Surgical d/o Flashcards

1
Q

Red flags of neonatal surgical d/o’s?

A
Maternal polyhydramnios
Delayed meconium passage
Abd distention (Obstruction)
Perinatal vomiting (bilious or non-bilious)
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2
Q

Maternal polyhydramnios is?

A

Inability of fetus to swallow/digest amniotic fluid = fluid backs up

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3
Q

MC TE fistula variation?

A

Esophageal atresia - w/ distal TEF

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4
Q

Esophageal atresia is?

A

Esophagus is incomplete and not continuous

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5
Q

Pathophys of Esophageal atresia?

A

Baby cannot swallow amniotic fluid >
Fluid cannot pass into intestine/transfer to placenta >
Mom cannot dispose >
=== Polyhydramnios (fluid backs up)

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6
Q

TE fistula presents as?

A
(MC) Cough, choking, respiratory distress, cyanosis
Excess saliva (drooling)
Symptoms worse w/ feeding
Single umbilical artery (common)
VACTRL
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7
Q

TE fistulas ass/w VACTRL are?

A
Anomalies
V - Vertebrae  (70%)
A - Anal atresia (imperforate anus)
C - Cardiac
T - TEF (itself) (70%) 
R - Renal 
L - Limb (polydactyly etc.) (70%)
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8
Q

TE fistulas are Dx how?

A

OG tube placement fails (CXR - catheter tube curled)
If difficult
- Water soluble gastrografin swallow study
- Methylene blue challenge

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9
Q

TE fistula TXT?

A

Ligate fistula, re-approximate esophagus
- anastomosis (may need to postpone due to gap)
Gastrostomy tube for feedings until surgery

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10
Q

Number one cause of Intestinal obstruction <3mo old?

A

Pyloric stenosis

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11
Q

MC pop of Pyloric stenosis

A

<3mo (2-6wk old MC)
M>F 5:1
1st born more common

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12
Q

Pyloric stenosis is?

A

Pyloric muscle hypertrophy and spasms = obstruction

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13
Q

Classic Pyloric stenosis presentation?

A

Post-prandial - nonbilious PROJECTILE vomit

Ravenously hungry > FTT and Lethargic

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14
Q

Labs of pyloric stenosis

A
Vomiting d/o = hypo Cl- and K+ (metabolic alkalosis)
Elevated BUN (dehydration)
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15
Q

Pyloric stenosis Abdominal exam signs?

A

Palpable - hypertrophied pylorus (An Olive)

LUQ Peristaltic Waves

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16
Q

Pyloric stenosis RADs? Findings?

A

U/S - elongated thickened pylorus
Barium Upper GI series - “String sign”
- barium passes elongated, constricted pyloric channel

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17
Q

Pyloric stenosis mgmt?

A

IV fluids/lytes resus (NS bolus > D5 w/ K+)
OG tube - slow feeds until surgery
Surgery = Pyloromyotomy

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18
Q

Congenital Diaphragmatic Hernia is?

A

Large posterolateral opening in diaphragm (usually unilateral) that allows bowel to herniate

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19
Q

Congenital Diaphragmatic Hernia occurs MC on what side?

A

L-side

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20
Q

Bochdalek formation is ass/w?

A

Congenital Diaphragmatic Hernia

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21
Q

Pathophys of Congenital Diaphragmatic Herniation?

A

Bowels develop BEFORE lungs >
Bowels impede NL lung development >
Left (Posteriorly)

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22
Q

Congenital Diaphragmatic Hernia presents as?

A
Progressive severe respiratory distress after delivery
Scaphoid Abd (hollowed anterior abd wall)
Bowel sounds in L-chest
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23
Q

Congenital Diaphragmatic Hernia Dx via?

A

XR

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24
Q

Congenital Diaphragmatic Hernia TXT?

A

Intubate/ventilate
Oro-gastric decompression
Surgery

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25
Q

Umbilical hernia is?

A

Imperfect closure/weakness of umbilical ring 1-5cm

May contain portions of Omentum/Sml intestines

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26
Q

What size Umbilical hernia will most likely NOT close on their own?

A

> 2cm

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27
Q

RFs of Umbilical hernia?

A

Low birth weight

AA

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28
Q

MC age Umbilical hernia is seen?

A

Most 6mo of age and disappear by 1yr

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29
Q

When is surgery recommended for Umbilical hernia?

A

Hernia persists to 4-5yo
Symptomatic or strangulated
Larger after 1-2yrs

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30
Q

Malrotation w/ midgut volvulus is?

