Pediatric Surgery Flashcards
(130 cards)
1
Q
What is the most common congenital anomaly of orofacial structures?
A
Cleft Lip (CL) and Cleft Palate (CP).
2
Q
What are the genetic causes of CL and CP?
A
Cleft lip and nose: failure of fusion of the median nasal process with the maxillary process;
CP: failure of fusion of the palatine processes.
3
Q
Cause of Cleft of philantrum & alveolus
A
Failure in fusion of median nasal process
4
Q
What environmental factors increase the risk for CL and CP?
A
Maternal epilepsy and certain drugs taken during pregnancy (e.g., Phenytoin, Diazepam, Steroids).
5
Q
Which syndrome is associated with cleft lip, cleft palate, and retrognathia?
A
Pierre Robin Syndrome
6
Q
Name some syndromes associated with CL and CP.
A
Van der Woude, DiGeorge, Stickler, Treacher Collins, and several trisomy syndromes (e.g., Patau, Edwards).
7
Q
What is the difference between a complete and partial cleft lip?
A
A complete cleft lip extends up to the nose. / detachment from vomer, while. a partial cleft lip does not reach the nose. / attached vomer
8
Q
Most common CL
A
Left side Cl
9
Q
What are some problems associated with cleft lip (CL) and cleft palate (CP)?
A
Airway, Breathing, Swallowing, Dentition, and Speech.
10
Q
At what stage of pregnancy can CL be diagnosed antenatally?
A
After 18 weeks of pregnancy.
11
Q
After birth 1-2 months
A
No surgery
Feeding modified feeding bottles
12
Q
What is the recommended timing for plastic surgery reconstruction for cleft lip, nose and hard palate ( muscle reconstruction)?
A
CL - 3 MONTHS
soft palate - 6
Hard palate- 12
13
Q
After surgery 1-7 yrs
A
Feeding, dentition, speech aesthetics
14
Q
After surgery frome 8- 10 yrs
A
Alveolar Bone grafting
15
Q
Formation of thyroglossal cyst?
A
When thyroglossal tract don’t obliterate after birth —- secretion accumulation —- cyst formation
16
Q
What is the common location of a thyroglossal cyst?
A
Midline ( subhyoid )
17
Q
What type of crystals may a thyroglossal cyst contain?
A
Cholesterol crystals.
18
Q
What movement is associated with the swelling of a thyroglossal cyst?
A
moves with deglutition (swallowing). Thus tongue protrusion
19
Q
What is the main characteristic symptom of a thyroglossal cyst?
A
Moves with tongue protrusion
20
Q
What is the primary treatment for a thyroglossal cyst?
A
Sistrunk’s operation (excision of cyst and thyroglossal tract, including the central portion of the hyoid bone).
21
Q
What is a complication of a thyroglossal cyst if it becomes infected?
A
can develop into an abscess, leading to rupture. Leading to either fistula or sinus
22
Q
Thyroglossal sinus vs fistula
A
Sinus - cyst connected to skin only
Fistula ( 2 opening ) - thyroglossal tract relation + skin
23
Q
Thyroglossal cyst can lead to which cancer
A
Papillary thyroid cancer
24
Q
Duodenal atresia
A
Congenital disease
absence of a portion of the duodenum due to the failure of fusion of the foregut with the midgut.
25
Duodenal atresia characteristics
bilious vomiting within hours after birth
26
classic radiographic finding of duodenal atresia
Double Bubble Sign, one duodenum second stomach separated by constricted pyloric sphincter
27
SBS, DBS, TBS, MBS - Cases for these Bubble signs on x-ray
SBS → Pyloris obs
DBS → Duodenal area
TBS → Jejonal obs /atresia
MBS → Small/ large intestine obs
28
What is Esophageal Atresia?
Absence of some part of the esophagus
## Footnote
Esophageal Atresia is often due to a posterior deviation of the tracheoesophageal septum.
29
What are the types of Esophageal Atresia?
Types include:
* Type A - Isolated esophageal atresia
* Type B - . Tracheoesophageal fistula b/ w trachea & proximal eso end
* Type C - Proximal esophagus blind & fistula b/ w trachea & distal end
* Type D- fistula b/ w trachea & both ends (2 fistulas)
* Type E - esophagus parts connected but tracheoesophageal fistula +nt
## Footnote
Type C is the most common type.
