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From Flashcardlet > Peds- Surgery & Constipation > Flashcards

Peds- Surgery & Constipation Flashcards

1
Q

Acute abdoment

A

severe abdominal pain of LESS than 24 hrs duration

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2
Q

Malrotation with midgut volvulus

A

incomplete rotation of bowel during embyronic devel= cecum incorrectly positioned
sets up narrow pedicle of mesentery around which bowel can twist (volvulus)
mesentery carries arterial supply
midgut volvulus restricts mesenteric blood flow
~60% found in 1st mo of life

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3
Q

Volvulus S & S

A

abrupt onset of bilious vomiting & abdominal distension

sometimes with hematochezia/ melena

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4
Q

What is the MC indication for emergency abdominal surgery in ch?

A

acute appendicitis

assumed outlet of appendix becomes blocked

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5
Q

Frequency of acute appendicitis

A

unusual in infants/ small ch
increases in freq w/ age
5% of pediatric cases are <5 yo

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6
Q

Incidence of perforating appendix is high in?

A

infants & children

lots of other reasons for similar sx’s, small ch do not localize pain well

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7
Q

S & S acute appendicitis

A 
short hx of worsening sx's (a few days)
anorexia +/- vomiting
\+/- fever
classical abdominal pain
classic signs of peritonitis
perforation signs
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8
Q

Classical abdominal pain in acute appendicitis

A

begins as periumbilical & diffuse pain (visceral pathways)
w/ early peritonitis, pain localizes to RLQ (somatic pathways)
often difficult to localize well in ch

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9
Q

classic signs of peritonitis

A

rebound tenderness
involuntary guarding
tenderness to percussion, shaking bed, curbs, bumps
psoas & obturator signs

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10
Q

Perforation signs with acute appendicitis

A

immediate relief of sx’s followed by worsening of overall abdominal pain, distress, & toxicity (vomiting, signs of sepsis, etc.)

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11
Q

Workup for acute appendicitis

A 
CBC
KUB
UA
ULS
CT
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12
Q

CBC in acute appendicitis

A

leukocytosis increases suspicion, but a nl WBC does not r/o appendicitis
WBC>10K in 89% w/ appendicitis, 93% w/ perf
WBC>62% w/o appendicitis

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13
Q

KUB in acute appendicitis

A

appendicolith (lucky) or if perforated, possibly free air

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14
Q

UA in acute appendicitis

A

+/- pyuria (peritonitis near bladder may create pyuria)

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15
Q

ULS in acute appendicitis

A

unperforated- noncompressible (diagnostic), large (>6mm, nondiagnositic) appendix
perforated- phlegmon in RLQ

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16
Q

CT in acute appendicitis

A

MOST useful test
sensitivity improves with adding up to 3 types of contrast (IV, oral, rectal)
contrast filled appendix rules OUT appendicitis
peri-appendiceal fat stranding is often NOT evident in thin ch who have very little intraabdominal fat
plenty of cases where appendix is not evident, leading to admission w/ serial abdominal exams

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17
Q

Acute appendicitis Tx

A

laparoscopic vs. open appendectomy

perforated appendicitis typically 1st tx’d w/ Abx for days/weeks before operative intervention

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18
Q

MC site of intussusception

A

ileocolic

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19
Q

Intussusception defined

A

telescoping of bowel to produce obstruction

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20
Q

Clinical findings of intussusception

A

cramping abdominal pain
emesis/diarrhea
blood in stool (classic “currant jelly” stool is a LATE finding)
may appear lethargic between bouts of pain (in DDx of altered mental status in infants & toddlers)

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21
Q

Currant jelly stools

A

classic LATE finding in intussusception

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22
Q

Dx of intussusception

A

abdominal film (insensitive)
ULS
air/contrast enema (diagnostic AND curative)

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23
Q

Tx of intussusception

A

Gut necrosis low- double contrast (water soluble & air) enema
Gut necrosis high- surgical (open reduction)

Likelihood of recurrence after either is high

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24
Q

Common causes of pediatric acute abdomen

A 
infectious enterocolitis
constipation
pyelonephritis
PID
pneumonia +/- ;leural effusion
incarcerated abdominal wall hernia
post-surgical adhesions
nephrolithiasis
ovarian/testicular torsion
perforation (d/t foreign body/ appendicitis)
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25
Q

Uncommon causes of pediatric acute abdomen

A 
pancreatitis
divertiulitis
paralytic ileus
acute cholecystitis
choledocolithiasis
mesenteric ischemia
ectopic pregnancy
perforation (PUD & causes other than those listed above)
abdominal tumor
stenosis/ atresia of gut segment
sickle cell crisis
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26
Q

Pyloric stenosis

A

gastric outlet obstruction resulting form hypertrophy of m. around pylorus
m>f
1:250-1:1000
some families w/ strong heredity of HPS

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27
Q

MC reason for abdominal surgery in 1st 6 mo of life?

A

pyloric stenosis

28
Q

Onset of pyloric stenosis?

A

first 6 month, usu. 3-4 wks after birth

29
Q

S & S of pyloric stenosis?

