception (onset)

A

6-12mos

39
Q

Intussusception (sxs 4)

A
  • Colicky abdominal pain (double up, squat, remit)
  • Vague mass on right side of abdomen
  • “Empty” RLQ
  • “Currant jelly” stools
40
Q

Intussusception (dx, mgmt)

A
  • Barium/air enema

- If not reduced radiologically, then surgery

41
Q

Child abuse (sxs 4)

A
  • Subdural hematoma
  • Retinal hemorrhages
  • Bone fxs at different stages of healing
  • Scalding burns
42
Q

Meckel diverticulum (presentation)

A

Lower GI bleed

43
Q

Meckel diverticulum (dx)

A

Radioisotope scan (looking for gastric mucosa in the lower abdomen): technetium 99m pertechnetate

Surg (7 decks)

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