Flashcards in Pestana Pediatric Surgery Deck (17):
A newborn who begins excessively salivating gets choking spells during first feeding? Tests? Complications? Treatment?
Esophogeal atresia. NG tube and x ray. Blind puch in upper esophagus and fistula between lower esophagus and trachea/bronchus. Surgical repair - gastrostomy if surgery is delayed.
What is the major constellation of congential anomalies seen in the first 24 hours?
VACTER: Vertebral, Tracheal, Esophogeal, Radial: xray, Anal: visual inspection, Cardiac: echo,
Treatment for imperforate anus? Timeline?
Colostomy (for high rectal pouch) and surgical repair. Level of pouch found by upside down x rays. Fix before toilet training.
Congential diaphragmatic hernias. Where does it present? When is the surgery preformed? Treatment if severe?
Left side, with bowel in the chest. Delay 3-4 day for maturation of pulmonary system. Endotracheal intubation, low pressure ventilation, NG, and ECMO if really severe.
Presentation difference between gastroschisis and omphalocele? Treatment?
G: exposed reddened intestines with normal cord. O: normal looking bowel (encased in the cord) exposed. Closed with silastic silo and pushing contents back into the abdomen. Gastroschisis require TPN for 1 month.
Etiology of bladder exstrophy? Timeline for treatment?
Protrusion of the bladder through the unfused pubic symphysis. Fix surgically within 48 hours.
A newborn has green vomit. Which conditions will also show double bubble on xray? Which have multiple air bubbles?
Duodenal Atresia, annular pancreas, and malrotation. Malrotation and intestinal atresia.
Where are the air bubbles found In "double bubble"?
Stomach and first portion of duodenum.
A 2 week old infant presents with crying, severe abdominal pain, green vomit, and acid reflux? Tests? Treatment
Malrotation. X rays (double bubble, additional bubbles = worse prognosis). Constrast enema (diagnostic). Surgical repair.
A newborn premature infant is intolerant to feeding during his first feeding and develops abdominal distension and rapid thrombocyopenia? Treatment? Complications?
Necrotizing enterocolitis. Stop feeding. Broad spectrum antibiotic. IV fluids, IV nutrition. Abdominal wall erythema, intestinal pneumatosis, pneumoperitoneum - correct surgically.
A baby with cystic fibrosis develops feeding intolerance and bilous vomiting? Tests and signs? Treatment?
Meconium ileus. X rays (dilated loops in small intestine and ground glass appearing lower abdomen). Gastrografin enema is both diagnostic and theraputic.
A 3 week old boy develops nonbilious projectile vomiting after feeding? What is found on physical exam? What could he have past exposure to? Metabolic state? Tests? Treatment?
Hypertrophic pyloric stenosis. Eryth/Azythromycin. Palpable olive sized mass in RUQ, signs of dehydration. Hypochloremic, hypokalemic, metabolic alkalosis. Sonogram. Rehydration, correction of alkalosis, and Remstedt pyloromyomoty/balloon dilation.
A 7 week old baby presents with progressively increasing jaundice? Tests? Rule of 1/3s?
Biliary atresia. Check serologies and sweat test. Preform HIDA scan after 1 week of phenobarbitol - if no bile comes out, surgical exploration. 1/3 can get long last surgical derivation, 1/3 need liver transplant after derivation, 1/3 need liver transplant asap
A young girl has a history of chronic constipation, and recently has developed fecal soiling? Tests?
Hirschsprung disease. X rays - distended proximal colon. Full thickness biopsy of rectal mucosa (diagnostic) - will be aganglionic.
A chubby 10 month old healthy child has transient (1 minute) colicky abdominal pain. He has his knees drawn up, and has currant jelly stool? Tests? Clinical Sign? Treatment?
Intussusception. Barium enema is diagnostic and theraputic. "empty" RLQ = Dance sign. Surgery if it recurs.
An infant presents with the subdural hematoma and retinal hemorrhages?
Shaken baby syndrome.