part 5

Question 1

What are the 2 stages of Hirschsprung’s Disease surgery?

Answer 1

• stage 1 temporary ostomy
• stage 2 is a pull-through procedure: repeated enemas, decreasing bacterial flora with antibiotics (systemic and colonic irritants)

Question 2

• transfer of gastric contents into esophagus
• occurs in everyone
• frequency and persistence is abnormal
• may occur without regurgitation

Answer 2

GER

Question 3

What are the diagnostic tests for GER?

Answer 3

upper GI and pH probe

Question 4

What is the management of GER?

Answer 4

• remove cows milk
• small frequent feeds
• reflux precautions: 1tbsp rice cereal and elevate after
• H2 receptor antagonists
• PPIs

Question 5

When is no therapy needed for GER?

Answer 5

if the infant is thriving and has no respiratory complications

Question 6

What is the surgery for GER and who is it reserved for?

Answer 6

Nissen fundoplication 
reserved for children with: 
recurrent aspiration
esophagitis 
failure to thrive

Question 7

-malformation that results from failure of esophagus to develop as a continuous tube during the 4th to 5th week of gestation?

Answer 7

tracheoesophageal fistula or atresia

Question 8

What is tracheoesophageal fistula or atresia caused by?

Answer 8

-defective separation, incomplete fusion or altered cellular growth

Question 9

abnormally closed or absent

Answer 9

tracheoesophageal atresia

Question 10

What is the diagnosis of tracheoesophageal fistula or atresia?

Answer 10

• history of maternal polyhydramnios
• unable to pass NG tube
• abd x-ray
• bronchoscopy
• endoscopy

Question 11

What are the 3 C’s related to tracheoesophageal fistula or atresia?

Answer 11

coughing
choking
cyanosis

Question 12

Besides the 3 C’s what are some other clinical manifestations of tracheoesophageal fistula or atresia?

Answer 12

• apnea, resp. distress after feeding
• abd distress
• excessive salivation, difficulty with secretions
• drooling
• 3 C’s: coughing, choking, cyanosis

Question 13

What will be placed in the meantime if surgical repair is in stages or delayed for a pt with tracheoesophageal fistula or atresia?

Answer 13

gastrostomy tube (G-tube) for feedings

Question 14

What is the first priority for a pt with tracheoesophageal fistula or atresia?

Answer 14

prevent resp distress: 
-remove secretions
-NPO
-positioning (elevate HOB) 
provide Nutrition: 
-GT feedings
-after repair esophageal may not be normal