Pediatric Surgery Handbook for Residents and Medical Students. On. Line Pediatric Surgery. HANDBOOKfor Residents and Medical Students.. The. Surgery Handbook (version August 2. PDF. HANDBOOK. PDFContent. Good nutrition can help prevent disease and promote health. There are six categories of nutrients that the body needs to acquire from food. Losing weight can be difficult at any age, but finding diets that work is the majority of the battle. If you categorize diet plans into three main groups, you have. Research Your Condition. Our articles, slideshows and videos can help you discuss your medical needs more intelligently with your doctor. 20 states in the US have legalized cannabis for medical purposes. Colorado and Washington state also permit recreational use of marijuana; Medical cannabis is. Created: March 1. Last. updated: May 2. I. Neonatal Physiologic Characteristics. Water metabolism. Water represents 7. Total body water (TBW) varies. TBW is. into extracellular fluid (ECF) and intracellular fluid (ICF). The ICF compartment is. TBW with potassium the principal cation. A1C A form of hemoglobin used to test blood sugars over a period of time. ABCs of Behavior An easy method for remembering the order of behavioral components. Our Specialty Conditions & Treatments. UCSF Medical Center is a world leader in health care, known for innovative medicine, advanced technology and compassionate care. Obesity Definition Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. Obesity is associated with increased. The Newborn's metabolic. A change in body water occurs upon entrance of the fetus to. There is a gradual decrease in body. This shift is interrupted with a. The newborn's body surface area is relatively much greater than. Insensible water loss are. Transepithelial (skin) water is the. Insensible. loss is affected by gestational age, body temperature (radiant. Neonatal renal function is generally adequate to meet. Renal characteristics of newborns are a low glomerular. The neonate is. active and production of solute to excrete in the urine is high. The. in the newborn can only concentrate to about 4. Osm/L initially. m. Osm/L the full- term compared to 1. Osm/L for an adult), and. Fluid and Electrolytes Concepts. Cellular energy mediated active transport of electrolytes along. Infants can retain sodium but. Electrolytes requirements of the full- term. Sodium 2- 3 meq/kg/day, potassium 1- 2 meq/kg/day, chloride 3- 5. As. a rule of thumb, the daily fluid requirements can be approximated too: prematures 1. Infants > 1. 0kg 1. Special need of preterm babies fluid therapy are: conservative. ECF tonicity. They are. High. intravenous therapy can lead to patent PDA, bronchopulmonary dysplasia. Impaired ability to. Estimations of daily fluid requirements should. Blood Volumes estimates of help during surgical blood loss are: premature 8. The degree of dehydration can be measured by clinical parameters. Intravenous. is one of the major advances in neonatal surgery and will be required. Newborn infants. 1. This is increased during. Minimum daily requirement are 2- 3. B. Variations in Individual Newborns. Types of Newborns Infantsa) The full- term, full- size infant with a gestational age of 3. TAGA)- they received. The preterm infant with a gestational age below 3. Pre. TAGA); c) The small- for- gestational- age infant (SGA) with a gestational age. A combination of (b) and (c), i. The characteristic that most significantly affects the survival of. Between. 2. 7 and 2. It. is only after 3. Metabolic and Host Defenses. Handling of the breakdown products of hemoglobin is also a difficult. The ability of the immature liver to. Unfortunately, the immature. Other problems affecting the. Newborns have a poorly developed gluconeogenesis system. Immature infants can develop. The preterm and surgical neonate is more prone to. Symptoms are jitteriness and seizures with. Calcium maintenance is 5. Human beings. are homeothermic organisms because of thermoregulation. This. is maintained by a delicate balance between heat produced and heal. Heat loss occurs from heat flow from center of the body to. There is an association between hypothermia. NICU's. The surgical neonate is prone to hypothermia. Factors that precipitate. Practical considerations to maintain temperature. NICU procedures use radiant heater with skin. The newborn's host defenses against infection. Total complement. C3,C4,C5 complex, factor B, and properdin. Ig. M, since it does not pass. Surgical Response of Newborns. The endocrine and metabolic response to surgical stress in newborns. NB) is characterized by catabolic metabolism. An initial elevation in. Cortisol circadian. Cortisol is responsible for protein breakdown, release. Glucagon secretion is increased. Plasma insulin increase. During surgical stress NB release glucose, fatty. Early postoperative parenteral. Factors correlating with a prolonged catabolic response. Anesthetics such as halothane and fentanyl can suppress. NB. II. Cervical Lymphadenopathy. An enlarged lymph node is the most common neck mass in children. Most. anterior to the sternocleidomastoid muscle. Infection is the usual. Acute. submandibular adenitis occur in early childhood (6 mo- 3 yrs), is. URI, the child develops erythema, swelling and. Chronic adenitis. Other causes are: (1) Mycobacterial adenitis- . MAIS complex), swollen, non- tender, nor- inflamed, positive. Fellis, transmitted by kittens, positive complement. Congenital Torticollis. Congenital muscular torticollis is a disorder characterize by. SCM). and tilting of the head to the opposite side. This is the result