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SURGERY
Pedi
Question | Answer |
---|---|
Sudden onset of bilious vomiting in newborn; presents within 1yr. What is the diagnosis, what tools to diagnose, what is the initial tx? | Malrotation of Gut, UGI to visualize malpositioned ligament of Treitz, Emergent laparotomy & Ladd’s procedure (rotate counterclockwise) w. resection of dead bowel |
Usually in males, presents as failure to pass meconium in 1st 24hr; abd distention, bilious vomiting; may present later w. constipation, diarrhea, slowed growth. What is the diagnosis, what tools to diagnose, what is the initial tx? | Hirschsprung’s Dz; AXR (dilated colon), unprepared barium enema, rectal biopsy; Colostomy proximal to transition zone, or resection & pull-through anastomosis |
Most in 1st born males 2 wks to 2 mos old; inc regurgitation then nonbilious projectile vomiting; dec wt, dec stool, epigastric mass (“olive”). What is the diagnosis, what tools to diagnose, what is the initial tx? | Pyloric Stenosis; H&P; U/S, barium swallow (string sign); Hydration, correction of lytes & acid-base disorder, Fredet-Ramstedt pyloromyotomy |
Bowel obstruction in 2mos to 2yr- old; preceded by viral infxn; sudden onset of recurring severe crampy abd pain, vomiting, drawing up legs, currant jelly stool; RUQ mass, empty RLQ-Dance’s Sx. diagnosis, what tools to diagnose, what is the initial tx? | Intussusception; Air or barium enema: coiled spring appearance; Hydrostatic reduction during air enema; surgical exploration if unsuccessful or if peritonitis; manual reduction; resection |
Painless bleeding, obstruction; usually within 2 yrs & in males; What is the diagnosis, what tools to diagnose, what is the initial tx? | Meckel’s Diverticulitis; Technetium- pertchnate scan if gastric mucosa; Wedge resection or segmental ileal resection; do w. appendectomy |
Cigarette burns, rope burns, scald to posterior thighs/buttocks, multiple or old Fx, genital trauma, delayed access to health care. What is the diagnosis, what tools to diagnose, what is the initial tx? | Child Abuse; admit child to hospital. |