BILIOUS EMESIS = DARK/BROWN GREEN EMESIS = BILE IN FLUID + BLOOD IN STOOL

CLEFT LIP CLEFT PALATE

DESC mst common pediatrc facial annomoly, incomplete fusion of oral cavity mst common pediatrc facial annomoly, incomplete fusion of palates
S/S
N/C MALES, early in gestation = 5th/9th week , elbow/hacket restraint, no prone MORE SEVER, FEMALES, early in gestation = 5th/9th week, repair bfr speech
lying, clean sutures, LOGAN BAR = pressure on upper cheeks = devlps, no straw/catheter suction, extensive orthodontic wrk = prosthestic teeth /
pressure on suture line, analgesia, bottle as tolerated realignment, speech therapy
Treat Repair @ 2-3 m Myringotomy / tube placement , repair btwn 6-12m

MALROTATION & VOLVULUS ANORECTAL MALFORMATION

DESC Abnrm rotation/twisting of bowel Congenital anomaly involving anus & rectum w/ or w/o fistula
S/S Volvulus = assoc w/ blood flw, intestinal necrosis, perforation, 4 types : ANAL STENOSIS = narrow anal opening, IMPERFORATE ANUS-CUTANEOUS
periontits, death MEMBRANE = complete covering of anus/no opening, ANAL AGENESIS – blind spot &
fistula, RECTAL ATRESIA = rare, anus normal but not contiguous
N/C Serious = twisting in itself

PYLORIC STENOSIS = ESOPHAGEAL ATRESIA + TRACHEAL – ESOPHAGEAL FISTULA

NON-BILIOUS VOMITING
DESC Hypertrophy /hyperplasia/ thickening of pylorus
=obstruction of pyloric sphincter
S/S Non bilious vomit that progress to PROJECTILE
VOMITING, OLIVE-SHAPED MASS = palpable in
abdomen, failure to gain weight
N/C Dx per hx, PE = olive like mass in right
epigastrium below liver’s edge, NPO, I/O
treat PYLOROMYOTOMY = excise pyloric muscle, US,
labs=electrolytes
TRACHEOESPHAGEAL FISTULA
ASSOC. W/POLYHYDRAMNIOS / other
congenital anomalies
r/t atretic esophagus = secretions, inability to Constant coughing, chocking, cyanosis
pass a catheter, Coughing, Chocking, Cyanosis
Esohohagus = end in blind pouch Clear lungs , nothing on xray
Esophagis and trachea = communicate via
fistula
Thoracotomy entry, division/ligation of fistula, end to
end/end to side anastomosis, chest tube, cervical
esophagostomy = temp hold to drain salvia w/ opening on
side of neck, esophageal replacement with colon
LWR GI INTUSSUSCEPTION –
BILIOUS EMESIS
DESC Telescoping of the bowel= one
segment into another = Bowel
inflammation from an obstruction
S/S Colicky, cramping abdominal pain,
“Currant jelly” stools = RBC leaking
into GI, Sausage shaped mass ,
sudden onset
N/C Bilious emesis , males 5-9
Hematachezia & bilious emesis = if
persist
NORAML BOWEL STOOL/ AFTR
TRATMT = SELF REPAIR
DX= abdominal film = catch
perforation, bariu, enema
Treat Hydrostatic reduction via barium
enema, water/air enema =reduce
lesion, non-operative= successful
in > 75%
HIRSCHPRUNGS (MEGACOLON)
BILIOUS EMESIS
Absence /paralized piece of bowels
(ganglion cells) = mechanical obstruction
d/t inadequate motility of affected bowel
CONGENITAL AGANGLIOTIC
MEGACOLON
Vary according to length of segmnt, dx age,
occurrence , Constipation, rectal vault
empty d/t stool trapped behind ganglion,
NO MECONIUM W/IN 24-48 HRS
MALES= vans deferns clser to bowles,
Bilious emesis, suspect w/ meconium ileus,
ENCOPORESIS (CONSTIPATION w/stool
swelling=constipation w/small amnt of liquid
stool, assoc. w/annomolies = Downs,
Dx= barium enema,
Tx = bowel resction = rmve aganglionic
segment, temp ostomy, Rectal biopsy ,
BOWEL RESECTION / PULL THROUGH
ULCERATIVE COLITIS
Inflammation of colon/ rectum,
ulcers = superficial/contiguous (on
top of each other w/o healthy tissue
between
GI BLEEDING, SKIP LESIONS
Severe Diarrhea / bloody diarrhea,
intestinal bleeding, weight loss,
anorexia, perianal dse,
fistula/stricture formation = rare
Diagnosed between 12-18 years,
increased risk of cancer
Colectomy = curative
CROHN’S
CONTIGUOUS LESIONS =
Inflammation of any part of GI
tract/bowel/ileum
GI bleeding , mild-sever diarrhea
or bloody diarrhea, abdmn pain,
mild-mod weight loss, anorexia,
perianal dsd, fistula /stricture
form =common
Deep/segmented ulcers = tissue
in btwn
Surgery for fistula/strictures,
resections = not curative
LWR GI APPENDICITIS - BILIOUS EMESIS
DESC Obstructed /d/t hardened stool = extreme
CONSTIPATION = abdominal pain in RLQ
S/S Inflammation, edema, invasion of leukocytes, referred
pain in per umbilical area, LOCALIZED PAIN AT
MCBURNEY’S POINT, vomit, rebound tendeness
N/C Most common surgical emergency, McBurney’s point,
AVG PEDIATRIC AGE IS 10
treat Dx= US, CT, Hx, PE, CBC / Tx=laproscopic surgry,
appendectomy=rupture, AB + surgry in 2-3 mnths vs
opn wound, penrose drain, delayed closure
NEC (NECTROTISING ENTEROCOLITIS) - BILIOUS EMESIS SHORT GUT SYND.
blood supply to bowel wall = cellular death = cell stop secreting Acquired dse d/t NEC,
mucus = allow bacteria (proteolytic enzymes) in = wall swell/break volvulus, gastroschisis,
dwn, & bcome permeable d/t no mucus to trap bacteria Chrohns = more, more,
GAS FORMING BACTERIA = invade to produce pneumatosis more of gut removed
intestinalis (SUB MUCOSAL AIR) = appears SOAP SUDSY in
abdominal flatplate
Abdominal distention, hematacheziam setptic appearance
SOAP SUDS abdominal x-ray, only PRETERM INFANTS affected, TPN feeding, central line
Cause = unknwn= 3 FACTORS : feeding = what,rate, how, infections, cholestasis,
intestinal ischemia to bowel, colonization of pathogenic bacteria liver dysfunction
Submucosal air
BOWEL RESECTION AND PULL THROUGH, NPO, antibiotics, Supportive, bowel
serial films, ostomies depending on damage transplantation

