Stevens #1 Common Surgeries Flashcards
What is palpated in Hypertrophic Pyloric Stenosis?
-olive shaped mass between midline and RUQ
What is Hypertrophic Pyloric Stenosis
Hypertrophy of muscularis layer
How is Hypertrophic Pyloric Stenosis diagnoisis made?
Ultrasound or barium swallow
What is the priority with Hypertrophic Pyloric Stenosis
- Intravascular volume
- Metabolic stabilization
Hypertrophic Pyloric Stenosis anesthesia considreations
- Empty stomach
- Local anesthetic is enough
- Careful w/ opioids
- Rectal tylenol
Hyperosmolar enemas are given w/ Duodenal and Ileal Obstruction Why, and what may occur?
- Clear viscid meconium plugs
- Shifts in intravascular volume
Duodenal Atresia is associated with what?
- Bilious vomiting 24-48hr after birth
- Small bowels cannot pass stomach contents
What does Xray reveal w/ Duodenal Atresia?
-Double bubble sign
When can elective nonincarcerated hernia be repaired?
-With no bowel obstruction
What is a sign of a high spinal.
- Sudden cessation of crying
- Apnea
When to wait for hernia repair in premies and why?
- 55 weeks post gestation
- Higher risk of apnea
What is omphalocele?
infant’s intestine or other abdominal organs stick out of the belly button
What is Gastroschisis
infant’s intestines stick out of the body through a defect of the umbilical cord.
What causes Omphalocle and Gastroschisis
- Folic acid deficiency
- Hypoxia
- Salicylates (pepto)
- ↑ Maternal serum alpha-fetoprotein
What occurs in associations with Omphalocle and Gastroschisis?
Polyhydraminos (too much amnotic fluid)
Neonate w/ omphalocele are usually in no distress, unless?
Associated hypoplasia
repair of omphalacele may precipitate __________, and ______ support
- Respiratory failure
- ventilator
Incidence of Gastroschisis is increasing to what 2 things?
- Young maternal age
- Low gravidity
Gastroschisis develops as a result of what?
occlusion of the omphalomesenteric artery during gestation
Gastroschisis is ______ with other anomalies
Not associated
What should be done w/ Gastroschisis preop and why?
- Plastic wrap
- ↓ volume loss
- ↓ hypothermia risk
If Gastroschisis closure is not possible due a _____ is created until ________ has resolved
- Silo
- Inflammation
What must be minimized w/ Gastroschisis?
-Fluid, electrolyte and heat loss
When should Gastroschisis silo be removed?
- Within a week
- Prevent infection
What is myelodysplasia?
- bone marrow does not function normally
- produces ↓ number of normal blood cells.
Myelodysplasia defects in spine are known as what?
Spina bifida
Meningoceles are lesions containing CSF w/o what?
Spinal tissue
Meningomyelocele is a meningocele with _______ _______ within the lesion.
Neural Tissue
In Myelodysplasia a ______ is needed for hydrocephalus.
VP Shunt
Myelodysplasia increases risk for what sensitivity?
Latex
Myelodysplasia anesthetic concerns
- Position for intubation
- Blood loss from skin graft
What is Arnold-Chiari Malformation?
- bony abnormality in the posterior fossa and upper cervical spine
- Caudal displacement below foramen magnum
Arnold-Chiari can present in healthy children as?
-Headache and neck pain
What is cystic fibrosis?
mucus to build up in the lungs, digestive tract, and other areas of the body
What is the most common fatal inherited disease?
Cystic fibrosis
Disruption of electrolyte transport in cystic fibrosis can cause what?
Elevated sweat chloride
What is the main cause of morbidity w/ cystic fibrosis?
-Lung disease
Pathophysiology of cystic fibrosis includes what?
- mucus plug
- infection
- inflammation
- epithelial injury
What causes slow mucus clearance in cystic fibrosis?
-Na absorption
-Chloride secretion
= decreased liquid on luminal surfaces
What are 3 common pathogens in cystic fibrosis?
- Staph Aureus
- Influenzae
- Psudamonas (later in life)
In cystic fibrosis pulmonary function are obstructive in nature and cause what?
- ↑ FRC
- ↓ FEV1
- ↓ peak flow rate
- ↓ vital capacity
In cystic fibrosis what produces lowered PaCO2?
Compensatory hyperventilation
In cystic fibrosis end stage cor pulmonale leads to what?
- Cardiomegaly
- fluid retention
- hepatomegaly
Low weight and BMI, are closely related to what?
Poor lung function
How dose diabetes arise from cystic fibrosis?
-Pancreatic disease
Hepatic dysfunction results in what?
- ↓ cholinesterase
- ↓ clotting factors
- ↓ Vitamin K
In cystic fibrosis, induction may be prolonged due to what 3 things?
- Large FRC
- Small tidal volume
- V/Q mismatch
What should be used in general anesthesia for cystic fibrosis and why?
- Humidified warmers
- to reach isothermic saturation point.
