Pediatric Surgery Flashcards
(89 cards)
1
Q
Foregut
A
lungs, esophagus, stomach, pancreas, liver, gallbladder bile duct, and duodenum proximal to ampulla
2
Q
midgut
A
- duodenum distal to ampulla, small bowel, and large bowel to distal 1/3 transverse colon
- rotates 270 degrees counterclockwise
3
Q
hindgut
A
distal 1/3 of transverse colon to anal canal
4
Q
low birth weight
A
< 2,500 g
5
Q
premature
A
< 37 weeks
6
Q
trauma bolus peds
A
20 cc/kg X 2, then give 10 cc/kg blood
7
Q
tachycardia (peds)
A
best indicator of shock (neonate > 150, < 1 year > 120, rest > 100
8
Q
urine out put
A
2-4 cc/kg/hr
children have poor concentrating ability
< 6 months 25 % capacity of adults
9
Q
maintenance fluids
A
4 cc/kg/hr for 1st 10 kg
2 cc/kg/hr 2nd 10 kg
1 cc/kg/hr every kg after that
10
Q
caloric need (kcal /day)
A
90-120 till age 1
70-90 1-12yrs
30-60 12-18 yrs
11
Q
pulmonary sequestration
A
lung tissue has systemic arterial supply (aorta) and either systemic venous or pulmonary vein drainage BUT DOESNT COMMUNICATE with tracheobronchial tree
- can be intralobar or extra lobar
- PRESENTS WITH INFECTION
TX lobectomy
12
Q
congenital lobar overnflation
A
- cartilage fails to develop in bronchus, leading to air trapping with expiration
- can develop hemodynamic instabiity (same mechanism as tension PTX) or respiratory compromise
- LUL, RML most commonly affected
- TX: lobectomy
13
Q
congenital cystic adenoid malforamation
A
- communicates with airway
- alveolar structure not well developed although lung tissue is present
- Sxs: respiratory infection or resp compromise
- TX: lobectomy
14
Q
Bronchogenic cyst
A
- extrapulmoary cyts formed from bronchial tissue and cartilage wall
- usually present with a mediastinal mass filled with milky fluid
- can become infected or compress adjacent structures
- TX: resect cyst
15
Q
Neuorgenic tumors
A
exs. neurofirbroma, neuroganglioma, neuroblastoma
MOST common mediatinal tumor in children - usually posterior located
16
Q
Mediastinal masses in children
A
present with respiratory symptoms and dysphagia
T cell lymphoma - can presnt anterior, middle or posterior
teratomas - ant and middle
thymomas, and thyroid cancer - middle
17
Q
choledochal cyst
A
TX resect
- risk of cholangiocarcinoma, pancreatitis, cholangitis, obstructive jaundice
- thought to be caused by refux of pancreatic enzymes in to the biliary system
18
Q
Types of choledochal cysts - TYPE I
A
MOST COMMON
fusiform dilation of entire common bile duct, midly dilated common hepatic duct
TX: hepaticojejunostomy
19
Q
Types of choledochal cysts- TYPE V
A
Carolis disease - intrahepatic cysts
hepatic fibrosis
20
Q
cystic hygroma
A
lymphangioma - found in lateral cervical and submandibular regions in neck
TX: resection
21
Q
asymptomatic lymphadenopathy
A
ABX for 10 days
excisional bxif no improvement –> lymphoma until proven otherwise
22
Q
fluctuant lymphadenopathy
A
FNA, CX, ABX may beed I&D
chronic causes: cat scratch fever, atypical mycoplasma
23
Q
lymphadenopathy
A
usually caused by acute suppurative adenitis associated with URI, or phyaryngitis
24
Q
diaphragmatic hernias
A
80% left sided
80% associated anomalies ( cardiac and neural tube defects, malrotation)
MOST COMMON - Bochdalk’s
TX: abdominal approach, reduce bowel, high frequency ventilation, prostacyclin (pulmonary vasodilator)
25
Bochdalek's hernia
located posterior laterally
26
Morgagni's hernia
diaphragmatic hernia - located anteriorly
27
eventration
failure of the diaphragm to fuse
28
pectus excavatum
(sinks in) sternal osteotomy, need strut
29
pectus carinatum
(pigeon chest) repair for emootinal stress
30
1st branchial cleft cyst
angle of mandible, may connect with external auditory canal, often associated with facial nerve
31
