Surgical d/o Flashcards
Red flags of neonatal surgical d/o’s?
Maternal polyhydramnios Delayed meconium passage Abd distention (Obstruction) Perinatal vomiting (bilious or non-bilious)
Maternal polyhydramnios is?
Inability of fetus to swallow/digest amniotic fluid = fluid backs up
MC TE fistula variation?
Esophageal atresia - w/ distal TEF
Esophageal atresia is?
Esophagus is incomplete and not continuous
Pathophys of Esophageal atresia?
Baby cannot swallow amniotic fluid >
Fluid cannot pass into intestine/transfer to placenta >
Mom cannot dispose >
=== Polyhydramnios (fluid backs up)
TE fistula presents as?
(MC) Cough, choking, respiratory distress, cyanosis Excess saliva (drooling) Symptoms worse w/ feeding Single umbilical artery (common) VACTRL
TE fistulas ass/w VACTRL are?
Anomalies V - Vertebrae (70%) A - Anal atresia (imperforate anus) C - Cardiac T - TEF (itself) (70%) R - Renal L - Limb (polydactyly etc.) (70%)
TE fistulas are Dx how?
OG tube placement fails (CXR - catheter tube curled)
If difficult
- Water soluble gastrografin swallow study
- Methylene blue challenge
TE fistula TXT?
Ligate fistula, re-approximate esophagus
- anastomosis (may need to postpone due to gap)
Gastrostomy tube for feedings until surgery
Number one cause of Intestinal obstruction <3mo old?
Pyloric stenosis
MC pop of Pyloric stenosis
<3mo (2-6wk old MC)
M>F 5:1
1st born more common
Pyloric stenosis is?
Pyloric muscle hypertrophy and spasms = obstruction
Classic Pyloric stenosis presentation?
Post-prandial - nonbilious PROJECTILE vomit
Ravenously hungry > FTT and Lethargic
Labs of pyloric stenosis
Vomiting d/o = hypo Cl- and K+ (metabolic alkalosis) Elevated BUN (dehydration)
Pyloric stenosis Abdominal exam signs?
Palpable - hypertrophied pylorus (An Olive)
LUQ Peristaltic Waves
Pyloric stenosis RADs? Findings?
U/S - elongated thickened pylorus
Barium Upper GI series - “String sign”
- barium passes elongated, constricted pyloric channel
Pyloric stenosis mgmt?
IV fluids/lytes resus (NS bolus > D5 w/ K+)
OG tube - slow feeds until surgery
Surgery = Pyloromyotomy
Congenital Diaphragmatic Hernia is?
Large posterolateral opening in diaphragm (usually unilateral) that allows bowel to herniate
Congenital Diaphragmatic Hernia occurs MC on what side?
L-side
Bochdalek formation is ass/w?
Congenital Diaphragmatic Hernia
Pathophys of Congenital Diaphragmatic Herniation?
Bowels develop BEFORE lungs >
Bowels impede NL lung development >
Left (Posteriorly)
Congenital Diaphragmatic Hernia presents as?
Progressive severe respiratory distress after delivery Scaphoid Abd (hollowed anterior abd wall) Bowel sounds in L-chest
Congenital Diaphragmatic Hernia Dx via?
XR
Congenital Diaphragmatic Hernia TXT?
Intubate/ventilate
Oro-gastric decompression
Surgery
Umbilical hernia is?
Imperfect closure/weakness of umbilical ring 1-5cm
May contain portions of Omentum/Sml intestines
What size Umbilical hernia will most likely NOT close on their own?
> 2cm
RFs of Umbilical hernia?
Low birth weight
AA
MC age Umbilical hernia is seen?
Most 6mo of age and disappear by 1yr
When is surgery recommended for Umbilical hernia?
Hernia persists to 4-5yo
Symptomatic or strangulated
Larger after 1-2yrs
Malrotation w/ midgut volvulus is?
Intestines fail to rotate during development causing a volvulus (obstruction/necrosis)
Pathophys of Malrotation w/ midgut volvulus?
Intestines fail to rotate during development > Intestines twist on itself > Intestinal obstruction > Mesenteric artery occlusion > Ischemia /infarcation/necrosis
Presentation of Malrotation w/ midgut volvulus?
Bilious vomiting in 1st mo of life or later in infancy
TTP Abd
Ladd’s bands are?
Duodenal constrictions that may cause vomiting despite malrotation of midgut
Malrotation w/ midgut volvulus Rad?
XR - obstruction
Barium enema - Cecum in RUQ (twist pulls cecum up)
Corkscrew effect of upper GI - barium swallow