30
What is the most common type of Esophageal Atresia?
Type C
## Footnote
In Type C, the upper esophagus is blind and there is a connection with the trachea.
31
What are the common clinical features of Esophageal Atresia?
Common features include:
* Continuous pouring of saliva from the baby's mouth
* Risk of regurgitation
* Risk of aspiration
* Risk of pulmonary complications
## Footnote
These symptoms are often observed at birth.
32
What is the initial bedside test for Esophageal Atresia?
Failure to pass a nasogastric tube beyond 10 cm
## Footnote
This test helps to assess the presence of esophageal atresia.
33
What does a chest X-ray (CXR) show in cases of Esophageal Atresia?
CXR may show:
* Coiling of the nasogastric tube in the upper esophagus
* Distended stomach
* Gas in the stomach indicating fistula
## Footnote
These findings help confirm the diagnosis.
34
What congenital anomalies are associated with Esophageal Atresia?
Associated congenital anomalies include:
* Vertebral defects
* Anorectal defects
* Cardiac defects
* Tracheoesophageal fistula
* Renal defects
* Limb defects
## Footnote
This group of anomalies is collectively known as VACTERL.
35
True or False: Polyhydramnios during pregnancy can be associated with Esophageal Atresia.
True
## Footnote
Polyhydramnios occurs due to the fetus's inability to swallow amniotic fluid.
36
What is the best investigation for Eso Atresia?
IOC - CECT
# FOOTNOTE
Initial bedside test - failure to pass nasogastric tube > 10 cm
Initial Invt. - CXR - findings:
1. Coiling of nasogastric tube ------- type 1,2
2. Distended stomach w/ gas indicating fistula of lower eso w/ trachea------- type 3,4,5
37
What is the procedure if the two ends of the esophagus are far apart?
Wait for 4 - 6 weeks ends still far then eso reconstruction using stomach /jejunum/colon
38
What is the waiting period for feeding jejunostomy?
4-6 weeks
39
What is the best investigation for Eso Atresia?
IOC - CECT [ contrast enhanced CT scan ]
40
What is the recommended surgical intervention for Esophageal Atresia?
Surgical correction on Day 1/2 after birth - eso - esophagostomy/ esojejunostomy
41
What is the procedure if the two ends of the esophagus are far apart?
Esojejunostomy bez if far ends tried to sutured would create tension
42
What is the waiting period for feeding jejunostomy?
4-6 weeks
43
What are the options for esophagus reconstruction?
Stomach, jejunum, colon
44
What is the procedure for feeding in cases of Eso Atresia?
Gastrostomy/ Jejunostomy
45
What is Dysphagia Lusoria?
Compression of the esophagus by Aberrant Subclavian artery.
46
What can a Double Aortic arch cause?
Compression of the esophagus.
47
What is Duodenal Atresia?
Absence of some part of the duodenum.
## Footnote
Most common cause of intestinal obstruction in newborns.
48
What is the main cause of Duodenal Atresia?
Failure of fusion of the foregut with the midgut.
49
What is a common symptom of Duodenal Atresia shortly after birth?
Bilious vomiting.
50
What is the most common gastrointestinal anomaly associated with Down's syndrome?
Duodenal Atresia.
51
What is the X-Ray sign associated with Duodenal Atresia?
Double Bubble Sign.
# foot note
Double Bubble Sign arise due to dilation of duodenum and pyloric part of stomach separated by constricted pyloric sohincter
52
What is the primary treatment for Duodenal Atresia?
Duodenoduodenostomy.
53
What is an alternative treatment for Duodenal Atresia?
Duodenojejunostomy.
# foot note
Done when two ends are distant
54
X ray signs indication
Single bubble sign
Triple bubble sign
Multiple bubble sign
Single - pyloric atresia / obstruction
Triple- jejunal obstruction
Multiple - ileal obstruction
55
What is a Branchial Cyst?
A remnant of the 2nd branchial cleft located at the anterior border of the sternocleidomastoid muscle at the junction of upper & middle neck, lined by squamous epithelium.
56
What is the treatment for a Branchial Cyst?
Excision.
57
What is a Branchial Fistula?
A persistent remnant of the 2nd branchial cleft located at the anterior border of the sternocleidomastoid muscle in the lower neck, lined by ciliated columnar epithelium.
58
Where is the internal & external opening of a Branchial Fistula located?