2nd branchial cyst
MOST COMMON
| ant border of SCM, goes through carotid bifurcation into tonsillar pillar
32
3rd branchial cyst
lateral neck
33
thyroglossal duct cyst
from the descent of the thyroid gland from the foramen cecum
may be only thyroid tissue pt has
presents as a midline cervical mass
TX excision of cyst, tract, and hyoid bone
34
hemangioma
rapid growth during first 6- 12 months of life, then involutes
TX: observation, UNLESS uncontrollable growth, impair function, persists after age 8, tx with steroids, laser, resection
35
neuroblastoma
#1 solid abdominal malignancy in children
most common location - adrenals
most common 1st 2 yrs of life
SXS: diarrhea, raccoon eyes (orbital metastases), HTN, unsteady gate (opsomyoclonus)
derived from neural crest cells
TX: chemotherapy, resect
36
diagnosing neuroblastoma
- abdominal xray - may show stippled calcifications in the tumor
- Increased cateholamines, VMA, HVA, metanephrines
37
neuron specific enolase
increased in neuroblastomas with mets
| rare mets to lung and bone
38
high risk neuroblastoma
> 1 yr, N- myc, diploid, LDH, shimada classification
39
Wilms tumor
nephroblastoma
mean age at diagnosis - 3 years
frequent mets to bone and lung
PROGNOSIS BASED ON TUMOR GRADE
40
Wilms tumor associations
Beckwith - Wiedmann syndrome (hemihypertrophy, cryptorchidism, Drash syndrome, aniridia)
41
Treartment of Wilms tumor
NEPHRECTOMY
ALL stage < 500 g actinomycin and vincristine (except stage I)
Stage II or greater > 500g add doxorubicin
Stage III or greater add XRT
42
Stage V Wilms tumor
Bilateral renal involvement
| 10%
43
Hepatoblastoma
MOST COMMON MALIGNANT liver tumor in children
AFP - increased in 90%
prefetal histology has best prognosis
44
TX of hepatoblastoma
RESECTION
| doxorubicin cisplatin based chemotherapy to downstage tumors and allow resection
45
Leukemia (ALL)
#1 childrens malignancy overall
46
CNS tumors
#1 solid tumor class
47
Neuroblastoma
#1 general surgery tumor
48
duodenal atresia
#1 cause of duodenal obstruction in newborns
49
malrotation
#1 cause of duodenal obstruction after newborn period (> 1 week)
50
Hirschsprungs disease
#1 cause of colon obstruction
51
painless lower GI bleeding in peds
meckels diverticulum
52
upper GI bleeding <1 yr
gastritis
53
Meckels diverticulum
```
persistent vitelline duct
found on antimesenteric border
rule of 2s
2 feet from ileocecal valve, 2%population, 2 % symptomatic, 2 tissue types (pancreatic, gastric), 2 presentations - diverticulitis and bleeding
TX: resect
```
54
pyloric stenosis
projectile vomiting
firstborn males @3-12 weeks
olive mass in stomach
hypochloremic, hypokalemic metabolic alkalosis
55
Diagnosing pyloric stenosis
US- pylorus > 4mm thick, > 14 mm long
56
Pyloric stenosis TX
pyloromyotomy (RUQ incison), circular muscles of the stomach
57
intussesception
invagination of one loop of intestine into another
3 months to 3 years
lead points: enlarged Peyers patches (MOST COMMON), lymphoma, Meckels
15 % recurrence after reduction
58
Intussesception symtoms
currant jelly stools ( from vascular congestions, not an indication for resection), sausage mass, abdominal distension, RUQ pain, and vomiting
59
Intussesception treatment
```
AIR CONTRAST ENEMA
max pressure:120 mm HG
max column if barium: 3 feet
80% successful,
peritonitis, free air, unable to reduce --> OR reduce via distal limb
```
60
intestinal atresia
result from intrauterine vascular accidents
sxs: bilious emesis, distension, most do not pass meconium
get barium enema to r/o hirschprungs before surgery -- > resection
61
Duodenal atresia
usually distal to ampulla of vater, causes bilious vomiting, feeding intolerance
associated with cardiac, renal, and other GI anomalies
20% have down syndrome
