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Clin Med- P > Surgery: pediatrics > Flashcards

Surgery: pediatrics Flashcards

1
Q

consent is a legal issue: what specific situations can kids seek care without parental consent? what type of intervention NEEDS an adults signature

A

substance abuse, contraception and pregnancy, psychiatric problems
BUT Operative intervention needs an adult’s signature

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2
Q

what is “assent”?

A

Consideration of child’s input

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3
Q

what are the 5 most common conditions that warrant pediatric surgery? (KNOW)

A 
Pyloric Stenosis
Meckel Diverticulum
Intussusception
Appendicitis
Splenic injury
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4
Q

Resuscitation for kids includes what? what might you need for severe hypovolemia? are oral fluids ok? KNOW

A

20 mL/kg bolus of isotonic fluid: Normal saline or lactated ringer’s (rare)
*May need additional boluses for severe hypovolemia
oral fluids OK for mild hypovolemia

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5
Q

two ways we remove intravascular fluid?

A

Diuresis and Dialysis

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6
Q

goal of mgmt for fluid management

A

make the pt euvolemic

not hypo or hypervolemic or fluid in the wrong place

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7
Q

fluid management: maintenance KNOW

A

Often 5% dextrose in 0.45% saline with 20 miliequivalents of potassium
“D5 ½ NS w/ 20 mEq K+”
4-2-1 rule

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8
Q

fluid mgmt: 4-2-1 rule KNOW

A
  • 4 mL/kg/hr for each of the first 10 kg weight
  • 2 mL/kg/hr for each kg from 10-20 kg
  • 1 mL/kg/hr for each kg above 20 kg

example: A 45 kg child would need 40 + 20 + 25 = 85 mL/hr

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9
Q

Most common cause of emesis (projectile vomiting) in infancy (KNOW)

A

pyloric stenosis

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10
Q

on physical exam: you palpate an olive shaped- mass in the abdomen (with projectile vomitting) KNOW

A

pyloric stenosis

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11
Q

what is the major danger with pyloric stenosis? KNOW

A

Hypochloremic hypokalemic metabolic alkalosis
- you have basic blood and acidic urine
so balance them!
RESUSCITATE immediately

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12
Q

what is the basic pathophys of pyloric stenosis?

A

Delayed hypertrophy, hyperplasia of pyloric circular muscles

Not present at birth, it develops

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13
Q

presentation of pyloric stenosis? (4) KNOW

A
  1. Progressive non-billious emesis : Undigested milk, can be coffee-ground with gastritis, diarrhea
  2. Dehydrated/malnourished : Increased appetite/thirst , Jaundice
  3. sunken fontanelles (if its progressed)
  4. “olive” felt in abdomen
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14
Q

txt of pyloric stenosis? KNOW

A

resuscitation (normal Na, Cl, bicarb <30) FIRST

  • can’t do surgery until they are electrodynamically stable
  • need bicarb < 30
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15
Q

surgery for pyloric stenosis? KNOW

A

Pyloromyotomy- divide hypertrophic muscular layer but not mucosa
** and then start re-feeding program

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16
Q

presentation of meckel’s diverticulum ? KNOW

A

often asymptomatic- incidental finding

- PE usually shows normal

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17
Q

what is the most common congenital GI abnormality? KNOW

A

meckel’s diverticulum

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18
Q

what is the “rule of 2s “ for meckel’s diverticulum? KNOW

A

“Rule of 2”

~2% population, 2 inches long, 2 cm in diameter, 2 feet from IC valve, can have 2 types of heterotopic mucosa, often presents by 2 years old

19
Q

txt for meckel’s diverticulum KNOW

A

Resect if symptomatic or causing pathology

–> Open and laparoscopic approaches (resection)

20
Q

Leading cause of obstruction before 2 years old KNOW

A

Intussusception

21
Q

how do you diagnose Meckel’s Divertculum? KNOW

A

Technetium-99 pertechnetate scan (aka a Meckel’s Scan)

- Ectopic gastric parietal cells

22
Q

what is intussusception? what is the usual cause?

A

Bowel “telescopes” in on itself and can cause ischemia; usually idiopathic

23
Q

presentation of intussusception ? KNOW

A

Severe intermittent pain with periods of complete relief
Blood and mucus in stool
May or may not have vomiting
Pain is cramping
* some infants demonstrate no signs of pain *

24
Q

what is the “dance sign” on Xray indicative of? KNOW

A

intussusception (RLQ empty)

25
Q

2 ways to Dx of intussusception? KNOW

A

Ultrasound: Target or “Donut” sign

Air or Contrast enema (can Dx and Txt with this- mainly ileocolic)

26
Q

intussusception txt (2), when would you operate? KNOW

A
  1. Fluid resuscitation
    2). Multiple attempts at reduction with enema if stable
    *small bowel will often spontaneously resolve
  2. Operate for peritonitis or persistent obstruction
    (Manually reduce intussusception)
27
Q

appendicitis presentation KNOW

A

Decreased appetite
Periumbilical pain that migrates to the RLQ
Laying very still, Felt every bump on the ride to hospital

28
Q

appendicitis: often will rupture in ___ - ___ hrs after onset of symptoms

A

24-36 hrs

29
Q

what are these indicative of?
Rovsing Sign – referred pain to RLQ
Psoas and obturator signs

A

appendicitis

30
Q

Dx of appendicitis ? KNOW

A

MOSTLY a clinical Dx but CT is helpful to confirm

31
Q

appendicitis txt KNOW

A

Laparoscopic appendectomy

32
Q

what is stump appendicitis? KNOW

A

the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy.

33
Q

PE of splenic injury KNOW

A
  • severe abd pain/discomfort
  • pale
  • tachy
  • hypotension (late finding)
34
Q

Dx of splenic injury KNOW

A 
CT scan (first) or FAST/US exam controversial in kids
*monitor Hb levels
35
Q

txt of splenic injury KNOW

A
  • 90% of grades I-IV can be done with supportive care
  • if operation is needed you can try to repair spleen with angioembolization
  • splenectomy and provide vaccines to avoid OPSI
36
Q

(OPSI)

A 
Overwhelming Post-splenectomy Sepsis
-Fairly rare, but more common in children
-Very severe once developed
Sepsis, meningitis 
Encapsulated organisms
37
Q

body weight fluid % for kids

A

total body water volume = 60% body weight
Intracellular = 40%
Extracellular = 20% (interstitial = 80%, plasma = 20%)

38
Q

how to diagnose pyloric stenosis? KNOW

A

abdominal US should be used first (also alkalotic labs)

39
Q

peak age of appendicitis? KNOW

A

11-12

40
Q

appendicitis pathophys KNOW (7)

A 
Luminal obstruction- (Lymphatic tissue, Fecalith, Parasites)
Stasis
Infection
Ischemia
Necrosis
Perforation
Abscess / phlegmon
41
Q

some sequelae for appendicitis? (4)

A

stump appendicitis
wound infection
post-op ileus
post-op abscess (consult IR for drain)

42
Q

Initial management of splenic injury KNOW

A 
Airway
Breathing
Circulation
Disability
Exposure
43
Q

Grades of splenic injury KNOW

A 
1 = laceration <1cm, subcapsular hematoma <10%
2 = laceration 1-3 cm, subcapsular hematoma 10-50%
3 = laceration >3cm, SH >50% OR ruptured SH
4 = segmental or hilar vascular injury and devascularization of >25%  of spleen
5 = hilar injury and shattered spleen
44
Q

post-splenectomy vaccines (3)

A

Streptococcus pneumonia
Haemophilus influenzaetype b
Nisseria meningitides

Clin Med- P (124 decks)

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