Surgical Flashcards
How common is perforation of the appendix in pediatric appendicitis?
Very common –
2/3 to 3/4 of cases
(the youngest children have the highest perf rates)
What age group is most likely to develop appendicitis?
Adolescents/young adults
What is the eponymic name for the spot in the right lower quadrant where appendicitis pain often localizes?
McBurney’s point
If a patient suspected to have appendicitis suddenly has relief of pain, what should you suspect?
He or she just perf’ed
What tissues are mainly involved in absorption of peritoneal fluid?
- Liver
- Portal venous system
- Lymphatics
What is the natural history of an umbilical hernia?
Most umbilical hernias smaller than 0.5 cm spontaneously close before a patient is 2 years old. Those between 0.5 and 1.5 cm take up to 4 years to close. If the umbilical hernia is larger than 2 cm, it may still close spontaneously, but may take up to 6 years or more to do so. Unlike an inguinal hernia, incarceration and strangulation are rare with an umbilical hernia
When should an infant with inguinal hernia have it electively repaired?
After the diagnosis of inguinal hernia is made, it should be repaired as soon as possible .
What are the clinical findings of malrotation of the intestine?
The lesion may display in utero volvulus, or it may be asymptomatic throughout life. Infants may display intermittent vomiting or exhibit signs compatible with complete obstruction. Any infant with bilious vomiting should be considered emergent and requires careful evaluation for volvulus and other high-grade surgical obstructions. Recurrent abdominal pain, distention, or lower GI bleeding may result from intermittent volvulus. Full volvulus with arterial compromise results in intestinal necrosis, peritonitis, perforation, and an extremely high incidence of mortality. Because of the extensive nature of the lesion, postoperative short gut syndrome is present in many patients who require resection. An upper GI contrast study is the examination of choice when the diagnosis is suspected.
What causes the intestinal obstruction in malrotation?
Malrotation of the intestine is the result of the abnormal rotation of the intestine in the tenth week of gestation around the superior mesenteric artery. Arrest of this counterclockwise rotation may occur at any degree of rotation. The cecum is unattached and located in the upper abdomen. One consequence of improper fixation of the mesentery allows for twisting ( volvulus ). Additionally, abnormal tissue (Ladd bands) connects the abnormally located cecum to the abdominal wall and may create a duodenal blockage
What is the most common cause of intestinal obstruction in young children?
Intussusception , which occurs when one portion of the bowel invaginates into the other is the most common cause of intestinal obstruction in young children. Intussusception usually occurs before the second year of life; half of all cases occur between the ages of 3 and 9 month
In what settings should intussusception be suspected?
Colicky pain is seen in more than 80% of cases, but it may be absent. It typically lasts 15 to 30 minutes, and the baby usually sleeps between attacks. In about two-thirds of cases, there is blood in the stool (currant jelly stools). Other presenting symptoms include massive lower GI bleeding or blood streaking on the stools. The infant may appear quite toxic, dehydrated, or in shock; fever and tachycardia are common. A right lower quadrant mass may be palpable, or the area may feel surprisingly empty. Distention may accompany decreased bowel sounds.
How frequently does intussusception recur?
Overall recurrence rates for intussusception are about 13%. The recurrence rate during the first 24 hours is low, 2% to 4%, so the vast majority of recurrences will not be identified by overnight hospitalization.
Rotavirus vaccine and intussusception: how are they intertwined?
Rotashield , an oral rotavirus vaccine licensed in the United States in 1998, was suspended from use in 1999 when increased rates of intussusception were noted. Two new rotavirus vaccines, RotaTeq and Rotarix, were licensed in 2006 and 2008, respectively. International postlicensure studies and U.S. data have demonstrated a slightly increased risk for intussusception during the first 3 weeks after the first dose of both vaccines.
Duodenal or jejunoileal atresia: which is associated with other embryonic abnormalities?
Duodenal atresia. Duodenal atresia is caused by a persistence of the proliferative stage of gut development and a lack of secondary vacuolization and recanalization. It is associated with a high incidence of other early embryonic abnormalities. Extraintestinal anomalies occur in two-thirds of patients with this condition.
Jejunoileal atresia occurs after the establishment of continuity and patency as evidenced by distal meconium seen in these patients. The etiology is postulated to be a vascular accident, volvulus, or mechanical perforation. Jejunoileal atresias are usually not associated with any other systemic abnormality.
How does the infant with biliary atresia classically present?
Biliary atresia is a condition in which the extrahepatic biliary system is obliterated, and bile flow is obstructed. In classic cases, an otherwise healthy-appearing term infant develops a recognizable jaundice by the third week of life, with increasingly dark urine and acholic stools. Usually, the child appears well, with acceptable growth. The skin color sometimes appears somewhat greenish yellow. The spleen becomes palpable after the third or fourth week, at which time the liver is usually hard and enlarged. In other cases, the jaundice is clearly present in the conjugated form during the first week of life. There is also a strong association between the polysplenia syndrome and earlier presentation of biliary atresia.
