Surgery Flashcards
Omphalocele vs gastroschisis
Omphalocele is through the umbilicus, covered by a sac
Gastroschisis is paraumbilical (usually to the right), no sac
Lab findings in pyloric stenosis
Hypokalemic hypochloremic metabolic alkalosis
Often associated with unconjugated hyperbilirubinemia
US findings in pyloric stenosis
Thickness 3-4 mm
Diameter 10-14 mm
Length 15-19 mm
Causes of intussusception
Idiopathic (90%)
Respiratory viruses/swollen Peyer’s patches
Rotavirus vaccine
Meckel diverticulum*
GJ/J tube
Neurofibroma
Classic triad of intussusception
Pain
Palpable sausage shaped mass
Bloody or current jelly stools
Seen in < 30%
Management of umbilical hernia
No surgery until 4-5 years old
Very rarely becomes strangulation
Less likely to close if > 2 cm, connective tissue disease, or genetic syndrome
Symptoms of peptic ulcer disease
Hematemesis or melena
Epigastric pain and nausea
Nocturnal pain in older children
Dyspepsia, fullness
Rule of 2s
Meckel Diverticulum
2% of infants, 2-6 cm long, approximately 2 feet from ileocecal valve
2 types of ectopic tissue (pancreatic or gastric)
Present before the age of 2 years, twice as common in females
Infant < 1 with bilious vomiting
Malrotation with volvulus until proven otherwise!
Diagnosis of malrotation
Contrast UGI is gold standard
Can see bird’s beak sign where gut is twisted
Ligament of treitz (holds antrum in place) will be on the right instead of left
Fibroadenomas (location, cause, characteristics, management)
Typically in upper outer quadrant
Develop because of local exaggerated response to estrogen, can enlarge during cycle
Well circumscribed, rubbery, mobile, non tender
Follow with serial US ever 6-12 months to check for malignant characteristics, excise if concerning
When to
1. Refer
2. Surgery
for undescended testes
- 6 months
- 9-15 months
Communicating vs non communicating hydrocele
Communicating: persistently patent processus vaginalis, size fluctuates, repair after 12-18 months, at risk for hernia
Non-communicating: processus vaginalis was obliterated, fluid should disappear by 1 year
How long to postpost GA if child has respiratory illness
6 weeks typically
If only clear rhinorrhea and no fever, could proceed
Low threshold to cancel if < 1 year old
Risk is airway hypersensitivity (bronchospasm, laryngospasm)
Varicocele
“bag of worms”
Left!! If on right or < 10 yrs, image in case of tumor
Typically painless, but can have dull ache especially with standing
Follow with semen analysis, can affect fertility
Direct vs indirect hernia
Indirect: patent processes vaginalis (congenital)
Direct: weakness in abdominal wall musculature, does not go through external ring
When to refer and do surgery for inguinal hernias
Will not resolve spontaneously, so refer on detection
Surgery ideally within few weeks because of risk for incarceration in first year
Femoral hernias
Females > males
Originates medially to femoral vein and descends inferior to inguinal ligament
Protrudes below the inguinal region
Does not enter scrotum or labia
Hirschsprung disease pathology
Absence of enteric ganglionic neurons
Results in aganglionic segment, internal sphincter, and anal canal to be constantly contracted
Proximal segment is dilated and hypertrophied
Hirschsprung enterocolitis
Happens if undiagnosed at 1 month
Fever with explosive stools, bloody diarrhea, distension
Dilated bowel with air fluid levels
Thought to be from bacterial overgrowth
Can occur after surgical correction as well
Tx: fluids, abx, NG decompression, rectal washouts, colostomy once stable
Treatment of perianal abscesses in
1. younger
2. older
patients
- Often will spontaneously drain and resolve, warm compresses and sitz baths, no abx
- More associated with crohns or immunocompromised, may need abx
Distal intestinal obstruction syndrome
Cystic fibrosis!
Like meconium ileus but in older children
RFs: pancreatic insufficency, deltF508, poor fat absorption, dehydration
Crampy RLQ abdo pain, distension, weight loss, poor appetite, mass in RLQ, can get vomiting
Tx: fluids and lyte corrections, NG lavage if no emesis, enemas if emesis, may need sx
When to repair
1. cleft lip
2. cleft palate
- 2-6 months
- 9-18 months
Polydacytly management
XR to define anatomy and evaluate for any co-existing bony anomalies
Surgical removal between 9-12 months
Isolated polydactyly can be AD
