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Phase 2 PEDs > Surgical d/o > Flashcards

Surgical d/o Flashcards

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1
Q

Red flags of neonatal surgical d/o’s?

A 
Maternal polyhydramnios
Delayed meconium passage
Abd distention (Obstruction)
Perinatal vomiting (bilious or non-bilious)
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2
Q

Maternal polyhydramnios is?

A

Inability of fetus to swallow/digest amniotic fluid = fluid backs up

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3
Q

MC TE fistula variation?

A

Esophageal atresia - w/ distal TEF

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4
Q

Esophageal atresia is?

A

Esophagus is incomplete and not continuous

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5
Q

Pathophys of Esophageal atresia?

A

Baby cannot swallow amniotic fluid >
Fluid cannot pass into intestine/transfer to placenta >
Mom cannot dispose >
=== Polyhydramnios (fluid backs up)

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6
Q

TE fistula presents as?

A 
(MC) Cough, choking, respiratory distress, cyanosis
Excess saliva (drooling)
Symptoms worse w/ feeding
Single umbilical artery (common)
VACTRL
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7
Q

TE fistulas ass/w VACTRL are?

A 
Anomalies
V - Vertebrae  (70%)
A - Anal atresia (imperforate anus)
C - Cardiac
T - TEF (itself) (70%) 
R - Renal 
L - Limb (polydactyly etc.) (70%)
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8
Q

TE fistulas are Dx how?

A

OG tube placement fails (CXR - catheter tube curled)
If difficult
- Water soluble gastrografin swallow study
- Methylene blue challenge

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9
Q

TE fistula TXT?

A

Ligate fistula, re-approximate esophagus
- anastomosis (may need to postpone due to gap)
Gastrostomy tube for feedings until surgery

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10
Q

Number one cause of Intestinal obstruction <3mo old?

A

Pyloric stenosis

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11
Q

MC pop of Pyloric stenosis

A

<3mo (2-6wk old MC)
M>F 5:1
1st born more common

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12
Q

Pyloric stenosis is?

A

Pyloric muscle hypertrophy and spasms = obstruction

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13
Q

Classic Pyloric stenosis presentation?

A

Post-prandial - nonbilious PROJECTILE vomit

Ravenously hungry > FTT and Lethargic

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14
Q

Labs of pyloric stenosis

A 
Vomiting d/o = hypo Cl- and K+ (metabolic alkalosis)
Elevated BUN (dehydration)
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15
Q

Pyloric stenosis Abdominal exam signs?

A

Palpable - hypertrophied pylorus (An Olive)

LUQ Peristaltic Waves

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16
Q

Pyloric stenosis RADs? Findings?

A

U/S - elongated thickened pylorus
Barium Upper GI series - “String sign”
- barium passes elongated, constricted pyloric channel

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17
Q

Pyloric stenosis mgmt?

A

IV fluids/lytes resus (NS bolus > D5 w/ K+)
OG tube - slow feeds until surgery
Surgery = Pyloromyotomy

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18
Q

Congenital Diaphragmatic Hernia is?

A

Large posterolateral opening in diaphragm (usually unilateral) that allows bowel to herniate

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19
Q

Congenital Diaphragmatic Hernia occurs MC on what side?

A

L-side

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20
Q

Bochdalek formation is ass/w?

A

Congenital Diaphragmatic Hernia

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21
Q

Pathophys of Congenital Diaphragmatic Herniation?

A

Bowels develop BEFORE lungs >
Bowels impede NL lung development >
Left (Posteriorly)

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22
Q

Congenital Diaphragmatic Hernia presents as?

A 
Progressive severe respiratory distress after delivery
Scaphoid Abd (hollowed anterior abd wall)
Bowel sounds in L-chest
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23
Q

Congenital Diaphragmatic Hernia Dx via?

A

XR

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24
Q

Congenital Diaphragmatic Hernia TXT?

