GI Pediatric Surgery
AGAIN: What is the gold standard for diagnosing malrotation? When should this NOT
be done? - ANS-UGI (Barium swallow)
Not done on pt in SHOCK or w/ MIDGUT VOLVULUS b/c of perforation
AGAIN: What is the most common VACTERL anomaly is seen in esophageal atresia? -
ANS-CARDIAC
All infants born w/ gastroschisis require ____ surgical tx. What must be done before
surgery? - ANS-URGENT surgical tx
Before surgery: Fluid resuscitation to replace significant evaporative fluid losses
An omphalocele that contains the liver is considered to be a ____ omphalocele. -
ANS-GIANT omphalocele
As soon as a baby is born with an omphalocele, what should be done immediately? -
ANS-Maintain body temperature by covering w/ SILO to reduce fluid loss
How do Proximal and Distal intestinal obstructions differ in terms of presentation? -
ANS-PROXIMAL:
-Emesis shortly after birth
-Minimal abd distension
Must rule out:
-Malrotation
DISTAL:
-Abd distension and THEN onset of emesis
-Delayed or absent stooling
Must rule out:
-Imperforate anus
-Meconium ileus
-Atresia
, How does a duodenal atresia present? - ANS--Bilious emesis w/o abdominal distension
(due to proximal level of obstruction)
How does entering a NG/OG tube in pts w/ esophageal atresia help dx esophageal
atresia? - ANS-Failure to pass NG/OG tube into stomach confirms esophageal atresia
How does malrotation w/ volvulus present? What is volvulus? - ANS--First 3 weeks of
life
-Bilious emesis
Volvulus: Mesentery twisting around the SMA (clockwise)
How is malrotation treated? - ANS-Ladd procedure
-Division of abnormal peritoneal bands
-Correct malrotation (turn counterclockwise)
-Restore broad based mesentery
-Appendectomy
If a baby is born with a esophageal atresia, what should be done next? - ANS-1) RULE
OUT VACTERL anomalies
2) Keep NG tube in proximal pouch on low intermittent suction to drain secretions and
prevent aspiration
3) Head of bed elevated to prevent reflux of gastric contents through distal fistula into
lungs
4) Surgical screening
If a child presents w/ Bilious emesis, you should think _____ and _____ ____. - ANS-If
child presents w/ bilious emesis you should think MALROTATION and MIDGUT
VOLVULUS
In gastroschisis, there (is or isn't) an overlying sac, so intestinal contents are bathed in
peritoneal fluid? This defect is located where? - ANS-There ISN'T an overlying sac, so
intestinal contents are bathed in peritoneal fluid.
This defect is located at jx of the umbilicus and skin on the RIGHT side of umbilicus
Jejenoileal artresias are caused by what? - ANS-Mesenteric vascular accident in utero
Malrotation w/o volvulus is best diagnosed with ____, what does it show? -
ANS-Malrotation w/o volvulus is best diagnosed with UGI (aka barium swallow)
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