Int.
At the anterior aspect of the posterior faucial pillar behind the tonsil.( folds formed by palatopharyngeus muscle)
Ext.
Skin
59
What is Cystic Hygroma?
A condition characterized by clear lymphatic fluid inside, due to sequestration of jugular lymphatic sacs, and lined by endothelium. Arises from post. Triangle of neck
60
What is the treatment for Cystic Hygroma?
Complete excision or sclerotherapy with Picibanil (OK 432) for weeks.
61
What is the internal opening of type III branchial fistula?
At the pyriform sinus.
62
What is a common diagnostic test for neck swellings?
Skin positive transillumination.
63
Conditions that shows positive illumination
Hydrocele
Cystic hygroma
Meningococcal
Branchial cyst (rare)
Ranula
64
What is an Annular Pancreas?
A ring of pancreatic tissue surrounds the duodenum.
65
What can an Annular Pancreas cause?
It can cause structural issues leading to a 'double bubble' sign.
66
How is an Annular Pancreas diagnosed?
Diagnosis can be made using X-ray and DBS.
67
What is the primary treatment for Annular Pancreas?
The primary treatment involves duodenal aboration and bypassing the ring.
68
What is an alternative treatment for Annular Pancreas?
An alternative treatment is duodenojejunostomy. When ring is wide
69
What structures are associated with the Annular Pancreas?
The gallbladder, duodenum, jejunum, and superior mesenteric artery and vein.
70
What is the condition characterized by hypertrophy of pyloric musculature?
Congenital Hypertrophic Pyloric Stenosis (CHPS)
## Footnote
Often seen in first-born male children.
71
When does Congenital Hypertrophic Pyloric Stenosis typically present?
During the 2nd to 6th week of life.
72
What is a common clinical feature of Congenital Hypertrophic Pyloric Stenosis?
Olive lump in epigastrium due to thickened pyloric muscle.
73
What visible sign may occur after a test meal in patients with Congenital Hypertrophic Pyloric Stenosis?
Peristalsis visible from left to right.
74
What metabolic condition can occur due to Congenital Hypertrophic Pyloric Stenosis?
Metabolic alkalosis due to loss of gastric acid.
75
What type of vomiting is associated with Congenital Hypertrophic Pyloric Stenosis?
Non-bilious projectile vomiting.
76
What laboratory findings may be present in Congenital Hypertrophic Pyloric Stenosis?
Hypochloremia, kaliuresis, hypokalemia and paradoxical aciduria.
77
What is the emergency treatment for Congenital Hypertrophic Pyloric Stenosis?
Rehydration and electrolyte correction.
78
What is the initial diagnostic imaging for Congenital Hypertrophic Pyloric Stenosis?
Ultrasound abdomen showing
thick pyloric muscle (> 3-4 mm)
Elongated pyloric length ( > 16 - 17 mm)
79
What is the initial treatment for Congenital Hypertrophic Pyloric Stenosis?
Pneumatic balloon dilatation.
80
What surgical procedure may be performed for Congenital Hypertrophic Pyloric Stenosis?
Ramstedt's seromyotomy (pyloromyotomy) - cut serosa & muscle
81
What is biliary atresia?
Absence of biliary channels. Exact cause unknown.
82
What are the types of biliary atresia?
I - Common Bile Duct (CBD) - No bile.
II - Common Hepatic Duct (CHD) - CBD.
III - Right & Left Hepatic Ducts (CHD, CBD).
83
What are common clinical features of biliary atresia?
Steatorrhoea, hepatomegaly, jaundice.
84
What causes jaundice in biliary atresia?
Bile backs up due to proximal duct obstruction.
85
What is the typical age for symptoms of biliary atresia to appear?
Symptoms typically appear in the 1st week of life.
86
What is the first investigation for biliary atresia?
Liver Function Test (LFT).
87
What imaging is used to assess biliary ducts?
Ultrasound abdomen shows ducts.
## Footnote
Second investigation.
88
What are some advanced imaging techniques for biliary atresia?
HIDA Scan, ERCP, MRCP.
89
What does HIDA Scan stand for?
Hepatobiliary Imino Diacetic Acid (Isotope).
90
What surgical procedure is performed for biliary atresia?
Roux en Y ( hepatico jejunostomy ) - I type
Kasai operation ( hepatico porto enteroatomy) - for II & III type
91
What is a choledochal cyst?
