Surgery (Gsx, optho, ent) Flashcards
Pyloric stenosis gas
hypochloremic hypokalemic metabolic alkalosis
common electrolyte derrangement in bowel obstruction
hypokaleia due to isotonic intravascular fluid depletion
Umbilical hernia management
no need to do surgery until school age (4-6 yrs)
if incarcerated, reduce and then repair soon
if strangulated, reduce in OR and then repair
It is recommended to repair any umbilical hernias with the defect of 1.5 cm or more in children over the age of 2 years because of minimal chance of spontaneous closure
Inguinal hernia management
refer asap - repair once stable but asap
US criteria for appendicitis
wall thickness ≥6 mm, luminal distention, lack of compressibility, a complex mass in the RLQ, or an appendicolith.
Omphalocele vs gastroschisis
Omphalocele
- awful
- sac around the abdominal contents because contents herniate into base of the cord
- often has associated anomalies (ex Beckwith Wiedeman, T13, T18, T21)
- bad baby, good gut
Gastroschisis
- typically smaller defect
- no membrane over the organs
- often isolated
- good baby, bad gut
Testicular torsion presentation
pain often is sudden in onset and may be associated with exercise or minor genital trauma, can see associated N/V, scrotum is often swollen, cremasteric reflex is often absent and the position (lie) of the testis is abnormal, and the testis position often is high in the scrotum
Epididymitis presentation
unilateral scrotal swelling and tenderness, erythema, often accompanied by a hydrocele and palpable swelling of the epididymis, associated with the history of urethral discharge
Diagnosis of testicular torsion
doppler US
Diagnostic test for Hirschsprung
Deep rectal biopsy (rectal suction biopsy)
Needs to be no closer than 2 cm above dentate line
Positive: aganglionosis
can also do contrast enemaa (only 70% sensitive)
Diagnostic test for diaphragm eventration
Dynamic US or diaphragm fluoroscopy (needs to be dynamic)
Timing for undescended testes surgery
6mo to 1 yr
bilious emesis in neonate
malrotation with volvulus
15 yr old sexually active male with 24 hrs low grade fever, dysuria, scrotal swelling and pain. Pyuria, microscopic hematuria. Treatment for the presumed diagnosis?
Epididymitis
STI
treat pt and partners with abx
Right sided vs left sided varicocele
right sided varicocele is concerning and should investigate for abdominal mass
left sided is likely due to SMA blocking the left renal vein
dull ache standing with bag of worms
Tubo ovarian abscess management
Ceftriaxone + doxycycline + metronidazole
Management of umbilical granuloma
Granulation tissue is treated by cauterization with silver nitrate, repeated at intervals of several days until the base is dry.
delayed umbilical cord separation
think leukocyte adhesion defect
normally separates within 1-2 weeks
Meckels diverticulum
Rule of 2’s:
2% of population
~2 feet from ileocecal valve
2 inches long
Presents in patients <2 50% of the time
“2 types of tissue” - usually contain ectopic mucosa
most common location for intuss
ileal colonic
Surgery indications for intuss
Indication for surgical reduction= refractory shock, suspected bowel necrosis or perforation, peritonitis, and multiple recurrences (suspected lead point)
2 year old girl with painless bright red blood per rectum. What test will best reveal diagnosis?
Meckel’s scan
Accounts for 50% of all lower GI bleeds in children younger than 2 yr of age
Painless rectal bleeding (peptic ulceration due to ectopic gastric tissue) Most are asymptomatic.
May cause perforation or peritonitis (like appendicitis). May be lead point for intussusception
Management G tube granulation tissue (CPS)
Ensure tube is secured to skin
Remove dressing
Apply warm saline compresses 3–4 times daily
If saline compresses are not effective and tissue is large, moist and friable, consider applying silver nitrate every 2–3 days until it resolves. Protect surrounding skin with a barrier cream before applying silver nitrate to avoid burning normal skin (1,15)
For balloon devices, ensure balloon is intact and appropriately inflated
age to start visual screening
3-5 yrs
Child with photophobia, squinting and tearing. Rt pupil bigger than left. Watery discharge and conjunctival injection of Rt eye. They are afebrile. Normal pupillary response and EOM but cornea is cloudy. What is the most likely diagnosis:
Glaucoma
pupil bigger
cornea opaque
blepharospasm (squinting)
Adenovirus ketatoconjunctivitis
pseudomembranse
foreign body sensation
looks like viral conjunctivitis
No specific medical therapy is available to decrease the symptoms or shorten the course of the disease. Emphasis must be placed on prevention of spread of the disease.