A

Intubate/ventilate
Oro-gastric decompression
Surgery

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25
Umbilical hernia is?
Imperfect closure/weakness of umbilical ring 1-5cm | May contain portions of Omentum/Sml intestines
26
What size Umbilical hernia will most likely NOT close on their own?
>2cm
27
RFs of Umbilical hernia?
Low birth weight | AA
28
MC age Umbilical hernia is seen?
Most 6mo of age and disappear by 1yr
29
When is surgery recommended for Umbilical hernia?
Hernia persists to 4-5yo Symptomatic or strangulated Larger after 1-2yrs
30
Malrotation w/ midgut volvulus is?
Intestines fail to rotate during development causing a volvulus (obstruction/necrosis)
31
Pathophys of Malrotation w/ midgut volvulus?
``` Intestines fail to rotate during development > Intestines twist on itself > Intestinal obstruction > Mesenteric artery occlusion > Ischemia /infarcation/necrosis ```
32
Presentation of Malrotation w/ midgut volvulus?
Bilious vomiting in 1st mo of life or later in infancy | TTP Abd
33
Ladd's bands are?
Duodenal constrictions that may cause vomiting despite malrotation of midgut
34
Malrotation w/ midgut volvulus Rad?
XR - obstruction Barium enema - Cecum in RUQ (twist pulls cecum up) Corkscrew effect of upper GI - barium swallow
35
TXT of Malrotation w/ midgut volvulus
Fluids OG decompression Immediate - laparotomy
36
Ddx Difference between bilious and non-bilious vomiting
Bilious - Malrotation w/ midgut volvulus - Intestinal atresia - Hirschsprung disease Non-bilious vomiting - Pyloric stenosis
37
Intestinal atresia ass/w?
Meconium ileus w/ cystic fibrosis (Check CF) | Trisomy 21
38
Intestinal atresia presents as?
``` Bilious vomiting Jaundice Polyhydramnios Failed attempts to feed Abd distention ```
39
Intestinal atresia Studies?
XR, Contrast study, Labs (CBC, CMP, amylase/lipase)
40
Intestinal atresia XR may show?
Double bubble sign - if Duodenal atresia | Long dilated segments of air filled bowel - Distal atresia
41
Intestinal atresia mgmt?
IV fluids OG/NG decompression Broad apectrum Abx Surgery
42
Gastrochisis is?
Split or open stomach - (Linear abdominal wall split/defect) exposes intestines to amniotic fluid w/ thick exudative peel over intestines (irritant)
43
Gastroschisis occurs on what side MC?
Right side
44
Does Gastroschisis involve umbilicus?
NO
45
Gastroschisis is ass/w?
Segments of atresia
46
Omphalocele pathophys is?
Impaired abdominal wall growth > Intestines to remain in umbilical cord > Herniation of bowel through umbilical ring
47
Which is ass/w umbilicus Gastroschisis or Omphalocele?
Omphalocele is ass/w the umbilicus
48
Gastroschisis/Omphalocele mgmt?
OG/NG decompress IVF and Parenteral nutrition Sterile dressing coverings Surgery
49
Gastroschisis/Omphalocele surgery considerations?
Small defects <2cm repaired immediately | Large defects req staged procedure
50
Meckel's diverticulum is?
A congenital malformation outpouching if ileum (remnant of vitelline duct) that may have ectopic mucosae similar to gastric/pancreatic
51
MC intestinal malformation is?
Meckel's diverticulum (true diverticulum)
52
Meckel's diverticulum rule of 2's?
``` 2% of population Presents w/in 2yrs of life W/in 2 ft of cecum on ileum 2 inches long 2 ectopic mucosae (gastric/pancreatic) ```
53
Meckel's diverticulum presents as?
Asymptomatic OR - Massive painless GI bleed - Ulceration of ileum - Intestinal obstruction
54
Complications of Meckel's diverticulum?
Intussusception or Volvulus = Obstruction Diverticulitis Bleeding > Perforation
55
Meckel's diverticulum Dx is performed?
Meckel Scan - (Technetium-99m scan) tests for gastric acid | U/S, video capsule endoscopy, surgical investigation
56
Anorectal malformations are?
Absence of normal anal opening | Fistulas connecting structues present (meconium leak)