Cystic dilatations of biliary channels
92
What is the exact cause of choledochal cysts?
Abnormal Pancreaticobiliary duct Junction
93
classification of choledochal cysts (todani Classification)
I - diffuse dilt. Of cbd
II- eccentric dilt. Of cbd above pancreas
III- dilt. Of cbd segment inside pancreas
IV a - both intra & extra hepatic duct dilt.
IV b - extra hepatic duct dilt. Only
V - intra hepatic duct dilt. Only
# Footnote
Multiple cysts in intrahepatic duct - caroli disease
It shows central dot sign corresponding to portal vein
94
What is choledochocele?
An specific type of choledochal cysts ( type III) that is defined as herniation of cbd into duodenum
95
What is the common presentation in infancy for biliary conditions?
Painless intermittent jaundice
## Footnote
Additional symptoms may include cholangitis with pain and fever.
96
What imaging studies are used for biliary conditions?
Liver function tests (LFT) and abdominal ultrasound (US abd)
## Footnote
ERCP may also be used for further evaluation.
97
How to deal with patient in OPD & emergency in case of choledochal cyst
OPD :
presentation - painless intermittent jaundice ( in infancy), RHC Mass
Investigation - LFT then US abd.
IOC - ERCP ( shows dilation better)
Rx - cyst excision + roux en y [ hepatico jejunostomy]
Emergency :
Presentation - charcot triad / Reynold pentane
Investigation-
Basic resuscitation I.e IVF, IV ab followed by lft then us abd
Rx- ERCP + stenting
98
What are potential complications of biliary conditions?
Cholangitis and cholangiocarcinoma
## Footnote
Cholangitis can lead to septicemia and Reynold's pentad.
99
Reynold's pentad & charcot triad
1. Jaundice, fever, right upper quadrant pain, septicemia ( hypotension, and mental confusion )
2. Pain, fever, jaundice
100
What is the most common site for cholangiocarcinoma?
Confluence of the right and left hepatic ducts
## Footnote
This is also known as Klatskin's tumor.( hilar cholangiocarcinoma)
101
What is the best investigation for intussusception?
cect abdomen
102
Result of lab investigation in intussusception
1. US abd. - doughnut sign
2. X ray abd. - crescent / meniscus sign
3. Barium enema - Claw Sign ( if both parts attached tightly ), Coiled Spring Sign ( if parts are loosely attached )
# Footnote
IOC - CECT abdomen
103
What is the treatment for intussusception?
Hydrostatic Reduction ( air / saline / barium enema )
## Footnote
Hydrostatic pressure when applied pushes the inner tube out if outer tube
If fails, Operative Reduction I.e opening abdomen applying pushing pressure ( like milking movt.) On outer tube pushing the inner tube out
If +nt gangrene then it's removal & anastomosis of both ends.
104
What is the principle to remember during reduction?
Never Pull, Always Push
105
Intussusception clinical features
- sausage lump in left paraumbilical region, concavity reaches umbilicus
- in infant cry and discomfort
- red current jelly stool = blood + mucus
- DRE = fingers comes out stained w/ blood
right iliac fossa empty - sign of dance
106
What is an absent kidney due to?
Renal agenesis.
107
What is an ectopic kidney?
A kidney that fails to ascend and is located in the pelvis in retroperitoneum.
mc- left side
108
What are the types of polycystic kidney disease?
Congenital (Adult) PKD - Autosomal dominant; Infantile PCKD - Autosomal recessive.
109
What are the associations of congenital (Adult) PKD?
Bilateral cysts, associated cysts in other organs (most commonly liver, spleen, pancreas, ovaries), and Berry aneurysm (Circle of Willis).
, mitral valve prolapse
110
What is the most common clinical manifestation of congenital (Adult) PKD?
Hypertension (75% of cases).
111
What are the clinical presentations of polycystic kidney disease?
Swelling, pain in the bilateral lumbar region, hematuria, and uremia.
112
What is the first imaging study for polycystic kidney disease?
Ultrasound of the abdomen.
113
What is the imaging of choice for polycystic kidney disease?
CECT abdomen.
114
What does IVU (IVP) show in polycystic kidney disease?
Spider leg appearance.
115
Define Orthotopic and heterotrophic transplant
Orthotopic - transplanting organ from same anatomical position in donor like liver
Heterotrophic- transplanting organ from different anatomical position in donor like kidney.
