GI Flashcards
(39 cards)
Baby is born w/ respiratory distress,scaphoid abdomen & this CXR (bowel in the lung).
Diaphragmatic hernia
Biggest concern for Diaphragmatic hernia?
Best treatment?
Pulmonary hypoplasia
If dx prenatally, plandelivery at @ place w/ECMO. Let lungs mature 3-4 days then do surg
Baby is born w/ respiratory distress w/ excess drooling.
Best diagnostic test?
TE- Fistula
Place feeding tube, take xray, see it coiled in thorax
Defect lateral (usually R) of the midline, no sac. *will see high maternal AFP
Gastroschisis
Complications for Gastroschisis
May be atretic or necrotic req removal. Short gut syndrome
Defect in the midline.Covered by sac.
Omphalocele
Defect in the midline. No bowel present.
Assoc w/ other disorders?
Treatment?
Umbilical Hernia
Assoc w/ congenital hypothyroidism (also big tongue)
Repair not needed unless persists past age 2 or 3.
4wk old infant w/ non-bileous vomiting and palpable “olive”?
-Metabolic complications?
–Tx?
Pyloric Stenosis
Hypochloremic, metabolic alkalosis
Immediate surg referral for myotomy
2wk old infant w/ bileous vomiting. The pregnancy was complicated by poly-hydramnios.
–Assoc w/?
Intestinal Atresia Or Annular Pancreas
Down Syndrome (esp duodenal)
1 wk old baby w/ bileous vomiting, draws up his legs, has abd distension.–Pathophys?
Malrotation and volvulus
*Ladd’s bands can kink the duodenum
Doesn’t rotate 270 ccw around SMA
A 3 day old newborn has still not passed meconium.–DDX? (name 2)
Meconium ileus- consider CF if +FH (*gastrograffin enema is dx & tx)
Hirschsprung’s- DRE-> explosion of poo. bx showing no ganglia is gold standard
A 5 day old former 33 weeker develops bloody diarrhea
–What do you see on xray?
–Treatment?
–Risk factors?
Necrotizing Enterocolitis
Pneumocystis intestinalis (air in the wall)
NPO, TPN (if nec), antibiotics and resection of necrotic bowel
Premature gut, introduction of feeds, formula.
A 2mo old baby has colicky abd pain and current jelly stool w/ a sausage shapend mass in the RUQ.
Intussusception*Barium enema is dx and tx
Contraindications to surgery
–Absolute?Diabetic Coma, DKA
–Poor nutrition?albumin <3, transferrin <200,weight loss <20%.
–Severe liver failure?bili >2, PT >16, ammonia > 150or encephalopathy
–Smoker?stop smoking 8wks prior to surgery
If a CO2 retainer, go easy on the O2 in the post op period. Can suppress respiratory drive.
Goldman’s Index
Tells you who is atgreatest risk for surgery
–#1 =CHF* EF. If <35%, no surg.
–#2 =MI w/in 6mo *What should you check?(EKGstress testcardiac cathrevasc)
–#3 =arrhythmia
–#4 =Old (age >70)
–#5 =Surgery is emergent
–#6 =AS, poor medical condition, surg in chest/abd
how do you check AS?
Listen for murmur of AS-Late systolic, crescendo-decrescendo murmur that radiatesto carotids. ↑ with squatting, ↓ with decr preload
Meds to stop
Aspirin, NSAIDs, vit E (2wks)
Warfarin (5 days)–drop INR to<1.5 (can use vit K)
Take ½ the morning dose of insulin, if diabetic
If CKD on dialysis
Dialyze 24 hours pre-op
Why do we check the BUN and Creatinine?
–What is the worry if BUN > 100?
There is an increased risk of post-op bleeding 2/2uremic platelet dysfunction.
–What would you expect on coag pannel for uremic platelet dysfunction.?
Normal platelets but prolonged bleeding time
Vent Settings
Assist-controlset TV and rate but if pt takes abreath, vent gives the volume.
*Pressure support Important for weaning.pt rules rate but a boost of pressure is given (8-20).
*CPAPpt must breathe on own but + pressure given all the time.
PEEPpressure given at the end ofUsed in ARDS or CHF*cycle to keep alveoli open(5-20).
you have a patient on a vent…*Best test to evaluate managemen
ABG
If PaO2 is low?If PaO2 is high?
increase FiO2, decrease FiO2
If PaCO2 is low (pH is high)?
If PaCO2 is high (pH is low?
Decr rate or TV
Incr rate or TV