of. SCM muscle. There is a relationship between birth. Congenital torticollis. The SCM muscle can be a fibrous mass, or a. Management is conservative in most cases. The severity of restriction. Those. with failed medical therapy or the development of fascial. SCM muscle. C. Thyroglossal Duct Cysts. Thyroglossal duct cyst (TDC) is the most common congenital anterior. Symptoms appear at an average age of four with the sudden. Males are more commonly affected than females. TDC is. embryologic anomaly arising from epithelial remnant left after descent. The lining is. columnar or pseudostratified epithelium. TDC is associated to. A legally protective. Sonograms will show a cyst between 0. Once infected. excision is more difficult and recurrence will increase. Management is. Sistrunk's operation: Excision of cyst with resection of duct along. Extensive dissection can cause. Branchial Cleft Fistulas. Branchial cleft fistulas (BCF) originate from the 1st to 3rd branchial. Anomalies of the. They can be a cyst. Fistulas (or sinus tract if they end. I have found that dissection along the tract (up to the. This will prevent injury to nerves. Occasionally a second. BCF are uncommon, located at. They have a close association with the fascial nerve. BCF. very rare, run into the piriform sinus and may be a cause of acute. E. Cystic Hygroma. Cystic hygroma (CH) is an uncommon congenital lesion of the lymphatic. The etiology is intrauterine failure of lymphatics. Prenatal diagnosis can be done. Differential. includes teratomas, encephalocele, hemangiomas, etc. There is a strong. Turner's syndrome (> 5. Noonan's syndrome) and chromosomic anomalies (1. Spontaneous. is less likely but can explain webbed neck of Turner and Noonan's. The airway should be. Intracystic injection of OK4. Streptococcus pyogenes) caused cystic (hygromas). III. OBSTRUCTIVE PROBLEMSLOGICAL APPROACH TO NEONATAL INTESTINAL. OBSTRUCTIONBy: Jordan J. Bilious vomiting is always abnormal. Abdominal distention (scaphoid abdomen possible). Delayed, scanty or no passage of meconium. Polyhydramnios in mother. Family history a. Hirschsprung's disease b. Diabetic mother c. Jejunal atresia. Work- up (Logical approach)1. While the infant is being studied, it must be kept in mind that. Sepsis of the newborn with associated. Intracranial lesions. Hydrocephalus. ii. Subdural hemorrhage c. Renal disease associated with uremia. Renal agenesis. ii. Polycystic disease. Other urinary tract anomalies which may be associated with severe. Plain roentgenograms of the abdomen. Diagnostic in complete high intestinal. Double bubble in. Few gas filled loops. Many gas filled loops (requires 2. Ileal atresia ii. Meconium ileus (an. Meconium plug. - obstruction of colon by a plug of meconium. Small left colon. Hirschsprung's disease. May be nonspecific in instances of malrotation. Calcifications - at some time during fetal. Contrast enema will differentiate the various types of low. Microcolon - complete obstruction of the small. Meconium plug syndrome - colon dilated. Hirschsprung's disease - although it may. Small left colon syndrome - colon dilated. In the past a contrast enema was thought to be the. Rectal biopsy - a pathologist competent in reading the slides. Suction biopsy of the rectal mucosa and. Hirschsprung's disease (ganglion. Full thickness biopsy of the rectal wall may. This procedure is difficult in the small infant and. All newborns who have delayed passage of. With this technique, Hirschsprung's. Whether or not a suction. Parents may not call before the infant gets into. Suction biopsy of the rectum is probably. A breast- fed infant who has Hirschsprung's. Concluding comments: The newborn suspected of having intestinal. It is important. it be definitely established that the infant has a surgical problem. This is usually not difficult in instances of. It is. important that the diagnosis of malrotation of the intestines be always. Prompt. and treatment of malrotation of the intestines which is often. In all of these clinical. If. disease is believed to be the problem, it must be diagnosed. Jejunal and ileal atresia occur as a result of a vascular. Consequently. there is a relatively low incidence of other congenital anomalies. It can be unsafe to rely on. Esophageal Atresia. Esophageal atresia (EA) with distal tracheo- esophageal fistula. EA without TEF also known. TEF. Incidence is one in every 2. The trachea. and esophagus initially begin as a ventral diverticulum of the foregut. A proliferation of. These. cell masses will divide the foregut into trachea and esophageal tubes. EA causes excessive salivation. Contrast studies are rarely needed and of. Correct dehydration, acid- base disturbances. Reploge tube). Correct. Reploge tube). Evaluate for associated conditions such as. Vertebral anomalies i. VSD, ASD, Tetralogy Fallot - Tracheo- Esophageal fistula (must be one of the associated. Renal deformities i. Delayed. (gastrostomy first) for all other patients. Repair consists of. TEF and primary anastomosis. Esophagogram is. 7- 1. Most important predictors of outcome: birth. Complications after surgery: anastomotic leak, stricture. TEF. Increase survival is. More than H- type is N- type, due. C7- T1). Pressure changes between both structure can cause. Barium in the trachea could. Upon radiologic doubt. Any delay in surgery is generally. Management. of surgical closure of the TEF through a right cervical approach. Hint. a small guide- wire threaded through the fistula during bronchoscopy may. Working in the tracheo- esophageal groove can cause.
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