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Flashcards in PEDS Deck (41)
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Meckel's workup

Put in NG tube first to rule out upper gastrointestinal bleed.

Technetium 99 – Meckel's scan

Increased sensitivity with H2 blocker, glucogon, tinted Gaston stimulation

angeo and tagged red blood cell not as good.

If failed to diagnose:
diagnostic laparoscopy

Consider non-umbilical sight of trocar because of risk of vitelline duct attachement.


Meckel's diverticulectomy

right peri Median incision(or laparoscopy)

Incidental appendectomy.

Ligate a large mesenteric vessel at tip of diverticulum.

If a acute hemorrhage:
Wedge resection of diverticulum and adjacent ilio alteration

Control sites of bleeding of ileal mucosa

Closed transversely handsewn

(may close with stapler if narrow base)

If an intestinal ischemia, extensive inflammation, irreducible intussusception, very wide diverticulum, or palpable ectopic mucosal tissue near the diverticulum:

Segmental RESECTION of involved illium

If significant alteration and bleeding opposite to the diverticulum on the mesenteric side:

Segmental RESECTION.


Omphalocele define

midline anterior abdominal wall

fascial defect > 4 cm.

The rectus muscles are present and normal but insert widely on the costal margins and do not meet in the middle at the xiphoid.

allows for herniation of the midgut and other abdominal viscera.

The herniated organs are contained within a membranous sac that consists of peritoneum, Wharton’s jelly, and amnion.

The umbilical cord inserts on the apex of this membrane.

Small omphalocele contains small bowel with or without stomach and has a fascial defect 5 cm.

Ruptured omphalocele is the third presentation of omphalocele where the sac has ruptured in utero or during birth.


Gastroschisis defined

is a full-thickness abdominal wall defect that occurs just to the RIGHT
of a normally inserted umbilical cord.

The herniated bowel and abdominal viscera are not covered by a membrane.

The viscera are subjected to exposure to amniotic fluid during gestation.


An umbilical hernia defined

abdominal wall defect caused by a persistent umbilical ring and is covered by skin.


Pentalogy of Cantrell defined

is a rare congenital


anterior diaphragmatic hernia,

malformation or absence of the pericardium,

sternal cleft,

and cardiac malformations.


Ectopia cordis thoracis defined

partial or complete failure of midline fusion of the sternum resulting in the heart protruding from the chest through a split sternum.

In contrast to the Pentalogy of Cantrell, the heart is not covered by a membrane in ectopia cordis thoracis.


prune belly syndrome

constellation of anomalies including deficient or absent abdominal wall muscles,

bilateral cryptorchidism,

dilated dysmorphic urinary tract.


work up of omphalocele

Chest x-ray, echocardiogram, renal ultrasound, and skeletal radiography are performed and note no abnormalities.


omphalocele associations

(Beckwith-Wiedemann, OEIS [omphalocele, exstrophy, imperforate anus, and spinal

Gershoni-Baruch, Donnai-Barrow)


with an associated chromosomal abnormality (trisomy 13,14, 15, 18, or 21 DOWNS).

Fifty percent to seventy percent of patients with an omphalocele will have at least one associated anomaly.

Cardiac defects represent the most frequent anomaly occurring in 30% to 50% followed by

Chromosomal abnormalities occur in 30%.

Omphalocele has also been seen with Turner’s syndrome and triploidy.


Beckwith-Wiedemann syndrome is

umbilical defect,


increased risk of
Wilms’ tumor,

Omphalocele is also part of the OEIS complex, which involves
bladder exstrophy,
imperforate anus,
spinal defects.

Lower midline syndrome includes
exstrophy of the
bladder or cloaca,
vesicointestinal fissure,
colon atresia,
imperforate anus,
sacral vertebral defects,
lipomeningocele or meningomyelocele.


Management of sick kids with omphalocele

Immediate D 10/0.25 normal saline IV

150 mL per kilogram per day

Then reduce to a maintenance of 100 mL per kilogram per day

If sac ruptured needs immediate surgical intervention.

