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116 Cards in this Set
- Front
- Back
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Foregut
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lungs, esophagus, stomach, pancreas, liver, GB, BD, duodenum proximal to ampulla
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Midgut
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duodenum distal to ampulla
Small bowel large bowel to distal 1/3 |
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Hindgut
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distal 1/3 of transverse colon to anal canal
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Maintenance IVF
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4cc/kg/hr for 1st 10kg
2cc/kg/hr for 2nd 10kg 1cc/kg/hr for everything after that |
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extralobar vs intralobar sequestration
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both have aortic supply
Extra - systemic venous drainage Intra - pulmonary venous drainage |
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management of pulmonary sequestration
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Lobectomy
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Congenital lobar overinflation (emphysema)
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no cartilage leading to air trapping
act like tension PTX LUL/RML mc affected |
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management of congenital lobar overinflation (emphysema)
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Lobectomy
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congenital cystic adenoid malformation
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lobectomy
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bronchiogenic cyst
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milky fluid filled mediastinal mass
Tx: resect cyst |
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MC mediastinal mass in children
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neurogenic tumors
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Etiology of choledochal cyst
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reflux of pancreatic enzymes
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Management of different types of choledochal cysts
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I hepaticojej
II resect off CBD III choledochojej IV resection +/-lobectomy V resection +/-lobectomy |
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MC type of choledochal cyst
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type 1 85%
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diaphragmatic hernias (mortality, laterality, presentation)
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mortality (50%)
left side (80%) asstd anomalies (80%) pulmonary HTN |
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Treatment of diaphragmatic hernias
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stabilize then reduce bowel an repair mesh
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3 types of diaphragmatic hernias
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Bochdalek (MC, posterolateral)
Morgagni Eventration |
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branchial cleft cysts treatment
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resection for all types
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types of branchial cleft cysts
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1st angel of mandible a/w CN7
2nd (MC) anterior border of SCM 3rd lateral neck |
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Thyroglossal duct cyst
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Descent of thyroid gland from foramen cecum
Midline cervical mass |
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Management of thyroglossal duct cyst
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Excise cyst, tract, hyoid bone
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Management of hemangioma
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@ birth
Rapid growth during 1st 6-12 mos |
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When do you act on hemagiomas?
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Observation usually (resolve by age 7-8)
1) uncontrollable growth 2) impaired function 3) after age 8 steroids first, laser/resxn |
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#1 solid abdominal malignancy in children
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neuroblastoma (neural crest cells)
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Presentation of neuroblastoma
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usually asx mass
secretory diarrhea raccoon eyes HTN |
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MC location of neuroblastoma
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adrenals
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MC age of neuroblastoma
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1st 2 years of life
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Neuroblastoma usually have increase levels of?
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catecholamines
VMA HVA metanephrines |
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Do neuroblastoma usually metastatize?
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rarely to lung and bone
increase NSE |
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Presentation of Wilm's tumor
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usually asymptomatic mass
hematuria HTN 10% B/L |
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Do wilm's tumor usually metastatize?
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frequently to bone and lung
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Prognosis of wilm is based on?
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tumor grade
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What syndrome is Wilm's tumor usually associated with?
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Beckwith-Wiedemann syndrome (hemihypertrophy, cryptorchidism, Drash syndrome, aniridia)
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Wilm vs neuroblastoma
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wilm replaces renal parenchyma not displacement as in neuroblastoma
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Chemo agents used in wilm's and indications?
