Presentation
Each full-color case begins with a patient presentation and proceeds through differential diagnosis, diagnosis and treatment, surgical procedures, postoperative management, and a case conclusion. [books.google.ro]
Peroperatively, 800 mL straw colored ascites was present. Right ovarian 5 Χ 5 cm and left ovarian 4 Χ 4 cm masses were present with the presence of variegated consistency and necrotic areas on cut sections. Omental caking was present. [onlinejets.org]
In the neonate, TGA is the most common condition presenting with profound cyanosis. [brainscape.com]
Clinical Presentation NB: Although clinical presentation can be quite variable, early NEC presents with feeding intolerance. A progressive ileus may also be present, resulting in abdominal distension, tachypnea, lethargy and gastric distension. [elearning.sumdu.edu.ua]
Hematological
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Hemophilia A
Of the following, the MOST likely cause of the bleeding is A. disseminated intravascular coagulation B. factor VIII deficiency hemophilia C. liver disease D. vitamin K deficiency E. von Willebrand disease 20- A newborn whose estimated gestational age [prep4usmle.com]
Entire Body System
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Pain
[…] lower quadrant pain, vomiting, and fever. [ahcmedia.com]
Distension activates visceral nerve pain fibers that cause pain symptoms referred to the perium-bilical area (T-10 dermatome). [elearning.sumdu.edu.ua]
A 12-year-old immunosuppressed boy presented with self-limiting abdominal pain, low-grade fever and progressive scrotal swelling. [link.springer.com]
Acute (Pediatric) Last Updated December 20, 2016 MODULE Abdominal Pain – Acute and Chronic Last Updated March 2, 2018 MODULE Abdominal Pain – Pediatric/Fellowship Level Last Updated June 2, 2018 MODULE Abdominal Trauma – Pediatric/Fellowship Level [surgicalcore.org]
No pain on percussion at the costovertebral angle b. Pain on deep palpation of all 4 quadrants c. The patient has stool in the rectal volt. d. The patient winces in pain when her bed is accidentally bumped e. [quizlet.com]
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Inflammation
[…] of vagina Inflammation of vaginal wall Inflammation of vaginal wall (finding) Mucopurulent vaginitis Mucopurulent vaginitis (disorder) NSV - Nonspecific vaginitis Nonspecific vaginitis PV - Vaginal infection Pneumatosis vaginalis Prepubertal vaginitis [averbis.com]
Its presence suggests entities that typically result in a greater degree of inflammation in the adjacent mesentery than in the bowel wall itself. [radiologykey.com]
Complications include bleeding, small bowel obstruction, inflammation (Meckel diverticulitis), and neoplasm[ 10 ]. [wjgnet.com]
The morphologic correlate is acute focal or diffuse swelling and inflammation of the pancreas. [elearning.sumdu.edu.ua]
It may be an initial inciting event that eventually leads to NEC (i.e. ischemia causing mucosal edema, inflammation, etc.) or the end result (i.e. initial event causes mucosal edema, inflammation, etc. which then decreases the tissue perfusion and oxygenation [pediatriceducation.org]
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Fever
[…] year Circumcised boys less than 6 months Lower threshold for prolonged fever or if accompanied by vomiting Term Indications for CXR Fever 38 C Tachypnea 0-6 months RR 59 6-12 months RR 52 12-24 months RR 42 Definition Term Fever without source - Workup [flashcardmachine.com]
A 12-year-old immunosuppressed boy presented with self-limiting abdominal pain, low-grade fever and progressive scrotal swelling. [link.springer.com]
[…] ssing disease-glandular fever/inf mononucleosis k!ssing ulcer-ant n post duodenal ulcers/vulval ulcer k! [aippg.net]
[…] quadrant pain, fever, leukocytosis Pericolonic inflammation, adjacent diverticulum Epiploic appendagitis Nausea and fever are rare Fatty pericolonic mass with dense rim and central high-attenuation focus Omental infarction Right-sided greater than left-sided [radiologykey.com]
Fever, nausea, and vomiting are somewhat variable. A tubal ovarian abscess often can complicate PID. [ahcmedia.com]