Given antibiotics and VITAMIN K

Close on Felicio with plastic wrap to maintain body heat

Glucose monitor
(asso with Beckwith- Wiedemann)


Fluid resuscitation for pyloric stenosis

D5 half normal saline
1/2 NS
20 mL per kilogram

4:2:1 with D5


What a electrolyte marker is used for adequate fluid resuscitation



What is normal bicarbonate level

22 – 26


What is normal sodium

135 – 145


What is normal chloride


100 – 112


What is normal potassium

Three – 4.5


What is normal B UN

10 – 12


What is normal creatinine

0.5 – 1.4


What is the inferior limit marking the pyloromyotomy

Main of Mayo


What is postoperative feeding recommendations after pyloromyotomy

Start feeds four – six hours
May have some emesis


what do you do with the sleeve resection of the Meckles



signs of baby obstruction

Polyhydramnios. The fetus swallows 50% of the amniotic fluid daily, which is largely absorbed in the upper intestinal tract. A high obstruction allows this fluid to back up and accumulate in excessive quantities. 2 Bilious vomiting. Nonbilious vomiting is common in infants; bilious vomiting is much more often pathologic. 3 Abdominal distention. Distention develops within 24 hours of birth in distal obstructions, as swallowed air accumulates above the blockage. 4 Failure to pass meconium. Within 24 hours of birth, 95% of term babies pass meconium. A delay may signify obstruction.


Meconium ileus

cystic fibrosis = thick secretions

"Ileus = ileum"

15% of infants with cystic fibrosis, from the abnormally viscid enzymes secreted by the pancreatic and intestinal glands.

nonoperatively with diatrizoate (gastrografin) enemas.

Gastrografin is a radiopaque fluid with a very high osmolarity that causes fluid to be drawn into the bowel lumen.

The sticky meconium is hydrated and may be spontaneously evacuated.

Intravenous fluids must be infused during the procedure, to avoid systemic hypovolemia.

If the obstruction persists or if there is evidence of perforation, surgery is mandatory.


Colon Obstruction Congenital colorectal obstruction may be due to:

(a) Hirschsprung’s disease,

(b) meconium plug

(NOT ileus that is in the ileum)

(c) neonatal micro left colon syndrome,

(d) atresia



ganglion cells of the parasympathetic nervous system are absent from the wall of the distal intestinal tract.

The transition zone between the narrow aganglionic distal bowel and the dilated normal proximal bowel is usually in the rectosigmoid colon

but can occur anywhere,

The aganglionic bowel is not capable of normal peristalsis, producing a functional obstruction at the transition zone.

first present in the newborn as a lower bowel obstruction or later in childhood as severe chronic constipation

A contrast enema usually demonstrates the transition zone

anorectal manometry will show absence of the internal sphincter relaxation reflex.

A rectal biopsy will confirm the absence of ganglion cells.


The treatment for Hirschsprung’s disease

classically staged:
temporary colostomy brought out proximal to the transition zone.

several months later by a “pull-through” procedure, in which the ganglionic bowel is brought down and anastomosed to the anal canal.

this traditional approach is being replaced by:
transanal pull-through procedure
during the first few days of life, with optional laparoscopic assistance.

Occasionally, patients with Hirschsprung’s disease may develop a severe enterocolitis, with dehydration, peritonitis, and sepsis.

This may be the first manifestation of the disease or may even occur after surgery.

Treatment of Hirschsprung’s enterocolitis must be prompt with intravenous fluids, antibiotics, and colonic irrigations.


Meconium plug



frequently occur in premature

probably caused by transient motility disturbances of the immature colon.

A contrast enema is generally both diagnostic and therapeutic.


micro left colon syndrome most common in



infants of diabetic

probably caused by transient motility disturbances of the immature colon.

A contrast enema is generally both diagnostic and therapeutic.

A contrast enema is generally both diagnostic and therapeutic.

Babies are usually normal after treatment, but subsequent testing for Hirschsprung’s disease or cystic fibrosis may be indicated.