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actinomycin and vincristine (add doxo if stage II or >500g)
all pts receive chemo except stage 1 <500g |
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Indications for XRT in Wilm's
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Stage III
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#1 children's malignancy
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ALL
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#1 solid tumor class
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CNS tumor
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#1 gen surgery pediatric tumor
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neuroblastoma <2 y.o
Wilm's >2 y.o |
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#1 cause of duodenal obstruction in <1 week old vs >1 week old
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duodenal atresia vs malrotation
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MC cause of painful LGIB
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benign anorectal lesions
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painless LGIB
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Meckel's diverticulum
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Location and embryology of Meckel's diverticulum
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antimesenteric SB; persistent vitelline duct
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Rule of 2s in Meckel's
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2 feet from IC valve
2% of population 2% symptomatic |
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2 tissue types and presentations of Meckel's diverticulum
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Pancreatic (MC) and gastric (sx)
Diverticulitis and bleeding |
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Indications to resect Meckel's diverticulum
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symptoms
suspicion of gastric mucosa narrow neck |
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When do you perform segmental resection in Meckel's?
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diverticulitis involving base
OR base>1/3 size of bowel |
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Metabolic abnormality in pyloric stenosis
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hypoCl, hypoK metabolic alkalosis
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age/sex/presentation of pyloric stenosis
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3-12 weeks firstborn males
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Management of pyloric stenosis
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resuscitate with 10% dextrose before OR --> pyloromyotomy (RUQ incision)
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Age & presentation of intussusception
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3 months to 3 years
currant jelly stools/sausage mass/abdominal distension/RUQ pain/vomiting |
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Lead points of intussusception in children
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#1) enlarged Peyer's patches
Lymphoma Meckel's diverticulum |
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Percentage of recurrence after reducing intussusception
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15%
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Treatment of intussussception (success rate)
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reduce with air-contrast enema - 80%
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OR for intussusception if...
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Max pressure of 120 or max column height of 1 meter are reached
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Caution with surgically reducing intussussception
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do not place traction on proximal limb
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Etiology of intestinal atresias
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intrauterine vascular accidents
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Presentation and location of intestinal atresias
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bilious emesis, distension, no meconium passing
MC in jejenum |
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Work up & management of intestinal atresia
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Barium enema to R/O Hirschsprung's and resect
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Location of duodenal atresia
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distal to vater
double bubble |
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Associations with duodenal atresia
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polyhydramnios in mother
cardiac, renal, and other GI anomalies 20% Down's |
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Treatment of duodenal atresia
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resuscitate and duodenoduodenostomy or duodenojejunostomy
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TE Fistulas (MC type and management)
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Type C (80-90%) Proximal esophageal atresia and distal TE fistula
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2nd MC type of TE fistula
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Type A (5-10%)
Esophageal atresia No fistula AXR - gasless abdomen |
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TEF workup
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VACTERL (check anus and ECHO)
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treatment of TEF
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Right extrapleural thoracotomy
Primary repair G tube Divide azygos vein usually |
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Management of TEF in premature, <2500 or sick babes
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Replogle tube
delay repair Gtube |
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Sudden bilious vomiting in babies
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Malrotation (Ladd's bands)
Volvulus a/w SMA compromise Failure of nl counterclockwise rotation |
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Workup, age, treatment of malrotation
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90% by 1st year (75% in 1st month)
UGI (duodenum does not cross midline) resect Ladds, counterclockwise rotation, cecopexy (LLQ), appendectomy |
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Pathophysiology of meconium ileus
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distal ileal obstruction (bilious vomiting)
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Necessary test in meconium ileus
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sweat Cl test
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AXR findings in meconium ileus
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dilated SB loops without air fluid levels
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Treatment of meconium ileus
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gastrografin enema (80%) or mucomyst enema
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Surgery for meconium ileus
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manual decompression
creation of vent for mucomyst antegrade enemas |
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Presentation of NEC
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bloody stools after 1st feeding in premature infant
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RF/Sx in NEC
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RF: prematurity, hypoxia, hypotension, anemia, polycythemia, sepsis
Sx: lethargy, resp. decomp, abd distensin, vomiting, BRBPR |
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Initial Tx of NEC
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resuscitation, NPO, Antbibx, TPN, OGT
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Surgery of NEC
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free air, peritonitis
resect dead bowel and ostomies barium contrast enema before taking down ostomies |
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Mortality rate in NEC
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10%
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Trteatment for congenital vascular malformation
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embolization and resection
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Management of imperforate anus
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check VACTERL
High (above levators) - colostomy Low - posterior sagittal anoplasty, no colostomy |
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s/p correction of imperforate anus need?