A

Intestines fail to rotate during development causing a volvulus (obstruction/necrosis)

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31
Q

Pathophys of Malrotation w/ midgut volvulus?

A
Intestines fail to rotate during development >
Intestines twist on itself >
Intestinal obstruction >
Mesenteric artery occlusion > 
Ischemia /infarcation/necrosis
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32
Q

Presentation of Malrotation w/ midgut volvulus?

A

Bilious vomiting in 1st mo of life or later in infancy

TTP Abd

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33
Q

Ladd’s bands are?

A

Duodenal constrictions that may cause vomiting despite malrotation of midgut

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34
Q

Malrotation w/ midgut volvulus Rad?

A

XR - obstruction
Barium enema - Cecum in RUQ (twist pulls cecum up)
Corkscrew effect of upper GI - barium swallow

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35
Q

TXT of Malrotation w/ midgut volvulus

A

Fluids
OG decompression
Immediate - laparotomy

36
Q

Ddx Difference between bilious and non-bilious vomiting

A

Bilious

  • Malrotation w/ midgut volvulus
  • Intestinal atresia
  • Hirschsprung disease

Non-bilious vomiting - Pyloric stenosis

37
Q

Intestinal atresia ass/w?

A

Meconium ileus w/ cystic fibrosis (Check CF)

Trisomy 21

38
Q

Intestinal atresia presents as?

A
Bilious vomiting
Jaundice
Polyhydramnios
Failed attempts to feed
Abd distention
39
Q

Intestinal atresia Studies?

A

XR, Contrast study, Labs (CBC, CMP, amylase/lipase)

40
Q

Intestinal atresia XR may show?

A

Double bubble sign - if Duodenal atresia

Long dilated segments of air filled bowel - Distal atresia

41
Q

Intestinal atresia mgmt?

A

IV fluids
OG/NG decompression
Broad apectrum Abx
Surgery

42
Q

Gastrochisis is?

A

Split or open stomach - (Linear abdominal wall split/defect) exposes intestines to amniotic fluid w/ thick exudative peel over intestines (irritant)

43
Q

Gastroschisis occurs on what side MC?

A

Right side

44
Q

Does Gastroschisis involve umbilicus?

A

NO

45
Q

Gastroschisis is ass/w?

A

Segments of atresia

46
Q

Omphalocele pathophys is?

A

Impaired abdominal wall growth >
Intestines to remain in umbilical cord >
Herniation of bowel through umbilical ring

47
Q

Which is ass/w umbilicus Gastroschisis or Omphalocele?

A

Omphalocele is ass/w the umbilicus

48
Q

Gastroschisis/Omphalocele mgmt?

A

OG/NG decompress
IVF and Parenteral nutrition
Sterile dressing coverings
Surgery

49
Q

Gastroschisis/Omphalocele surgery considerations?

A

Small defects <2cm repaired immediately

Large defects req staged procedure

50
Q

Meckel’s diverticulum is?

A

A congenital malformation outpouching if ileum (remnant of vitelline duct) that may have ectopic mucosae similar to gastric/pancreatic

51
Q

MC intestinal malformation is?

A

Meckel’s diverticulum (true diverticulum)

52
Q

Meckel’s diverticulum rule of 2’s?

A
2% of population
Presents w/in 2yrs of life
W/in 2 ft of cecum on ileum
2 inches long
2 ectopic mucosae (gastric/pancreatic)
53
Q

Meckel’s diverticulum presents as?

A

Asymptomatic OR

  • Massive painless GI bleed
  • Ulceration of ileum
  • Intestinal obstruction
54
Q

Complications of Meckel’s diverticulum?

A

Intussusception or Volvulus = Obstruction
Diverticulitis
Bleeding > Perforation

55
Q

Meckel’s diverticulum Dx is performed?

A

Meckel Scan - (Technetium-99m scan) tests for gastric acid

U/S, video capsule endoscopy, surgical investigation

56
Q

Anorectal malformations are?

A

Absence of normal anal opening

Fistulas connecting structues present (meconium leak)

57
Q

Anorectal malformations mgmt?

A

Lateral XR = gas in bladder > distention > cath

MRI - check tethered spinal cord

58
Q

Other complications of Anorectal malformations?

A

Urologic dysfx

59
Q

Anorectal malformations TXT?

A

Surgery - colostomy after anogenital reconstruction

60
Q

Hirschsprung disease is?