A

regurgitation of feeds that progressively worsens
nonbilious vomiting that may become projectile (>3 ft)
infreq. finding of abd. “olive”
metabolic alkalosis
classic triad- hypochloremia, hypokalemia, metabolic alkalosis

30
Q

Classic triad for pyloric stenosis

A

hypochloremia
hypokalemia
metabolic alkalosis

31
Q

Pyloric stenosis studies?

A

ULS

upper GI contrast study

32
Q

Tx of pyloric stenoisis

A

surgery (pyloromyotomy)
hydration
electrolyte abnormality correction

33
Q

Umbilical hernia

A

weakness in the midline fascia surrounding the umbilical area
herniation of abdominal contents (incarceration=surgical emergency)

34
Q

Tx of umbilical hernia

A

observation

rarely causes incarceration

35
Q

Inguinal hernia

A

weakness in lower abdominal wall where the processus vaginalis remains open
abdominal contents (intestine, ovary, etc) can slip down towards the scrotum/labia)
common in PRE-term infants
less common in females

36
Q

Tx of inguinal hernia

A

surgical repair is called herniorrhaphy

often w/ mesh on inner abdominal wall to prevent recurrence

37
Q

Inguinal hernia exam findings

A

usually based on hx: “fullness”, evidence of swelling during crying/ Valsalva
silk glove feeling: thick or full spermatic cord, incarceration=surgical emergency

38
Q

Stool

A

each individual will have his/her own stooling patterna & assessment should be individually tailored
some bf infants will have no bowel mvnts for 7-10 days
withholding behavior
toileting habits
change in environment (school, daycare, diet)

39
Q

Consitpation

A

delay/difficulty w/ defecation
emphasis on DIFFICULTY
variation with age

40
Q

constipation & newborn

A

1st BM in 24 hrs

41
Q

constipation & 1st wk of life

A

avg. 4 stools/day
bf- usually ABOVE avg
formula fed- usual BELOW avg

42
Q

constipation & 2 years of age

A

avg 2 /day

43
Q

constipation & 4 years of age

A

avg 1/day

44
Q

Categories of constipation

A

functional- 97%

organic- 5%

45
Q

Functional constipation

A 
diet
transitions
r/o organic dz
rectal exam (rectal vault)
evidence of spinal dysraphism
46
Q

Functional constipation & transitions

A 
change from breast milk to formula
intro of solids
formula to cow's milk
toilet training
start school
47
Q

Functional constipation & r/o organic dz

A 
delayed growth
urinary incontinence
FTT
vomiting, diarrhea
delayed passage of meconium
48
Q

Tx principles for functional constipation

A

tx early & often
tx from above, not below
anticipate transitions
behavior modification: encourage + reinforcement and child’s mastery over toileting

49
Q

Medications for infant with functional constipation

A

prune juice

lactulose (after 6 mo)

50
Q

Meds for toddler with functional constipation

A

mineral oil
lactulose
polyethylene glycol

51
Q

Meds for school age with functional constipation

A

mineral oil

polyethylene glycol

52
Q

General meds for functional constipation

A

avoid enemas

glycerin suppositories on regular basis

53
Q

Lab studies for organic causes of constipation

A 
UA, urine cx
CBC
TSH, thyroxine level
electrolytes, serum Ca++
lead level
plain abd film
barium enema
MRI
anaorectalmanometry
colonic transit studies
54
Q

Hirschprung’s Dz (organic cause of constipation)

A

motor d/o of the colon caused by the failure of neural crest cells to migrate completely during colonic development

55
Q

Hirschprung’s Dz symptoms

A 
chronic constipation
FTT
onset of sx's in 1st wk of life
delayed passage of meconium
abdominal distention
vomiting
transition zone on a contrast enema
56
Q

Dx Hirschsprung’s Dz

A 
abdominal film
barium enema
anorectal manometry
rectal bx (GOLD STD)
57
Q

Tx for Hirschsprung’s Dz

A 
excision of aganglionic segment
2 stage surgery: 
   colostomy placement, re-anastomosis
megacolon
   emergenct mgnt: fluid, Abx
58
Q

Infantile botulism

A

neuroparalytic syndrome from the action of a neurotoxin elaborated by Clostridium botulinum

59
Q

Sx’s of infantile botulism

A 
constipation
weakness
feeding difficulties
hypotonia
drooling
weak cry
60
Q

Lead poisoning

A

lead intake from environmental exposure

ingestion (dirt), lead paints, lead pollution (fuel) lead pottery

61
Q

Sx’s of lead poisoning

A

abdominal pain
vomiting
constipation

62
Q

Cow’s milk intolerance

A

chronic constipation pts changed from cow’s milk had remarkable resolution of sx’s

63
Q

Cystic Fibrosis (organic cause constipation)

A

stool is thick & may become obstructive

meconium ileus develops

64
Q

Hypothyroidism (organic cause constipation)

A 
lethargy
slow movnt
hoarse cry
feeding problems
macroglossia
umbilical hernia
dry skin
short stature
65
Q

other organic causes of constipation

A

intestinal pseudo-obstruction
neurologic handicaps
extremely low birth wt
multiple endocrine neoplasia type 2

From Flashcardlet (8 decks)

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