116
Contrast studies for upper & lower urinary tract
Upper - IVP (retro/ ante grade pyelography )
Lower - cystogram ( retrograde urethrogram , micturating cystourethrogram )
#Footnote
Voiding cytogram is for post. Urethral valve and vesicular ureteric reflux.
117
Contrast studies for upper & lower urinary tract
Upper - IVP ( retro, ante grade pyelography)
Lower - cystogram [ retrigrade urethrogram, micturating cystourethrogram]
# Footnote
Voiding cystogram for post urethral valve & vesicular ureteric reflux
118
What is Horse shoe kidney?
It is pain of ectopic kidneys fused together at median subdivision of lower poles of kidneys.
location - L4
# Footnote
Usually asymmetrical , complicated with UTI, urinary stones
119
Horse shoe kidney :
I investigation, IOC, IVP finding
I invest. - us abd.
IOC - CECT
IVP - flower vase ureter [ thand joining sign ]
120
House shoe kidney treatment
UTI - ab.
stone - removal
# Footnote
surgical removal of isthmus is not Rx OC
121
Define:
1. Umbilical faecal & urinary fistula
2. Umbilical sinus
3. Meckel's diverticulum
4. cong. UB diverticulum
1. a) failure of involution of vitello intestined duct ( VID) [ intestinal content comes out
of Umb.]
b) failure of inviolation of allantois [watery discharge out of Umb.]
2. Potent umbilical ends of VID ,allantois (mucus discharge from Umb.)
3. Potent intestinal end of VID
4. Potent vesical end of allantois
122
Define:
1. Umbilical faecal & urinary fistula
2. Umbilical sinus
3. Meckel's diverticulum
4. cong. UB diverticulum
1. a) failure of involution of vitello intestined duct ( VID) [ intestinal content comes out
of Umb.]
b) failure of inviolation of allantois [watery discharge out of Umb.]
2. Potent umbilical ends of VID ,allantois (mucus discharge from Umb.)
3. Potent intestinal end of VID
4. Potent vesical end of allantois
123
Compare cong. Vs Acq. diverticulums
I. Cong: Contain all layers of organ . + nt by birth. Called true div. Occurs in child. Eg : Meckel 's div.
2. Acq : contains only mucosa & submucosa. Called False div. Occous in Elders.Eg: sigmoid colon div., Zencker's div.
Reason - Certain obs. inc. pressure inside Proximal intestine causing the content to go in spaces b/w intestinal muscles
124
1. Rule of2 for M div.
2. Location of Meckel's diverticulum.
3. signs
1. 2 cm wide, 2 inch long, 2 feet from ileocaecal junct.. Occurs at 2 yr of age, symptomatic in 2% population
2. + nt 2 feet away from iIeocaecal junct. at anti- messenteric border.
3. Generally asymmptomatic but if + nt mimics acute appendicitis
125
1. Meckel 's div epithelium
2. Relation b/w M div. & hernia
3. Diverticulitis
1. heterotrophic - M.c gastic >Pancreatic> colon epi.
2. Div.in hernial sac - LITTRE'S HERNIA
3. food in div. -- - obs -- - infection (diverticulitis)
126
1. Meckel 's div epithelium
2. Relation b/w M div. & hernia
3. Diverticulitis
1. heterotrophic - M.c gashic >Pancreatic> colon epi.
2. Div.in hernial sac - LITTRE'S HERNIA
3. food in div. -- - obs -- - infection (diverticulitis)
127
M.div. complication
Bleeding (M. C)
Div. perforation
Diverticulitis
Peptic ulceration
Intussusception
intestinal obs.
128
M div. Diagnosis, IOC
Meckel's scan [ Radioisotope scan] - IOC
Technetium Pertechnetate scan
#. Footnote
this method involves
Barium meal follow through
Video capsule endoscopy
129
M div. Diagnosis, IOC
Meckel's scan [ Radioisotope scan] - IOC
Technetium Pertechnetate scan
#. Footnote
this method involves
Barium meal follow through
Video capsule endoscopy
130
Meckel's div Rx
Rx only when its symptomatic
1 Narrow mouth div - diverticulectomy
2. Wide mouth div - resection of div. w/ segment of involved intestine followed by end to end anastomosis
# Footnote
instrument used - linear stapler
