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Choledochal cysts: must excise

  • Leaving cyst:
  • 25% cancer
  • 30% pancreatitis

  • Type I: (>90%) whole CBD involved.
    • Excise, do hepatico-jejunostomy

  • Type II: diverticulum.
    • Do diverticulectomy

  • Type III: Choledochocele involving sphincter.
    • Excise, sphincteroplasty

  • Type IV: Intra- and Extrahepatic cysts (Caroli's disease)
    • Transplant

  • Type V: Intrahepatic cysts.
    • Transplant

Pulmonary sequestration:

  • Extralobar has systemic artery and vein
  • Intraloabar has aorta in and pulmonary vein out.
  • Resection is treatment for both.
  • #1 presentation = infection (not as respiratory distress in newborn)

Congenital lobar emphysema:

  • Massive hyperinflation of a single lobe, usually upper/middle
  • 1/3 have respiratory distress at birth, only 5% present after age 6 months
  • M:F ratio is 2:1
  • CXR: radiolucency of affected lobe, compression of other lobe
  • Severely symptomatic: lobectomy, excellent Prognostic

Cystic hygroma: lymphangioma è resect

  • Infection is #1 complication

Sistrunk procedure: Excision of thyroglossal duct cyst (midline) with hyoid bone

CHF in children: 1st sign is hepatomegaly

Strawberry hemagioma: appear in 1st few weeks of life

Tx: Leave alone since most involute by age 7.

Neuroblastoma: #1 solid pediatric malignancy

  • 90% have increased VMA
  • High HVA (homovanillic acid) è worse prognosis
  • From neural crest
  • Only 30% cure
  • Associated with N-myc

#1 peds malignancy overall is leukemia

Wilm's tumor: Nephroblastoma.

  • 80% cure with nephrectomy

Biliary atresia: Need Kasi procedure (before age 3 months) = hepatoportoenterostomy

Meckel's diverticulum:

  • A true diverticulum
  • Embryology = persistent omphalomesenteric duct
  • On anti-mesenteric border.
  • 2 feet from ileocecal valve
  • 2% population
  • 2% symptomatic
  • 2 types of tissue (pancreatic, gastric)
  • 2 common presentations (diverticulitis, GIB).
  • #1 GIB in children.
  • Obstruction mc presentation in adults
  • Dx: Meckel scan (99Tc)
  • Tx:
    • Uncomplicated: diverticulectomy
    • Complicated: segmental resection

Intussusception:

  • Reduce with air/contrast enema.
  • IV glucagon can help (relaxes smooth muscle).
  • Usually < 3 yo. To OR if peritonitis, free air.
  • Adult w/intussusception goes to OR since high likelihood of malignancy at lead point

Intestinal atreasias:

  • Are secondary to intra-uterine vascular events.
  • Mother may have polyhydramnios.
  • 10% of atresias are multiple.

Duodenal atresia:

  • Presents w/bilious vomiting
  • "double-bubble"
  • #1 neonatal duodenal obstruction
  • Associated with trisomy 21 (Down's)
  • 1/3 have cardiac defects

TE fistulas:

  • 90% are type C as in "Common"
  • Blind esophagus, distal TEF
  • Spit up feeds
  • NGT won't pass
  • 5% are type A
  • Blind esophagus, no fistula
  • No air in entire GI tract
  • Associated with: VATER =
  • Vertebral, anorectal (imperforate anus in 10%). TEF, radial, renal anomalies.


Ladd's procedure: (for mal-rotation)

  • Appendectomy
  • Take down bands
  • Counterclockwise rotation.

Meconium ileus (cystic fibrosis):

  • Try gastrograffin enema (Dx and Tx)

Hirschsprung's: #1 cause of colon obstruction

  • No BM in 1st 24 hours
  • Dx with rectal bx)

NEC: Presents after initiating feeds in neonate (preemie) with blood in stool.

  • OR for free air, peritonitis, acidosis, thrombocytopenia, clinical deterioration (resect, ostomies)
  • Must do contrast evaluation before reconnecting bowel weeks later (20% will have stenosis)

Imperforate anus:

  • If high, have meconium in urine (fistula to bladder, vagina or urethra) need colostomy.

Gastroschisis:

  • Intrauterine rupture of umbilical cord
  • No associated defects
  • Lateral (right) defect, no sac

Omphalocele:

  • Midline defect
  • May contain liver or other non-bowel contents
  • Frequent anomalies (cardiac, pericardium, sternum, diaphragm = Cantell pentology)
  • Has peritoneal sac.

Pages in category "Pediatrics"

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