AXR: double bubble
TX: duodenostomy
62
Tracheoesophageal (TE) fistulas
Type C - most common; promximal esophageal atresia (blind pouch) and distal TE fistula
Sxs: newbors spit up feeds, excessive drooling, respiratory sxs.`
63
VACTERL
vertebral, anorectal, cardiac, TE fistula, radius/renal, limb anomalies
TX: right extrapleural thoracotomy
complications: GERD, LEAK, empyema, stricture, fistula
64
Malrotation
sudden onset of bilious vomiting (Ladds bands from right retroperitoneum attached to cecum cause duodenal obstruction)
compromise of SMA
failure of the normal 270 counterclockwise rotation
65
Malrotation treatment
UGI diagnosis
| resect LAdds bands, counterclockwise rotation, cecopexy LLQ, appendectomy`
66
meconium ileus
distal ileal obstruction, abdominal distension, bilious vomiting
sweat chloride test or PCR for cl channel defect
(cystic fibrosis 10%)
AXR: soap suds appearance
TX. gastrograffin enema
alt: N-acetlycysteine enema
67
Necrotizing entercolitis
bloody stools after 1st feeding in premature infant
risk factors: hypoxia, hypotension, anemia, polycythemia, sepsis
Sxs: lethargy, resp decompression, abdominal distension, vomiting blood PR
68
Diagnosing NEC
AXR: pneumatosis intestinalis, free air, portal vein air
69
NEC - TX
resuscitation, NPO, ABX, TPN, orogastric tube
| OR--> free air, peritonitis, clinical deterioration, needs barium enema first r/o distal obs, then ostomies
70
congenital vascular malformation
surgery for hemorrhage, ischemia, chf, nonbleeding ulcers, fuctional impairment and limb discrepancy
embolization
71
imperforate anus
high (above levators) - meconium in urine of vagina(fistula to bladder/vagina/prostatic urethra)
TX: colostomy, later anal reconstruction with posterior sagittal anoplasty
low (below levators) - perform sagittal anoplasty
72
gastroschisis
intrauterine rupture of umbilical vein; does not have a peritoneal sac
herniates to the right of umbilicus
TX: saline soaked guaze, TPN NPO, repair when stable, silo
73
omphalocele
failure of embryonal developement, midline defect,
increased congenital anomalies (50%) , peritoneal sac with cord attached
TX: silo, later closure
74
cantrell pentology
```
cardiac defects
pericardium defects
sternal cleft
diaphragmatic septum transversum absence
omphalocele
```
75
hirschprungs
infants fail to pass meconium in 1st 24 hrs
dx rectal bx (absence of ganglion cells in myenteric plexus)
failure of neural crest cells to progress in craniocaudal direction
76
hydrocele
transluminates
| TX: surgery at 1 if not resolved or if thought to communicate
77
umbilical hernia
failure of closure of linea alba; most close by age 3
| TX: surgery if not closed by age 5 or incarceration
78
inguinal hernia
persistent processus vaginalis M>F, R>L
79
cystic duplication
most common in ileum, often on mesenteric border
| resect
80
biliary atresia
most common cause of neonatal jaundice requiring surgery
81
jaundice persisting > 2 weeks after birth
biliary atresia
82
liver bx showing periportal fibrosis, bile plugging
biliary atresia
83
TX of biliary atresia
hepaticoportojejumostomy
| preform before age 3 months
84
teratoma
AFP, beta HCG
| neonates - sarcococcygeal
85
sarcococcygeal teratomas
90% benign at birth
| if presents > 2 months --> malignant
86
associated with bilateral cryptochidism
prune belly syndrome
87
laryngomalacia
most common cause of airway obstruction in infants
outgrow by 12 months
caused by immature epiglottis cartilage with intermittent collapse
88
choanal atresia
obstruction of choanal opening by either bone of mucus membrane, usually unilateral
intermittent resp distress, poor suckling
89
laryngeal papillomatosis
most common tumor of the peds larynx
involutes after puperty
possible HPV form mom
