Stevens #1 Common Surgeries

Question 1

What is palpated in Hypertrophic Pyloric Stenosis?

Answer 1

-olive shaped mass between midline and RUQ

Question 2

What is Hypertrophic Pyloric Stenosis

Answer 2

Hypertrophy of muscularis layer

Question 3

How is Hypertrophic Pyloric Stenosis diagnoisis made?

Answer 3

Ultrasound or barium swallow

Question 4

What is the priority with Hypertrophic Pyloric Stenosis

Answer 4

• Intravascular volume

- Metabolic stabilization

Question 5

Hypertrophic Pyloric Stenosis anesthesia considreations

Answer 5

• Empty stomach
• Local anesthetic is enough
• Careful w/ opioids
• Rectal tylenol

Question 6

Hyperosmolar enemas are given w/ Duodenal and Ileal Obstruction Why, and what may occur?

Answer 6

• Clear viscid meconium plugs

- Shifts in intravascular volume

Question 7

Duodenal Atresia is associated with what?

Answer 7

• Bilious vomiting 24-48hr after birth

- Small bowels cannot pass stomach contents

Question 8

What does Xray reveal w/ Duodenal Atresia?

Answer 8

-Double bubble sign

Question 9

When can elective nonincarcerated hernia be repaired?

Answer 9

-With no bowel obstruction

Question 10

What is a sign of a high spinal.

Answer 10

• Sudden cessation of crying

- Apnea

Question 11

When to wait for hernia repair in premies and why?

Answer 11

• 55 weeks post gestation

- Higher risk of apnea

Question 12

What is omphalocele?

Answer 12

infant’s intestine or other abdominal organs stick out of the belly button

Question 13

What is Gastroschisis

Answer 13

infant’s intestines stick out of the body through a defect of the umbilical cord.

Question 14

What causes Omphalocle and Gastroschisis

Answer 14

• Folic acid deficiency
• Hypoxia
• Salicylates (pepto)
• ↑ Maternal serum alpha-fetoprotein

Question 15

What occurs in associations with Omphalocle and Gastroschisis?

Answer 15

Polyhydraminos (too much amnotic fluid)

Question 16

Neonate w/ omphalocele are usually in no distress, unless?

Answer 16

Associated hypoplasia

Question 17

repair of omphalacele may precipitate __________, and ______ support

Answer 17

• Respiratory failure

- ventilator

Question 18

Incidence of Gastroschisis is increasing to what 2 things?

Answer 18

• Young maternal age

- Low gravidity

Question 19

Gastroschisis develops as a result of what?

Answer 19

occlusion of the omphalomesenteric artery during gestation

Question 20

Gastroschisis is ______ with other anomalies

Answer 20

Not associated

Question 21

What should be done w/ Gastroschisis preop and why?

Answer 21

• Plastic wrap
• ↓ volume loss
• ↓ hypothermia risk

Question 22

If Gastroschisis closure is not possible due a _____ is created until ________ has resolved

Answer 22

• Silo

- Inflammation

Question 23

What must be minimized w/ Gastroschisis?

Answer 23

-Fluid, electrolyte and heat loss

Question 24

When should Gastroschisis silo be removed?

Answer 24

• Within a week

- Prevent infection

Question 25

What is myelodysplasia?

Answer 25

- bone marrow does not function normally | - produces ↓ number of normal blood cells.

Question 26

Myelodysplasia defects in spine are known as what?

Answer 26

Spina bifida

Question 27

Meningoceles are lesions containing CSF w/o what?

Answer 27

Spinal tissue

Question 28

Meningomyelocele is a meningocele with _______ _______ within the lesion.

Answer 28

Neural Tissue

Question 29

In Myelodysplasia a ______ is needed for hydrocephalus.

Answer 29

VP Shunt

Question 30

Myelodysplasia increases risk for what sensitivity?

Answer 30

Latex

Question 31

Myelodysplasia anesthetic concerns

Answer 31

- Position for intubation | - Blood loss from skin graft

Question 32

What is Arnold-Chiari Malformation?

Answer 32

- bony abnormality in the posterior fossa and upper cervical spine - Caudal displacement below foramen magnum

Question 33

Arnold-Chiari can present in healthy children as?

Answer 33

-Headache and neck pain

Question 34

What is cystic fibrosis?

Answer 34

mucus to build up in the lungs, digestive tract, and other areas of the body

Question 35

What is the most common fatal inherited disease?

Answer 35

Cystic fibrosis

Question 36

Disruption of electrolyte transport in cystic fibrosis can cause what?

Answer 36

Elevated sweat chloride

Question 37

What is the main cause of morbidity w/ cystic fibrosis?

Answer 37

-Lung disease

Question 38

Pathophysiology of cystic fibrosis includes what?

Answer 38

- mucus plug - infection - inflammation - epithelial injury

Question 39

What causes slow mucus clearance in cystic fibrosis?

Answer 39

-Na absorption -Chloride secretion = decreased liquid on luminal surfaces

Question 40

What are 3 common pathogens in cystic fibrosis?

Answer 40

- Staph Aureus - Influenzae - Psudamonas (later in life)

Question 41

In cystic fibrosis pulmonary function are obstructive in nature and cause what?

Answer 41

- ↑ FRC - ↓ FEV1 - ↓ peak flow rate - ↓ vital capacity

Question 42

In cystic fibrosis what produces lowered PaCO2?

Answer 42

Compensatory hyperventilation

Question 43

In cystic fibrosis end stage cor pulmonale leads to what?

Answer 43

- Cardiomegaly - fluid retention - hepatomegaly

Question 44

Low weight and BMI, are closely related to what?

Answer 44

Poor lung function

Question 45

How dose diabetes arise from cystic fibrosis?

Answer 45

-Pancreatic disease

Question 46

Hepatic dysfunction results in what?

Answer 46

- ↓ cholinesterase - ↓ clotting factors - ↓ Vitamin K

Question 47

In cystic fibrosis, induction may be prolonged due to what 3 things?

Answer 47

- Large FRC - Small tidal volume - V/Q mismatch

Question 48

What should be used in general anesthesia for cystic fibrosis and why?

Answer 48

- Humidified warmers | - to reach isothermic saturation point.