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2011-12-11 12:39:43
26 pediatric abdomen

The pediatric abdomen" jaundice and common surgical conditions
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  1. pediatric exam prep for abd and pelvis
    • abd
    • 0-2 npo 4 hr
    • 3-5 nop 5 hr
    • 6+ npo 6 hr

    • pelvis
    • 0-9 juice/water 30 min prior and no voiding
    • 10+ 32oz water 1 hr before, no voiding
  2. right hepatic lobe
    • should not extend more than 1cm below costal margin in one infant
    • older infants and children- should not extend below at all
  3. jaundice
    extra or intrahepatic obstruction of bile flow

    • extra
    • choledochal cyst
    • biliary atresia (hepatitis)
    • perforation of bile ducts

    • intra
    • hepatitis
    • metabolic disease

    • unconjugated hyper bilirubiemia occurs in 60% normal 80% premature infants
    • if persists past 2 wks- three most common causes:
    • hepatitis, biliary atresia, choledochal cyst
  4. scintigraphy
    nuclear med-radioactive substance into the body to photograph to see function, collection, or secretion

    hepatic- see infant cause of jaundice
  5. inspissated
    thickened by absorption, evaporation, or dehydration

    bile in gb of jaundice infant
  6. three common causes of neonatal jaundice
    • hepatitis
    • biliary atresia
    • choldochal cysts
  7. neonatal hepatitis
    • occurs in liver in first 3 months
    • reaches liver through placenta via vagina from infected maternal secretions or through catheters or blood transfusions

    bacterial hep from vagina to endometruim, placenta, and amniotic fluid

    liver may be enlarged, echogenic, cant see portal structures well
  8. biliary atresia
    • narrowing or underdevelopment of biliary ductal system
    • males
    • results from inflammation of hepatobiliary system
    • latter most common form has absence of gb
  9. acholic stool
    absence or deficency of bile secretion or failure of bile to enter alimentary tract (obstruction) stool is clay like and colorless
  10. symptoms of biliary atresia
    • persistent jaundice
    • acholic stools
    • dark urine
    • distended abd from hepatomegally

    • surgery or else cirrhois, liver failure, death
    • normal size gb may be seen
    • change in size after feeding proved patency of cbd

    poly splenia linked to biliary atresia
  11. choledochal cyst
    • abnormal cystic dilation of biliary tree
    • frequently effects cbd
    • fusiform dilation most common but carolis (dilation of intrahepatics), dilation of intraduodenal at cbd (choledochocele), diverticula of cbd- are types of choledochal cysts
  12. two most common liver neoplasms in pediatric
    • hemangioendothelioma
    • hepatoblastoma
  13. benign liver tumors
    • 40% of liver tumors in ped are benign
    • hemangioma is most common
    • other benign tumors that make up about half are: mesenchymal hamartomas, adenomas, focal nodular hyperplasia
  14. hemangioma
    • vascular
    • active endothelial growth- causes avshuting which then causes high output heart failure in infant
    • lakes within the lesion with little blood flow as it matures
  15. infantile hemangioendothelioma
    • most common benign vascular liver tumor of early childhood in liver
    • usually occurs in first 6mo of life
    • grows rapidly causing distention
    • hepatomegaly- hypoechoic lesions, congestive heart failure, hemangioma
    • AFP elevated
    • spotaneous regression 12-18 months
  16. mesenchymal hamartoma
    • rare
    • asymptomatic under 2yrs
    • multisepated cystic mass from periportal mesenchyma
  17. adenoma
    • usually seen in adults
    • only in infants if liver disease is present
  18. malignant liver tumors
    • cant distinguish benign from malig with sonongraphy
    • two most common of peds
    • wilms tumor (nephroblastoma)
    • neuroblastoma (adrenal)
    • hepatoblastoma
  19. hepatoblastoma
    • pediatic version of hepatocellular carcinoma
    • associated with beckwith-widemann
    • single, solid, large, poor marginated, small cyts with irregular shape calcification
    • may have areas of necrosis and hemorrhage
    • high velocity flow
    • elevated afp
  20. hepatocellular carcinoma
    • malignant
    • usually have preexisting liver disease
    • solid mass
    • look for portal vein thrombus or tumor invasion
  21. common surgical conditions
    • hypertrophic pyloric stenosis
    • appendicitis
    • intussusception
  22. hypertrophic pyloric stenosis
    • pyloric muscles between stomach and duodenum hypertrophy- causing delayed gastric emptying
    • acquired condition
    • male 2-6wks old
    • bile free vomiting, projectile
    • dehydration and weight loss
    • olive shaped mass in ruq treated surgically
    • normal measurement of pylorus is 3.5mm muscle thickness, 3.5 each or 20mm together is hypertrophy
  23. appendicitis
    • most common acute abdominal inflammatory process in children
    • appendiceal lumen becomes obstructed and infected
    • more rapid in young children
    • rlq pain and vomiting
    • linear array transducer
    • rebound tenderness
    • appd is ant and med to psoas, lat to illiacs
    • seen as long tubular in sag and bullseye in trnd
    • does not compress
    • 6mm
    • increased blood flow
    • if perforated may see phelgmon or abcess, ff, enlarged lymphnodes
  24. appendicolith
    • hyperechoic
    • produces shadow
    • single or multiple
    • intraluminal or surrounded by periappendiceal phlegmon or abcess
    • fecalith
  25. intussusception
    • most common acute abd disorder in early childhood
    • bowel prolapses into more distal bowel (telescoping)
    • causes obstruction (ileum into ileum or ileum into cecum)
    • children 6mo to 2 yrs
    • males
    • usually upper respiratory tract infection 1st
    • hypechoic and hyperechoic rings, echogenic center (target sign/donut) in short axis, sandwich or pueudokidney sign in long
    • poor color flow-ischemia
  26. volvus
    • malrotation of the bowel in development causing a "knot"
    • can be mechanically fixed
    • can cause necrosis if blood circulation is cut off
  27. layers of stomach muscles
    • oblique
    • circular
    • longitundnal
  28. calculate organ size of child
    = 5.7 + .31 x age (years)
  29. adult child commonness
    • hemangioendothelioma- most common in children
    • hemangioma- most common in adults