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Pediatrics > Common Pediatric Surgeries > Flashcards

Common Pediatric Surgeries Flashcards

1
Q

Defect of anterior abdominal wall to the right of the umbilical cord- Gastroschisis or Omphalocele?

A

Gastroschisis

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2
Q

Which is more common- gastroschisis or omphalocele?

A

Omphalocele

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3
Q

Which is associated with other anomalies-gastroschisis or omphalocele?

A

Omphalocele

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4
Q

Which one is the umbilical cord within the defect-gastroschisis or omphalocele?

A

Omphalocele

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5
Q

Which is considered a lateral defect (to the right)-gastroschisis or omphalocele?

A

Gastroschisis

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6
Q

Which is associated with Beckwith-Wiedemann Syndrome-gastroschisis or omphalocele??

A

Omphalocele

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7
Q

Which is associated with less damage to the abdominal contents- gastroschisis or omphalocele?

A

Omphalocele

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8
Q

Which is associated with only large and small intestine involvement- gastroschisis or omphalocele?

A

Gastroschisis

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9
Q

Which is associated with small fascial defect (2-5cm)- gastroschisis or omphalocele?

A

Gastroschisis

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10
Q

What vascular event is associated with gastroschisis?

A

Abnormality of the right omphalomesenteric artery and/or right umbilical vein

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11
Q

What are the 5 abnormalities associated with Beckwith- Wiedemann Syndrome?

A
  1. Omphalocele
  2. Visceromegaly
  3. Macroglossia
  4. Microcephaly
  5. Hypoglycemia
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12
Q

What is the preferred method of abdominal wall abnormalities- primary repair or staged?

A

Staged

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13
Q

Over how many days is the abdominal cavity repaired over in a staged repair approach?

A

3-14 days

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14
Q

What are some negative effects of tight abdominal closure?

A
  1. Impairs diaphragmatic excursion (inadequate ventilation, increased airway pressure)
  2. Impedes venous return (profound hypotension)
  3. Aortocaval compression (bowel ischemia, decreased CO, renal and hepatic dysfunction).
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15
Q

What are unsafe primary abdominal closure parameters?

A
  1. Intragastric pressure >20mmHg
  2. Change in CVP >4mmHg from baseline
  3. EtCO2 > 50mmHg
  4. Peak Inspiratory Pressure > 35 cm H2O
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16
Q

How should massive fluid losses be mitigated for abdominal wall abnormalities?

A

MIVF 2-4 x maintenance rate
Urine output 1-2ml/kg/hr.
Normothermia with covered abd contents with warm saline soaked gauze

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17
Q

What are post-operative management for abdominal wall abnormalities?

A
  1. Mech vent for 24-48hrs
  2. Fluid requirements watched closely
  3. Cynanotic lower limbs and bowel ischemia
  4. Prevent infection
  5. Prolonged post-operative ileus (TPN required for days).
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18
Q

Post-operative complications for abdominal wall repair?

A
  1. Pneumonia
  2. NEC
  3. Renal insufficiency
  4. Abdominal wall breakdown
  5. GERD
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19
Q

How frequent is CDH in live births?

A

1: 2,000-5,000

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20
Q

What is the potential cause of CDH?

A

Prenatal history of Polyhydramnios

21
Q

What are the associated anomalies with CDH?

A

Malrotation of gut 40%.
Cardiovascular 20%.
CNS/GI/GU 15-30%

22
Q

CDH complications factors?

A
  1. Bilateral lung hypoplasia
  2. Pulmonary HTN and arteriolar reactivity
  3. Left ventricular dysfunction
23
Q

What is classic triad of clinical presentation with CDH?

A
  1. Dyspnea
  2. Cyanosis
  3. Apparent dextrocardia
24
Q

What are 5 things found on physical exam for CDH?

A
  1. Bulging chest
  2. Scaphoid abdomen
  3. Decreased breath sounds
  4. Distant or right displaced heart sounds
  5. Bowel sounds in the chest
25
Q

What are current standards for medical management and preoperative treatment of CDH?

A
  1. Maximize arterial oxygenation
  2. Correct acidosis
  3. Intubation with mindset to minimize barotrauma/volutrauma.
  4. Hyperventilation
  5. Nitric oxide- decrease PVR
  6. ECMO
26
Q

What are criteria for ECMO?

