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Pediatrics

Doug Lehman; Jarom Gilstrap; Anthony Georges

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    AMA Citation
    Lehman D, Gilstrap J, Georges A. Lehman D, Gilstrap J, Georges A Lehman, Doug, et al.Pediatrics. In: Dangleben DA, Lee J, Madbak F. Dangleben D.A., Lee J, Madbak F Eds. Dale A. Dangleben, et al.eds. ABSITE Slayer New York, NY: McGraw-Hill; . http://accesssurgery.mhmedical.com/content.aspx?bookid=2500&sectionid=201383022. Accessed June 06, 2020.
    MLA Citation
    Lehman D, Gilstrap J, Georges A. Lehman D, Gilstrap J, Georges A Lehman, Doug, et al.. "Pediatrics." ABSITE Slayer Dangleben DA, Lee J, Madbak F. Dangleben D.A., Lee J, Madbak F Eds. Dale A. Dangleben, et al. New York, NY: McGraw-Hill, , http://accesssurgery.mhmedical.com/content.aspx?bookid=2500&sectionid=201383022.

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TEST TAKING TIPS

Test Taking Tips

  • Remember typical ages at presentation for various congenital disorders that may manifest in similar fashion (eg, duodenal atresia vs malrotation). The age of a neonate can clue you in to the probably diagnosis.

  • Many pediatric surgical disorders can be observed for possible resolution. Do not rush to the operative intervention. Examples include umbilical hernias, hernias, and MEN syndromes, where surgery is delayed until a certain age.

Is bilious vomiting a surgical emergency in the newborn and why?

  • Must rule out malrotation with mid-gut volvulus in a patient with proximal obstruction because the gut can be strangulated (time = bowel).

  • Differential diagnosis—(memorize this list—the ABSITE will point you toward one of these!) annular pancreas, malrotation, jejunoileal atresia, meconium ileus, meconium plug syndrome, duodenal web/atresia, Hirschsprung, hypoplastic left colon. Always remember 1 anomaly begets additional associated anomalies.

Meconium ileus is associated with what anomaly?

  • Cystic fibrosis

Duodenal atresia and malrotation are associated with what anomaly?

  • Down syndrome

What other abnormalities are associated with malrotation?

  • Diaphragmatic hernia, jejunoileal atresia, abdominal wall defects

Which abdominal wall defects are associated with malrotation?

  • Both omphalocele and gastroschisis

What is the diagnostic study of first choice to rule in malrotation with midgut volvulus?

  • Upper gastrointestinal

Surgical procedure for malrotation:

  • Ladd procedure

  • Counterclockwise rotation, divide peritoneal bands crossing the duodenum, position SB to right and colon to the left

  • Look for other abnormalities (see above)

  • Appendectomy (cecum is now on the left side of the abdomen, perhaps delaying the diagnosis of acute appendicitis.)

FIGURE 25-1.

Ladd procedure for malrotation. (A) Lysis of cecal and duodenal bands. (B) Broadening of the mesentery. (C) Appendectomy. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 25-2.

Abdominal radiograph showing the "double bubble" sign in a newborn infant with duodenal atresia. The 2 bubbles are numbered. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Why do patients with malrotation have bilous vomiting?

  • Ladd bands cross the duodenum

  • Remember that BILIOUS vomiting in newborn is malrotation until proven otherwise. (most common presentation)

Why is blood flow to ...

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