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Falling
Review of these cases and of 32 reported cases falling within the pediatric age range discloses that the disease occurs most frequently in patients whose general condition is poor, that it is very often associated with congenital or acquired disease of [pediatrics.aappublications.org]
Preterm babies are proportionately small & their weights fall in the normal range for the GA -use Ballard scoring system to determine GA What are 5 complications of SGA babies? 1. Fetal death 2. [cram.com]
[…] also called intestinal pneumatosis pneumatosis seasoned brown rice recipe reviews citrus pectin cystoides intestinalis or pneumatosis coli) is pneumatosis of Lyrics to ‘Heart Attack’ by Demi Lovato: So I’m putting my defenses up ‘Cause I don’t wanna fall [ediempoli.eu]
Tack both ends to the fascia so they don’t fall back into the abdomen. The distal end almost always sloughs off, so leave a little length to avoid it receding behind the fascia. It is not necessary to mature the stoma. Dr. [videolibrary.globalcastmd.com]
There was no history of any foreign body insertion, vigorous douching, fall, or any other trauma. Iatrogenic persistence of air in the peritoneum is unlikely to persist 10 weeks postsurgery. [onlinejets.org]
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Weakness
Celiac sprue Dx : Diarrheaa, steatorrhea, weightloss, weakness. Associated with dermatitis herpetiformis. Celiac sprue Dx : Diarrheaa, steatorrhea, weightloss, weakness. [aippg.net]
Formation of cystic spaces in mature teratoma can be due to dilatation of lymphatic vessels confirmed by FVIII positivity though only focal and weak(10). [newslab.sk]
Inguinal hernias may be caused by weak- ening of muscular aponeurosis and fascia due to age, cigarette smoking, or collagen deficiency.3,34 Weakness in the linea alba at the umbilicus leads to umbilical/paraumbilical hernia. [docsity.com]
Gastrointestinal
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Nausea
[…] insufficiency or infection with gas producing bacteria, such as Clostridia ( Am J Med Sci 2006;332:100 ) Clinical features Either benign or fulminant form Often indolent clinical course, although radiographically can resemble carcinoma Patients may have nausea [pathologyoutlines.com]
[…] pain Nausea and fever are rare Triangular or ovoid fatty/heterogeneous lesion deep to right anterior abdominal wall Mesenteric fat stranding can result from a broad variety of inflammatory and neoplastic disease processes; therefore, it is important [radiologykey.com]
A 23-year-old woman presents to the emergency department with a 2-day history of cramping abdominal pain, nausea, and vomiting. She also reports passing dark stools. [quizlet.com]
The hallmark presenting symptom is diarrhoea; however, patients may also present with abdominal pain, nausea, vomiting, fever or anal pain [ 5 ]. [ncbi.nlm.nih.gov]
Fever, nausea, and vomiting are somewhat variable. A tubal ovarian abscess often can complicate PID. [ahcmedia.com]
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Diarrhea
Sx occur while fasting VIPoma Makes Vasoactive peptide (VIP); Sx WDHA (watery diarrhea, hypokalemia, achlohydria; unexplained secretory diarrhea; laparoscopy for Dx Glucagonoma tumor of alpha islet cells; 80% women; 80% malignant; Necrolytic Exfoliating [usmleforum.com]
On readmission on February 9 the patient still had diarrhea and refused to eat. At that time he weighed 4 pounds 12 ounces (2,155 Gm.). He was dehydrated and cyanotic, with stippling of the skin of the trunk. [jamanetwork.com]
The most acceptable theories concerning the pathogenesis are discussed, with their possible relation to infantile diarrhea. Received April 15, 1950. [pediatrics.aappublications.org]
[…] infection with gas producing bacteria, such as Clostridia ( Am J Med Sci 2006;332:100 ) Clinical features Either benign or fulminant form Often indolent clinical course, although radiographically can resemble carcinoma Patients may have nausea, vomiting, diarrhea [pathologyoutlines.com]
It can appear at presentation as a bowel obstruction or, conversely, as increased stool output or diarrhea. The clinician should have a high level of suspicion for intestinal stricture in a patient with a history of NEC. [pedsinreview.aappublications.org]