A
  1. Weigh greater than 2.0 kg

2. Gestation >35weeks

27
Q

Anesthetic management for CDH?

A
  1. Awake intubation or RSI (Avoid mask ventilation).
  2. Avoid N2O
  3. Avoid hypoxia/acidosis
  4. Prevent hypothermia
28
Q

CDH Postoperative management?

A
  1. Vent support
  2. Meticulous fluid/nutrition management
  3. Hemodynamic monitoring
  4. Often honeymoon period followed by deterioration
29
Q

What typically occurs after the honeymoon period following CDH repair?

A
  1. Increased intrabdominal pressure
  2. Decreased perfusion of the viscera and the periphery
  3. Decreased diaphragmatic excursion
  4. Worsening pulmonary compliance./
30
Q

How often does pyloric stenosis occur in live births?

A

1: 5,000

31
Q

Are males or females more prone to pyloric stenosis?

A

Males 4:1

32
Q

T/F: Pyloric stenosis causes forceful projectile bilious vomiting?

A

False; it is non-bilious

33
Q

What can be done to verify pyloric stenosis diagnosis?

A
  1. Upper GI series with barium
  2. Xray
  3. Abdominal US
34
Q

What types of acid-base imbalance does pyloric stenosis cause?

A

Metabolic alkalosis d/t loss of acidic gastric juices rich in H+, Cl-, and Na+

35
Q

What electrolyte abnormalities can result from pyloric stenosis?

A
  1. Hyponatremia
  2. Hypokalemia
  3. Hypochloremia
  4. Metabolic alkalosis
36
Q

What could cause pyloric stenosis to change from a metabolic alkalosis to a metabolic acidosis?

A

Severe dehydration and hypoperfusion

37
Q

Is pyloric stenosis a surgical emergency?

A

No; but it is a medical emergency (must correct fluid and electrolyte disturbances).

38
Q

What is the primary anesthetic management concern for pyloric stenosis repair?

A

Aspiration of gastric fluid

39
Q

Describe induction for pyloric stenosis?

A
  1. IV in place
  2. O2 by mask
  3. Atropine 10-20mcg/kg
  4. Suction stomach with large bore catheter
  5. RSI with succ/tylenol/propofol (DO NOT VENTILATE)
40
Q

Why should narcotics be avoided with pyloric stenosis repair?

A

Patients are prone to post-operative respiratory depression secondary to preexisting central alkalosis

41
Q

What is clinical presentation of transesophageal fistula (TEF)?

A
  1. Inability to manage oral secretions
  2. Excessive salivation
  3. Choking on first feed
  4. Coughing
  5. Cyanosis
  6. Aspiration
  7. Gastric distention
  8. Pneumonia
42
Q

How is TEF diagnosed?

A

Inability to pass suction catheter/orogastric tube into stomach with CXR confirmation of catheter position in esophageal pouch

43
Q

Describe VACTERL:

A 
Vertebral anomalies
Anorectal anomalies
Cardiac anomalies
TEF
Esophageal atresia
Renal anomalies
Limb anomalies
44
Q

What is considered mandatory preoperative preparation for TEF repair?

A

12 Lead EKG, ECHO d/t 20% cardiac anomaly risk

45
Q

How would anesthetic management change for an unstable infant vs stable infant?

A

Unstable: consider gastrostomy insertion and awake intubation

Stable: IH induction with spont vent or IV induction with minimal PPV or RSI

46
Q

How does ETT placement technique differ with TEF repair?

A

Right mainstem intubation, withdraw ETT until breath sunds are confirmed at the L axilla.

47
Q

What positioning method is typically used for TEF repair?

A

Left lateral decubitus position for Right thoracotomy

48
Q

What are introperative complications for TEF repair?

A
  1. Airway compromise (intubate fistula, R mainstem, ETT obstruction
  2. Hypothermia
  3. Hypoglycemia
  4. Resumption of fetal circulation (R-L shunting).
49
Q

What are post-operative concerns for TEF repair?

A
  1. No extension of head (puts tension on the anastomosis).
  2. No esophageal suctiong beyond the level of esophageal anastomosis
  3. Long term= tracheomalacia, GERD, esophageal strictures

Pediatrics (5 decks)

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