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GI Exam 1 > Peds Surgery -Safoui > Flashcards

Peds Surgery -Safoui Flashcards

1
Q

What things are associated with esophageal atresia?

A
  • polyhydramnios in pregnancy

- VACTERL (veretebral, anorectal, cardiac* (most common), trachoesophageal, renal, limb)

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2
Q

What is the most common type of esophageal atresia? How is EA diagnosed?

A

Type C

(proximal atresia with distal fistula)

can be diagnosed prenatally with MRI and US

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3
Q

How does a baby with an EA present?

A
  • newborn with excessive drooling w/in first few hours
  • choking when attempting feeding
  • cyanosis/resp distress
  • Type C=abdominal dissension when crying (air into stomach)
  • failure to pass NG tube (will coil in mouth or esophagus)
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4
Q

If there is a pure atresia, will there be air in the abdomen?

A

NO!

there is no fistula to get air into the abd

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5
Q

What is the treatment for a esophageal atresia?

A

1: rule out the VACTERL anomalies (esp cardiac=most common)

  • NG tube in proximal pouch to prevent aspiration
  • elevate the head (prevent reflux)
  • surgical consult and do the ECHO
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6
Q

What vessel will be in the way in an esophageal atresia repair?

A

Azygous vein

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7
Q

What is an omphalocele?

A
  • Defect in abdominal wall at the site of the umbilical ring in which bowel and solid viscera protrude (lateral folds do NOT close)
  • Covered by peritoneum and amniotic membrane=protected.
  • Umbilical cord inserts into sac.
  • associated with congenital anomalies
  • can see on US
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8
Q

What is the most common anomaly seen with omphaloceles?

A

cardiac

10-50% premature

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9
Q

What is the temporary treatment for an omphalocele?

A

maintain body temp and cover omphalocele to reduce fluid loss (silo)

-normally 4 cm+

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10
Q

What is the difference between omphalocele and gastroschisis?

A
  • gastroschisis has NO overlying sac on the intestinal contents
  • also it is normally to the RIGHT of the umbilicus (instead of through it with omphalocele)
  • Gastroschisis is also < 4 cm while omphalocele is > 4 cm
  • no anomalies associated with gastrocschisis
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11
Q

What anomalies are associated with gastroschisis? How large are they normally?

A

NONE

–> can be seen 10% of the time with esophageal atresia

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12
Q

What is the treatment for gastroschisis?

A

resuscitate if need and then urgent surgery because NOT covered

close surgically within 1-2 weeks

if atresia, will have to close first then go back to correct the atresia

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13
Q

What is the most common cause of vomiting in childhood?

A

acute viral gastroenteritis

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14
Q

What does bilious emesis in a child indicate? What has to be ruled out?

A

an intestinal obstruction (dark green)

most important to rule out=malrotation with midgut volvulus =surgical emergency

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15
Q

What is pyloric stenosis? What is the typical presentation?

A

postnatal muscular hypertrophy of the pylorus –> gastric outlet obstruction

  • often seen in newborn male with projectile postprandial non bilious emesis
  • palpable “olive:” in the RU abd
  • Hypochloremic hypokalemic metabolic alkalosis with a paradoxical aciduria
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16
Q

What US finding is diagnostic of a pyloric stenosis?

A

channel length of >16 mm and pyloric thickness of >4 mm

17
Q

What is the treatment for pyloric stenosis?

A

*Must fluid resuscitate and correct the metabolic alkalosis first!

  • Once electrolytes are normal, then surgical intervention.
  • -> Ramstedt pyloromyotomy (small cut to allow it to open the obstruction)
18
Q

How will a proximal vs distal obstruction present in a newborn with bilious emesis? What has to be ruled out in proximal obstructions?

A

Proximal:

  • emesis first, no distension
  • r/o malrotation with midgut ovules

Distal:

  • abd distension and then emesis
  • absent/delayed stool (>24 hours)
19
Q

What is the most common cause of malrotation?

A

nonrotation

20
Q

What is the gold standard for malrotation diagnosis without vovulus? Who should this NOT be performed on?

A

upper GI =corkscrew appearance “whirlpool sign”

do NOT perform on a pt in shock or with midgut volvulus*

21
Q

What is an annular pancreas? What is it associated with?

A

Due to incomplete rotation of the ventral pancreatic bud resulting in the pancreas encircling the 2nd part of the duodenum.

annular=ring

Associated with trisomy 21.

22
Q

What is the most common cause of obstruction in newborns < 1 week? What is the most common embryological cause of this?

A

Duodenal atresia

*failure to recanalize

23
Q

What are the x ray findings seen with duodenal atresia? What is this associated with?

A

“double bubble” on x ray
-if distal air–> r/o midgut volvulus

associated with trisomy 21

24
Q

What is the most frequent cause of intestinal obstruction in the first 2 years of life (6-24 months)? When does this normally occur?

A

Intussusception

normally after a viral illness

terminal ileum telescopes into the colon

25
Q

What is the clinical presentation of intussusception?

A

waves of abd pain then diarrhea with currant jelly stools (bloody bowel movements with mucus)

-may palpate a sausage mass in the upper abd.

26
Q

What are most pts with meconium ileus associated with? How is this treated?

A

Cystic fibrosis

water-soluble enema then surgery if needed

ground glass appearance on x-ray

27
Q

What is the most frequent and lethal GI disorder in preemies? What area is most commonly involved?

A

Necrotizing enterocolitis (NEC) =bowel distention with patchy areas of thinning, pneumatosis, gangrene, and frank perforation.

most commonly involves the terminal ileum and the colon

28
Q

What plain film finding is pathognomonic for NEC?

A

pneumatosis intestinalis –> invasion of the ischemic mucosa by gas-producing microbes

29
Q

What is short gut syndrome? what is the most common cause of short gut syndrome?

A
  • Removal of more than 50% of small bowel length.
  • Ranges from 150 to 300 cm in a newborn
  • Need at least 30 cm with ICV
  • Without ICV need at least 70 cm

*most common cause=neonatal intestinal resection (most reason for it is NEC)

30
Q

What is the most common cause of death in short gut?

A

liver failure from TPN

31
Q

What is Hirschsprung disease? What is the clinical finding associated with this?

A

Congenital Aganglionic Megacolon

  • Absence of ganglion cells in the submucosal and muscular layers of the colon
  • failure to pass meconium within 48 hours of life
  • can be associated with trisomy 21
32
Q

What will happen to a kiddo with biliary atresia that is not corrected?

A

Biliary cirrhosis, hepatic failure, and death occur uniformly by age 18–24 months without surgical correction or transplantation

want to diagnose before 3 months or will need a liver transplant

GI Exam 1 (16 decks)

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