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postop anal dilation to avoid stricture
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Etiology of gastroschisis vs omphalocele
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intrauterine rupture of umbilical vein vs failure of embryonal development
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Midline, peritoneal sac, congenital abnormalities in gastroschisis vs omphalocele
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Gastroschisis (no sac, right of midline, 10% congenital abnormalities)
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Treatment of gastroschisis
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Place saline-soaked gauzes and resus pt
TPN, NPO Repair when stable reduce bowel (may need vicryl mesh silo) |
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Cantrell pentalogy
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cardiac, pericardium, sternal, diaphragmatic, omphalocele
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Treatment of omphalocele
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place saline soaked gauze and resus pt, TPN, NPO
repair, may need mesh and subsequent closure |
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What can happen with malrotation?
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gastroschisis & omphalocele
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bowel character in gastroscihsis vs omphalocele
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inflammed in gastroschisis
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relationship of umbilical cord in gastroschisis and omphalocele
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gastroschisis (right of cord)
Omphalocele (attached to cord) |
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#1 cause of colonic obstruction in infants
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Hirschsprung's disease
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MC sign of hirschsprung's dz
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can't pass meconium in 1st 24 hours
explosive diarrhea with DRE can have nl barium enema |
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Diagnosis and etiology of hirschsprung's dz
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rectal biopsy (aganglionic myenteric plexus)
neural crest cells failure to progress in craniocaudal direction) |
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Treatment of Hirschsprung's
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may need colostomy
resect colon to where gangion cels appear |
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Tx of hirschsprung's colitis
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rectal irrigation
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Evolution and findings of hydrocele
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most disappear by 1 year; transilluminate
surgery if communicating or @ 1 year resect hydrocele and ligate processus vaginalis |
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When do you operate on umbilical hernia?
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age 5, incarcerate, VP shunt
most close by age 3 |
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inguinal hernia etiology
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persistent processus vaginalis
3% infants M>F R 60% L 30% |
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Treatment of inguinal hernia
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elective repair with high ligation
explore contralateral side if L sided, female or <1year |
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Tx of cyst duplication
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MC in ileum
antimesenteric resect cyst |
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MCC of neonatal jaundice
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biliary atresia (jaundice>2 weeks)
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how do you diagnose biliary atresia
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liver biopsy (periportal fibrosis, bile plugging, eventual cirrhosis)
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Treatment of biliary atresia
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Kasai procedure (before 3 months)(hepaticoportojejunostomy)
1/3 improve, transplant, die |
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Mets in osteosarcoma?
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pulmonary
resect primary and pulmonary mets if isolated |
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hormones in teratoma?
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elevated AFP and Beta HCG
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location of teratomas in neonates vs adolescents
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sacrococcygeal vs ovarian
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Timing of sacrococcygeal teratomas
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90% benign @ birth
>2 months 90% malignant coccygectomy |
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Undescended testes
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wait until 2 years to treat
high risk of seminoma even if brought down |
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Further w/u in bilateral undescended testes
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chromosomal studies
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treatment of undescended testes
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orchiopexy through inguinal incision
(if can't be reached - close and wait 6 months, if not divide spermatic vessels) |
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Prune belly syndrome
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hypoplasia of abd wall
urinary tract abnormalities bilateral cryptoorchidism |
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MCC of infantile obstruction
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laryngomalacia
stridor exacerbation in supine position |
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Etiology/course of infantile obstruction
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Immature epiglottis cartilage vs
most children outgrow this by 12 months |
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MC tumor of pediatric larynx
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laryngeal papillomatosis
frequently involutes after puberty |
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Etiology/tx of laryngeal papillomatosis
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HPV during passage
endoscopic removal but recurs |
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cerebral palsy usually develops
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GERD
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