(精编)【体外膜肺ECMO精品课件】 Blood and Neoplastic教学课件.pptVIP

* * * * * * * * * * Pearls Infants and small children are top heavy and “lead” with their head when thrown Cervical spine injury can occur with only subtle radiographic evidence (sciora) so images must be interpreted properly Blunt trauma to the chest can injure chest organs without fracturing ribs * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Proximal Obstructions Malrotation with midgut volvulus until proven otherwise. NPO, IVF, NGT UGI series if stable Corkscrew duodenum Ligament of Treitz normally located to the left of midline at the level of the gastric antrum. Pearls: Malrotation ABSOLUTE SURGICAL EMERGENCY Birds beak on UGI- midgut volvulus; Detorse counterclockwise- “turn back the hands of time” Ladds procedure- appendectomy Pearls: Duodenal Atresia/ Stenosis Associated with Down’s syndrome and congenital heart disease Non-bilious emesis Double bubble on x-ray. Associated with annular pancreas Treated with duodenoduodenostomy Not emergent but make sure that you are not dealing with malrotation Pearls: Jejunal Atresia Caused by intrauterine vascular accident. Must check for additional atresias intraoperatively. Microcolon on contrast enema. 3 day old fails to pass meconium A 3 day old infant has been vomiting bilious material all day. His abdomen is now markedly distended although he does not seem have any abdominal pain. Of note, he has failed to pass any meconium since birth. A rectal exam is met with explosive foul smelling green stool which hits another isolette across the room. What is your differential diagnosis? How does this case differ from the malrotation case earlier? How would you proceed with your workup? Initial Management: Hirschsprung’s Disease IVF, NPO, NGT Contrast enema Rectal irrigations Flagyl for enterocolitis Primary pullthrough vs leveling colostomy Pearls: Hirschsprung’s Disease Suction rectal biopsy: absence of ganglion cells in myenteric plexus, hypertrophied nerve fibers. 95% of babies pass meconium in first