57
Anorectal malformations mgmt?
Lateral XR = gas in bladder > distention > cath | MRI - check tethered spinal cord
58
Other complications of Anorectal malformations?
Urologic dysfx
59
Anorectal malformations TXT?
Surgery - colostomy after anogenital reconstruction
60
Hirschsprung disease is?
Absent Motility defect causing congenital megacolon(dilation) proximal to aganglionic segment causing functional obstruction.
61
Hirschsprung disease is MC located where in GI?
Rectosigmoid region 75%
62
Hirschsprung disease presents as?
95% don't pass stool by 24hrs of age Abd distention due distal bowel obstruction Bilious vomiting
63
Hirschsprung disease Dx via?
XR - Dilated SML/LRG bowel proximal Barium enema - Megacolon/Colonic impaction Rectal Bx of aganglionic mucosa Anorectal manometry DRE - finger withdrawn = stool expulsion or empty.
64
Hirschsprung disease TXT?
Surgery Colostomy above affected segment - Remove aganglionic section - Decompress distended/inflamed bowel
65
Necrotizing enterocolitis is?
Ischemia 2nd to immature GI system and is ass/w prematurity and enteral feedings.
66
Necrotizing enterocolitis mgmt?
Stop enteral feeds > Total parenteral nutrition (TPN) GI decompression w/ NG Fluid/Lyte replacement Broad spectrum Abx Surgery - laparotomy w/ excision of affected bowel.
67
Necrotizing enterocolitis EARLY presentation?
Abd distention feeding intolerance Rectal bleed/occ. diarrhea Emesis
68
Necrotizing enterocolitis LATE presentation?
``` Bluish abdomen = Intestinal perforation Bilious vomiting Ascites Lethargy DIC/Shock ```
69
Necrotizing enterocolitis Dx?
Clinical S/S | XR
70
Necrotizing enterocolitis XR shows?
Ileus w/ bowel loop thickening and air-fluid levels Bacterial Gas between bowel wall (pneumatosis int) Dilated bowel Pneumoperitoneum = perf Intrahepatic venous gas
71
Intussusception is?
Telescoping of proximal bowel into distal bowel
72
Intussusception ass/w?
Meckels diverticulum (Ileocecal valve) Peyer's patched (lymphoid hyperplasia) Rotavirus infection
73
Intussusception presents as?
``` Paroxysmal, crampy abd pain/distention Bilious vomiting Currant jelly stools RUQ/epigastric sausage shaped mass Lethargy, Crying and drawing legs up Refuses feeds ```
74
Currant jelly stools appears?
Mixture of mucus, sloughed mucosa, and blood.
75
Intussusception Dx?
Pneumatic or Barium enema w/ fluoroscopy | - Dx and TXT
76
Intussusception Mgmt?
Fluid resuscitation NG tube decompression Pneumatic/Barium enema (Dx and TXT) Surgical consult - reduction or resection
77
MC surgical emergency in children?
Appendicitis
78
Peak age for pediatric appendicitis?
10-12yo
79
Appendicitis is?
Obstruction of appendix lumen (MC-fecalith or LN hyperplasia after viral infection.
80
Appendicitis pathophys?
Obstruction > Trapped bacteria proliferation > Invade appendix wall > Inflammation/rupture
81
Timeframe for Appendicitis rupture after onset of S/S?
W/in 48hrs of s/s
82
Appendicitis presents as?
``` Periumbilical visceral pain RLQ pain - McBurney's point Appendiceal distention Voluntary guarding > rigidity > rebound TTP N/V ```
83
Alvarado/Mantrels rule applies to? Is?
``` Appendicitis (<4pt = unlikely OR > 7pt = likely) (1pt each) - Pain migration to RLQ - Anorexia - N/V - Rebound pain - Fever - WBC L-shift >75% Segs (2pt each) - RLQ TTP - Leukocytosis >10k ```
84
Appendicitis Dx?
CT w/ IV contrast - MOST accurate U/S XR - Abd series/KUB Lab - CBC, CMP, UA/Cx
85
Appendicitis mgmt?
Appendectomy | IV Antibitoics
86
Appendicitis PE signs for surgery?
Guarding/rigidity Sev TTP + rebound TTP or referred pain
87
Appendicitis tests to perform in PE?
``` Heel strike Obturator sign (Int rotation of flexed thigh) Psoas sign (Extension of hip on side) ```

Phase 2 PEDs (23 decks)

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