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    14 views12 pages

    Pedia Surg

    Uploaded by

    bo gum park

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 12
    PEDIATRIC SURGERY ys AL elgg au a eon kaw WDE len tole) atch ects) Peston Eau Pees ire LISS Taro ae sels rls 1. Peculiarities of the Infant Respiratory System CeCe cee ewe uele ANTERIOR ABDOMINAL WALL DEFECTS SERON we Romolo) PMT Rosme ge (o- elie tools a CPN Lue el Pec INTESTINAL OBSTRUCTION IN PEDIATRIC PATIENTS Pee ela aca e sre a Pe TO lee Retell Cote meet THE PEDIATRIC ACUTE ABDOMEN Leon Pee aero nC E Ts orn aM act ie PART ONE . ea OVERVIEW OF FLUIDS, ELECTROLYTES, AND NUTRITION IN PEDIATRICS 1. FLUID REQUIREMENTS + Daily requirementsare higher than adults due to higher insensible losses and limited ability of the immature kidneys to concentrate urine + Total body water is a higher percentage of body weight (80%) than in adults (60%) + Total blood volume in a newborn is about 8% of body weight, which becomes similar to adults (5%) in older children + Urine output should be between 1-2 mL/kg/hour Il, ELECTROLYTES *Childrenless than 6 months old should be given 10% dextrose in 0.2596 saline with potassium chloride, 20 mEq/L + Children older than 6 months should be given 5% dextrose in 0.45% saline with potassium chloride, 20 mEq/L. + Daily sodium requirements are 2-3 mEq/kg and daily potassium requirements are 1-2 mEq/kg, A. Normal Fluid Requirements In Children Based On Weight et ett a 0010 100 mL/kg. ‘4 mL/kg 1020 1000mL Sonifipfereaigso (Ral >a 500ml + 20:L/Agforeachgs20 | ml B. Conditions Increasing or Reducing Water Requirements Ee ee Eee ra Bx Gta + Abnormal water and electrolyte losses + Edematous and antidiuretic states + Fever (12% increasefor every®Cabove 37:5) | + Hypothermia (15% decrease) + Sweating (10-25% increase) + Sedated or paralyzed patient (40% decrease) + Sustained hyperventilation or excessive _| + Compromised renal function and oligoanuria muscular activity (25 to 50% increase) ‘Infants and children nursed in high + Hypermetabolic states severe thermal environmental humidity injury, salicyate intoxication & thyrotoxicosis | + Enclosed incubator (25-50% decrease) (25-75% increase) ‘+ Newborn and young infant on radiant heat or phototherapy (25% increase) “Source: Modified from Navarso et, Fundamenial of Pdiarcs. Competency-based, ol: 201. st Ill. NUTRITION + Carbohydrates should supply 40 t0 45%, lipids 35%, and protein 15% of total calories inthe diet + Enteral nutrition is the preferred method for delivering calories to.a child + The normal daily caloric and protein needs in children is shown in the table below: eee Pera Per eren) tor 9010120 204035 io? 750090 202s Tet ow7s 20 ini 20t060 i [pte 2t030 10 ‘Source: Medi ied from Grose Peditric Surgery, 6th ed; 2006 IV. PREOPERATIVE PREPARATION ‘= Preoperative antibiotic prophylanis is indicated for children with cardiac anomalies, ventriculoperitoneal shunts, and implanted prosthetic device ‘* Most common regimen: ampicillin (50 mg/kg) and gentamicin (1.5 mg/kg) given 60 minutes before and 6 hours after the procedure Wn enone er a Cy See eeu <6 months Shours ‘hours >6months ‘hours hours Pidyears hours hours Source: Medifed [rom Rimgenstin ate The Washington Mansel of Sorgery, 5th ef 2008. 518 1. PECULIARITIES OF THE INFANT RESPIRATORY SYSTEM ~ Obligate nasal breathing Dependence on diaphragm motion + Liability to return to fetal circulation inthe face of elevated pulmonary vascular resistance + Greater sensitivity to thoracic pressure changes because ofa mobile mediastinum + Susceptibility tosevere CNS damage withrelative hypoxia + Retrolental fibroplasia with oxygen toxicity Il. COMMON RESPIRATORY DISORDERS IN PEDIATRIC PATIENTS ‘Congenital disorder where the choana | « Inability to pass anasal | + Maintain oral airway (posterior nasal passage)is obstructed, | catheter + Operative insertion of usually by abnormal bony or membranous | + Contrast studies ‘nasopharyngeal tubes tissue from failed recanalization during | + CTscan + Definitive treatment: development surgical perforation of ‘Infant may present with continuous mucus theatresiato createa raining from one or both nostrils or nasopharyngeal airway cyanosis while breastfeeding + Cyanosis may improve when baby cies (because oral airway is used at this time) + Presence of herniated viscera within chest | + Radiographs (chest and | « Nasogastric *"Bochdalek hernia (posterolateral abdominal) decompression defect, usually lft) + Oxygenation < Morgagni hernia (anterior defect) + Correction of acidosis Hiatus hernia + Operative repair + Respiratory distress within minutes after Dias delivery + Others manifestations tachypnea, tachycardia, intercostal retraction, absent breath sounds overinvolved side + May cause acute airway obstruction + Fluoroscopy + Heimlich maneuver *Manifests as cough, stridor, diminished | « Bronchoscopy *Transtracheal needle breath sounds, cyanosis + Gricothyroidotomy + Endoscopic or operative removal + Congenital abnormality of laryngeal + Laryngoscopy + improves with time cartilage resulting in collapse of ‘Tracheostomy supraglottic structures during inspiration + Manifest with early inspiratory stridor and diminished sounds when crying 519 inane) CeO SLU} DUN Isy Congenital Lobar Emphysema (or Congenital Lobar Overinflation) DIN g “= Results in progressive overinflation of one ‘or more lobes of aneonate’s lung ‘+ Manifests with respiratory distress usually in the neonatal period *= Chest radiograph: present ‘as hyperlucent lung, segment with overinflation & contralateral mediastinal shift + Ventilation/perfusion scan + Ventilatory support + Emergency thoracotomy and fobectomy Pulmonary Sequestration += Solid or cystic mass composed of nonfunctioning primitive tissue that does not communicate with the tracheobronchial tree with an anomalous systemic blood supply ++Extralobar: usually asymptomatic + Intralobar: may present with recurrent pulmonary infection “= Chest radiograph «= Ventilation/perfusion scan + Angiography + Operative excision Subglottic Stenosis + Narrowing of the subglottis + Manifests with poor cy, wheezing, barking cough + Inspiration-expiration chest radiograph = Usually improves with time + Otherwise, tracheostomy and surgery may be needed 520 Ce ANTERIOR ABDOMINAL WALL DEFECTS 1. OVERVIEW OF COMMON DEFECTS + Gastroschisis: abdominal wall defect whereinthe bowelsare located outside the body via the defect, + Omphalocoele: abdominal wall defect in which intestines, ver, and other organs are located outside the body via the defect + Bladder exstrophy: protrusion of the urinary bladder through an abdominal wall defect, ey rele) a BScas Ct Cerra Location | + Rightof umbilicus | « Umbilical ring + Below umbilicus Fascial fapcat | + small (

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