Flashcards in EXAM #3: PEDIATRIC SURGICAL PROBLEMS Deck (43):
1
What are the three etiologies of lymphadenopathy?
1) Infectious
2) Reactive
3) Malignancy
2
What is the difference between acute and chronic lymphadenopathy?
- Less than 6 weeks= acute
- Greater than 6 weeks= chronic
3
What is the surgical procedure to diagnose lymphadenopathy?
Biopsy
4
What do you need to do for the proper diagnosis of a thryoglossal duct cyst?
US to ensure there is normal thyroid tissue
5
What is the surgical procedure for a thyroglossal duct cyst?
Sistrunk procedure
A small incision is made over the cyst. The cyst and the entire tract are removed, as well as the middle portion of the hyoid bone
6
When is surgery indicated for congenital torticollis?
Failure to resolve within a year with aggressive conservative therapy
7
How is congenital torticollis treated surgically?
Division of the involved SCM
8
What is the most common type of tracheo-esophageal fistula?
Proximal atresia with distal fistula
9
What is the most common presenting symptom of a TE fistula?
Excessive salivation
10
How is a TE fistula managed surgically?
Right toracotomy and exptrapleural repair
*May require gastrostomy
11
What is the VATER association with TE fistula? Why is this important?
Vertebral
Anorectal
Cardiovascular
Tracheal
Esophageal
Renal
Limb
Any kid with a TE fistula will need to be associated for these issues as well.
12
What is the eponym for the most common location of a diaphragmatic hernia?
Foramen of Bochdalek in the left pleuroperitoneal membrane
13
When do you know if a chest wall deformity needs to be repaired?
At least 14 years of age--only intervene earlier if cardiopulmonary compromise
14
What anomalies are associated with omphalocele?
1) Heart
2) Urinary Tract
3) Beckwith-Wiedeman
15
What is the difference between major and minor omphalocele?
Minor= less than 4cm
Major= greater than 4cm
16
What is Bechwith-Wiedeman Syndrome?
This is an overgrowth disorder usually present at birth; it is characterized by an increased risk of childhood cancer and congenital anomalies, including:
1) macroglossia (large tongue),
2) macrosomia (above average birth weight and length),
3) midline abdominal wall defects (omphalocele/exomphalos, umbilical hernia, diastasis recti),
4) ear creases or ear pits, and
5) neonatal hypoglycemia
17
What is Gastrochisis?
Abdominal wall defect right of the umbilicus
18
What is worse, gastrochisis or omphalocele?
Omphalocele
19
What are the complications of gastrochisis and omphalocele?
1) Heat loss-->warm
2) Third space heat loss
3) Infection-->antibiotics
20
At birth, what should you remember about gastrochisis or omphalocele?
Leave the umbilical cord long
21
What is the presentation with malrotation and volvulus?
Forceful often bilious emesis
*Remember, bilious emesis is a red flag*
22
How do you diagnose malrotation/ volvulus?
Upper GI series
23
What is the classic imaging for duodenal atresia?
"Double bubble sign"
24
How is duodenal atresia repaired surgically?
Duodenoduodenostomy
25
What causes midgut atresia?
In utero mesenteric vascular accident
26
What is the rule of two's for Meckel's Diverticumlum?
- 2 feet from ileocecal valve
- 2% population
- Most before age of 2
27
How does Meckel's Diverticulum present?
Massive bleeding
28
What is the first thing you need to do if you suspect Meckel's Diverticulum?
1) Resuscitate
2) Meckel's Scan
29
How do you work-up Hirschsprung's Disease?
1) Barium enema
2) Rectal biopsy* gold-standard
30
On x-ray, what is suggestive of Hirschsprung's Disease?
No gas in the rectum
31
How do you treat Hirschsprung's Disease with surgery?
1) Possible colostomy
2) Remove affected contracted region
32
What is an imperforate anus?
Cloaca that does NOT separate rectum and urogenital sinus
33
What is the typical age that you would repair an umbilical hernia?
3-5 years old
34
What is the classic presentation of Intussception?
- Paroxysmal, crampy abdominal pain
- Currant jelly stool (late sign)
35
How is Intusssception worked up?
1) US--> "target sign"
2) Barium enema
36
What are the buzzwords for pyloric stenosis?
- Projectile non-bilious emesis
- Olive mass
- Hypochloremic hypokalemic alkalosis (emesis contains Cl- and K+)
37
How does biliary atresia present?
Persistent direct hyperbilirubinemia
38
What is the definitive treatment for biliary atresia?
Transplant (initial surgery, "Kasai" only buys time)
39
What type of hernia is more common in kids?
Indirect
40
What increases the risk of indirect hernia?
Premature
41
What should you remember about pediatric inguinal hernias?
Should be fixed ASAP
42
When do undescended testes need to be fixed?
By 1-year (may descend by six months)
43