A

Absent Motility defect causing congenital megacolon(dilation) proximal to aganglionic segment causing functional obstruction.

61
Q

Hirschsprung disease is MC located where in GI?

A

Rectosigmoid region 75%

62
Q

Hirschsprung disease presents as?

A

95% don’t pass stool by 24hrs of age
Abd distention due distal bowel obstruction
Bilious vomiting

63
Q

Hirschsprung disease Dx via?

A

XR - Dilated SML/LRG bowel proximal
Barium enema - Megacolon/Colonic impaction
Rectal Bx of aganglionic mucosa
Anorectal manometry
DRE - finger withdrawn = stool expulsion or empty.

64
Q

Hirschsprung disease TXT?

A

Surgery Colostomy above affected segment

  • Remove aganglionic section
  • Decompress distended/inflamed bowel
65
Q

Necrotizing enterocolitis is?

A

Ischemia 2nd to immature GI system and is ass/w prematurity and enteral feedings.

66
Q

Necrotizing enterocolitis mgmt?

A

Stop enteral feeds > Total parenteral nutrition (TPN)
GI decompression w/ NG
Fluid/Lyte replacement
Broad spectrum Abx
Surgery - laparotomy w/ excision of affected bowel.

67
Q

Necrotizing enterocolitis EARLY presentation?

A

Abd distention
feeding intolerance
Rectal bleed/occ. diarrhea
Emesis

68
Q

Necrotizing enterocolitis LATE presentation?

A
Bluish abdomen = Intestinal perforation
Bilious vomiting
Ascites
Lethargy
DIC/Shock
69
Q

Necrotizing enterocolitis Dx?

A

Clinical S/S

XR

70
Q

Necrotizing enterocolitis XR shows?

A

Ileus w/ bowel loop thickening and air-fluid levels
Bacterial Gas between bowel wall (pneumatosis int)
Dilated bowel
Pneumoperitoneum = perf
Intrahepatic venous gas

71
Q

Intussusception is?

A

Telescoping of proximal bowel into distal bowel

72
Q

Intussusception ass/w?

A

Meckels diverticulum (Ileocecal valve)
Peyer’s patched (lymphoid hyperplasia)
Rotavirus infection

73
Q

Intussusception presents as?

A
Paroxysmal, crampy abd pain/distention
Bilious vomiting
Currant jelly stools
RUQ/epigastric sausage shaped mass
Lethargy, Crying and drawing legs up
Refuses feeds
74
Q

Currant jelly stools appears?

A

Mixture of mucus, sloughed mucosa, and blood.

75
Q

Intussusception Dx?

A

Pneumatic or Barium enema w/ fluoroscopy

- Dx and TXT

76
Q

Intussusception Mgmt?

A

Fluid resuscitation
NG tube decompression
Pneumatic/Barium enema (Dx and TXT)
Surgical consult - reduction or resection

77
Q

MC surgical emergency in children?

A

Appendicitis

78
Q

Peak age for pediatric appendicitis?

A

10-12yo

79
Q

Appendicitis is?

A

Obstruction of appendix lumen (MC-fecalith or LN hyperplasia after viral infection.

80
Q

Appendicitis pathophys?

A

Obstruction >
Trapped bacteria proliferation >
Invade appendix wall >
Inflammation/rupture

81
Q

Timeframe for Appendicitis rupture after onset of S/S?

A

W/in 48hrs of s/s

82
Q

Appendicitis presents as?

A
Periumbilical visceral pain
RLQ pain - McBurney's point
Appendiceal distention 
Voluntary guarding > rigidity > rebound TTP
N/V
83
Q

Alvarado/Mantrels rule applies to? Is?

A
Appendicitis (<4pt = unlikely OR > 7pt = likely)
(1pt each)
- Pain migration to RLQ
- Anorexia
- N/V
- Rebound pain
- Fever 
- WBC L-shift >75% Segs
(2pt each)
- RLQ TTP
- Leukocytosis >10k
84
Q

Appendicitis Dx?

A

CT w/ IV contrast - MOST accurate
U/S
XR - Abd series/KUB
Lab - CBC, CMP, UA/Cx

85
Q

Appendicitis mgmt?

A

Appendectomy

IV Antibitoics

86
Q

Appendicitis PE signs for surgery?

A

Guarding/rigidity
Sev TTP
+ rebound TTP or referred pain

87
Q

Appendicitis tests to perform in PE?

A
Heel strike
Obturator sign (Int rotation of flexed thigh)
Psoas sign (Extension of hip on side)