COLIC GERD NON-BILIOUS

DESC Immature esophageal Sphincter = reflux of gastric contents into esophagus =
esopagitis
S/S Effortless NON-BILIOUS vomitin
N/C Monitor Ph, thicken formula=adds weight=prvnt vomit, tissue dmge=disease, feed
upright
treat H2 (acid) antagonist, NISSAN FUNDOPLICATION=sevre

Abdomnl wall OMPHALOCELE GASTROSCHESIS HERNIAS DIAPHRAGMATIC HERNIA

 dfct
DESC Herniation of bowel through
abdomen
S/S Assoc. w/ serious cardiac /
chromosomal abnormalities =
survival, viscea-gradually pushed
into abdominal cavity, third spacing =
intra-abdominal pressure/ filling
heart pressure
N/C Protect viscera w/ saline soaked
dressing, prvnt hypothermia, bowel
bags, decompress, staged repair =
dpnd on size, silastic mesh = create
silo=used when abdominal cavity to
small to hold stomach contents
Intestines found Protrusion of an organ /portion of mvemnt of bowel through abnrml opning in
outside baby body organ through opening. Inguinal diaphragm through chst
exiting through a hole hernia = most common=5% of
near belly button babies, Umbilical hernias= rslve abt
3-5 ys= incomplete infusion of
umbilical ring= “outie”,
Significant RDS, dyspnea, cyanosis,
scaphoid abdomen, CO/breath snds
silastic mesh = create If protrusion constricted = circulation TREAT = Intubate, HFOV,ECHMO, opiods,
silo=used when impaired =INCARCERATION = paralytics, prvnt metabolic acidosis d/t it
abdominal cavity to blood flow PHTN , repair
small to hold stomach
contents

Hepatic dsrdr HEPATITIS BILIARY ARTRESIA

DESC Type A = oral/fecal route / Type B = sexually transmtd, hands can be fulminant Inflamm= causes intra/extra hepatic bile
Type C= fulminant, transplantation, chronic, assoc. w/ hepatocellular carcinomas duct fibrosis = obstructed ducts
S/S Parenchymal cells swell, tissue degenerates, necrosis, and fibrotic / 4 STAGES: 1= onflamm of bile
duct=prvnt bile frm leaving liver, 2= formation of duct jewls/secondary passages, 3=scarring, 4= scorosis
N/C LFT, bilirubin Fatal w/in 2 yrs= left untreated d/t no
connection btwn liver & Gi tract
treat Dx = biopsy= severity, serologic markers= confirm Kasai procedure, Roux-en Y=intestine
stitched to side of small intestine, liver
transplant,