Pestana- 5. Pediatric Surgery Flashcards Preview

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Flashcards in Pestana- 5. Pediatric Surgery Deck (58)
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1

What do you expect if a baby shows up with excessive salivation noted shortly after birth or choking spells when first feeding is attempted?

esophageal atresia

2

What can be done to make the diagnosis of esophageal atresia?

pass an NG tube and see it coiled up in the chest on CXR

3

What is the sign that a baby has the most common form of esophageal atresia (blind pouch in upper esophagus and fistula between lower esophagus and tracheobronchial tree)?

normal gas pattern in the bowel

4

What must you also look for in a patient with esophageal atresia?

VACTERL
(imperforate anus, cardiac anomalies, renal anomalies, vertebral anomalies)

5

What must you do in a patient with esophageal atresia if surgery has to be delayed?

gastrostomy (protects lungs from acid reflux)

6

What should you look for if your patient has an imperforate anus?

nearby fistula (to vagina or perineum)

7

If a fistula is nearby, what does this mean for surgery?

it can be delayed (but needs to be done before toilet training)

8

How do you determine the level of the rectal pouch?

x-ray taken upside down with metal marker taped to the anus

9

Congenital diaphragmatic hernia is always on what side?

left (bowel up in chest)

10

What is the major problem in CDH?

hypoplastic lung that still has fetal-type circulation

11

How long must you wait before you repair CDH?

3 or 4 days

12

What is the treatment for pre-op CDH?

-Endotracheal intubaiton
-Low pressure ventilation
-Sedation
-NG suction

13

What may you have to do for difficult cases of CDH?

Extracorporeal Membrane Oxygenation

14

When is CDH usually diagnosed?

before birth (sonogram)

15

What side is gastrochisis on?

right

16

Is there a cord in omphalocele?

not really, the cord goes to the defect

17

What all is in the omphalocele membrane?

normal-looking bowel and a little slice of liver

18

How long does silo closure usually take?

about a week

19

How long does it take gastrochisis bowel to start working?

around a month (baby needs vascular access for TPN)

20

How quickly must you repair exstrophy of the bladder?

within 1-2 days of life

21

In what 3 conditions may you see "double-bubble" and bilious vomiting?

-Duodenal atresia
-Annular pancreas
-Malrotation

22

WHy is malrotation very dangerous?

volvulus can occur and the bowel can become ischemic and die

23

If you see double bubble with little normal gas pattern beyond, what should you think of?

malrotation

24

How do you diagnose malrotation?

-Contrast enema (safe but not always diagnostic)
-Upper GI study (risky but more reliable)

25

When will malrotation typically present?

within the first few weeks of life

26

What do you expect with bilious vomiting and multiple air-fluid levels?

intestinal atresia

27

What leads to intestinal atresia?

vascular accident in utero

28

What do you suspect in a premature infant who develops feeding intolerance, abdominal distention, and a rapidly dropping platelet count after their first feed?

necrotizing enterocolitis

29

How do you treat necrotizing enterocolitis?

-Stop feedings
-Broad spectrum Abx
-IVF
-IV nutrition

30

When is surgical intervention required for necrotizing enterocolitis?

-Abdominal wall erythema
-Air in portal vein
-Intestinal pneumatosis
-Pneumoperitoneum (necrosis + perf)