Pediatric Surgery Rahşan

GER

GER

relaxation of LES and pass of gastic into esophagus

GER freq increases if

eshophagial atresia

diapgragmatic hernia

anterior abdo wall defects

hiatal hernia

neumotor retardation

antireflux anatomic barriers

• angle of his

• pinchcock effect of diaphgram

• LES

• intraabdo esophagus

• phrenoesophageal membrane

antireflux physio barriers

peristalsis of esophagus and normal stomach emptying

GER signs

• vomiting mc

• aspiration→tekrarlayan AC hastalıkları, stridor

• heartburn

• melena/hematouria

• iron def anemia

• dysphagia→scar tissue

  • failure to thrive and malnutrition

• barretts esophagus olana kadar reversible

GER dx

• upper gi contrast

• 24h pH moniterization: GS

• endoscopy+biopsy

GER tx

• conservative: freq and small V feeding, upright position

• medical

• surgery: if no response to medical, complication, anatomic anomaly, mental retard

GER medical tx

• antacids

• PPI

• H2 receptor blocker: cimetidine, rantidine

  • prokinetics: domperidone, metoclopramide

ger surgery

fundoplication: alt ES’nin basıncını arttırıyo

NİSSEN: dalaktaki short gastric damarlara bağlayıp mide fundusunu özafagusa bağlıyorum

sliding hiatal hernia

GER: HİS bozuldu, frenoözafagial lig basınçtan çıkmış

paraesophagial hernia

gastric volvulus, incarceration, or strangulation

hiatal hernia tx

suergery: NİSSAN fundoplication ve hiatusu daralt

achalasia

failure of LES relaxation, motility disorder

functional obstr proximalde dilatasyon

achalasia signs

• dysphagia

• vomiting and regurgitation

  • weight loss

achalasia dx

• upper gi contrast stude: dilated esophagus, insuff peristaltic act, distal: bird beak

  • manometry: LES P measurement

achalasia tx medical

ca channel blocker nifedipin

achalasia endoscopic tx

• baloon dilatation (perforation risk, GER, dysphagia)

  • botox injection

achalasia tx surgery

standard esophagomyotomy (HELLER) and anterior duplicationi

infantile hypertrophic pyloric stenosis

mc reason of gi obst infants, pilor kasında hipertirofi ve hiperplazi

first male baby of the family

infantile hypertrophic pyloric stenosis history

3-6weeks old, nonbilious projectile vomiting soon after the feeds

infantile hypertrophic pyloric stenosis PE

• pyloric mass in RUQ (OLIVE)

• visible gastric peristalsis

  • dehydration (late)

infantile hypertrophic pyloric stenosic metabolic

hypochloremic hypokalemic metabolic alkalosis

paradoxial aciduria

infantile hypertrophic pyloric stenosis dx

history and olive palpation

USG and erect abdo xray

infantile hypertrophic pyloric stenosis tx presur

MEDICAL EMERGENCY:

• stop oral feeds, NGT

• bolus (20cc/kg) kristaloid

• 5-10% dektroz+0.45 or 0.09 NaCl + K (after urine output)

  • monitor cardiac act, 1ccde 40’ı geçme

infantile hypertrophic pyloric stenosis surgery

fredet-ramstedt pyloromyotomy

bronchogenic cyst

from foregut ayrılma sırasında anomali

radio: single cyst, round oval mass

usually asymptomatic

congenital cystic adenomatoid malformation

a single lobe abnormal, pulmonary hypoplasia

congenital cystic adenomatoid malformation 1

multiple large, mc, good prog

congenital cystic adenomatoid malformation 2

multiple small w renal agenesis

congenital cystic adenomatoid malformation 3

adenomatous solid

congenital lober emphysema

lobar hyperinflation, congenital bronchial stenosis, def in cartilage of bronchial wall

male x3, left upper lobe

respi insufficiency

pectus axcavatum, funnel chest

mc, male, cosmetic

RAVITCH, NUSS

vacuum bell application

pectus carinatum, pigeon chest

male

poland

unilat chest wall deficit

sternal defects

sternal fusion deficiency

1. cleft

2. cervical ectopia cordis

3. theracal ectopia cordis

   1. thoracoabdominal ectopia cordis

congenital diaphragmatic hernia

postero-lat diapgragmatic defect

bochdalec hernia

daha ağır

morgagni hernia

retrosternal, ass anomalies, generally asymp

congenital diaphragmatic hernia embryo

persistency of canalis pleuro-peritonealis, 8-10w

congenital diaphragmatic hernia patho

pulmonary hypoplasia, bronchial branching and alveoli

congenital diaphragmatic hernia clinic

polihidroamniosis→bad prognosis

resp stress, cyanosis, tachypnea

heart sounds on the right

bowel sounds on the left

congenital diaphragmatic hernia dx

prenatal US, xray, upper gi contnrast

congenital diaphragmatic hernia prognosis

degree of pulmonary hypoplasia and pulmonary HT

congenital diaphragmatic hernia tx

1. resp support

2. NGT: intestinal decomp

3. urinary catheterization

4. monitoring

5. medications to reduce pht: inhaled no, sildenafil, tolazoline

6. ECMO mechanical lung

congenital diaphragmatic surgery

laporptomy, thoracotomy

morgagni hernia dx

barium enama

eventration of the diaphragm

1 kubbenin ötekinden daha yukarıda olması, nedenleri:

• congenital aplasia or maldevelopment of diaphragm

• paralysis of phrenic nerve

resp disrress, recurrent pulm infections

tx: diaphragmic pliacation

thyroglossal cyst

mc neck lesion, remnants of the thyroglossal duct

hyoid midline: dilini çıkarınca yukarı hareket ediyor

dd: ectopic thyroid

thyroglossal cyst surgery

sistrunk’s: hyoid ortasını çıkar

1st branchial cyst

auditory canal

2nd brancial cyst

most common, ant of SCM-tonsillar fossa

3 ve 4 brancial cyts

ant of clavicula

brancial cyst signs

mucoid secretion, lumps in neck

dx by US

tx by surgical excision

congenital muscular torticollis

fibrosis ile iyileşen eğri boyun

congenital muscular torticollis surgery

FT ve bipolar tenotomy

cystic higroma

congenital neck lesions

cystic higroma tx

alcohol solution and bleomycin

hemangioma

most common tm

1 yaşına kadar hızlı büyür, 10 senede çözülür

hemangioma complications

ulceration, bleeding, infection

life thratening (resp cardiac)

kasabach-merittt syndrome (thrombocytopenia and hemangioma)

hemangioma tx

streroid, propranolol

neuroblastoma

neural crest cells: adrenal medulla and sympath ganglia

2 years when dx

ass anomalies: hirschsprungs, type 1 neurofibromatosis

neuroblastoma symptoms

horner’s synd, sup vena cava syn

vipoma: tx dirençli susu idrar

paraspinal tm: spinal cord compression

cilt altı nodül

panda eyes

neuroblastoma dx

CT and MRI for surgical exicision

neuroblastoma lab

ferritin, LDH yükselir

neuronspecific enolase NSE

stage IV

disease in liver skin or bone marrow

iyi prognoz regrese olabiliyo

kemik met yok!

neuroblastoma tx

vascular lesion→unresectable

trucut biopsy for chemo

teratoma

ectoderm endoderm and mesoderm

teratoma sacrococcygeal

alpha fetoprotein