Liver, Gall & Pancreas
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Jaundice
They can occur anywhere, vary in size, & are sharply demarcated Cephalohematoma Overlying nondepressed skull fracture Jaundice may require phototherapy This is a subperiosteal bleed due to birth trauma. [cram.com]
ERCP This baby is a full term and has 14 days of jaundice, therefore needs an urgent conjugated bilirubin check to rule out biliary atresia. If physiological jaundice the unconjugated bilirubin levels will be increased. [brainscape.com]
Risk Factors HBV, HCV, Alcoholic cirrhosis, Aflatoxins (fungal metabolites) Benign Hep Adenomas oral contraceptives Exocrine Pancreatic CA Ductal CA, Courvoiser's Law palpable nontender GB in a jaundiced patient is a head of Pancreas tumor. [usmleforum.com]
Nov 14, 2007 - 12:15 AM #1 1- A 2-week-old infant is jaundiced. [prep4usmle.com]
Charcot's triad (fever, right upper quadrant pain, jaundice) suggests ascending cholangitis. If obstruction to bile flow occurs, jaundice and acholic stools are seen. [elearning.sumdu.edu.ua]
Skin
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Eruptions
[…] pelpermissible exposure level pelprimary effusion lymphoma pempolymorphic epithelial mucin pemprotein energy malnutrition pemtphosphatidylethanolamine methyltransferase penpenicillin pepparietal epithelial cell pepphosphoenolpyruvate peppolymorphic eruption [medabb.com]
Musculoskeletal
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Muscle Cramp
McArdles Disease musclephosphorylase is absent, muscle cramps & incr. myoglobin after exercise Jaundice Prehepatic hemolysis, gilbert's disease, Crigler Najjar; Hepatic hepatocellular or cholestatic; Post Hepatic Biliary obstruction, AST & LDH also incr [usmleforum.com]
Psychiatrical
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Suggestibility
Each case includes key technical steps, potential pitfalls, take-home points, and suggested readings. The patient stories in these clinical scenarios provide context to faciliate learning the principles of safe surgical care. [books.google.ro]
In addition, multiple tubular structures are seen in the right hemithorax, suggestive of bowel. These ultrasound and color Doppler images are suggestive of right diaphragmatic hernia, and a very large one at that. [ultrasound-images.com]
In this setting, meconium in the rectum can erroneously suggest a small presacral mass. However, if air entirely surrounds the meconium mass, it will outline the contour of the mass and suggests the correct diagnosis. [emedicine.medscape.com]
A tissue biopsy of the laparotomy specimen showed the presence of "empty-looking" broad aseptate fungal hyphae of irregular width, occasionally branching, suggestive of mucormycosis. [indianpediatrics.net]
Neurologic
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Hyperactivity
Besides neonatal necrotizing enterocolitis (NNEC), there are numerous other causes of bowel perforation in a neonate and these include stress, hypoxia, or shock leading to the regional hypo-perfusion and transient intestinal ischemia initiating local hyperactivity [afrjpaedsurg.org]
It is a disease of the airway hyperactivity c. It can be triggered by viral infxns, exercise, or emotions d. The presence of wheezing is diagnostic e. Inhaled sympathomimetics are effective therapy Definition d. [flashcardmachine.com]
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Spastic Paralysis
Tetanus Opisthotonus(severe spastic paralysis) 53. Syphilis (chancre) 54. Entamoeba histolytica(cause of amoebiasis) 55. Giardia lamblia(Giardiasis) 56. [slideshare.net]
Urogenital
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Dysuria
A 4 year old boy presents with symptoms of dysuria and urinary frequency. A urine dipstick is positive for blood and nitrites. A UTI is suspected. Which of the following follow up strategies is most appropriate? A. Watchful waiting B. Cystoscopy C. [brainscape.com]
dysuria or frequency) can occur when an inflamed appendix is lying near the ureter or bladder. Physical exam Most specific finding: Rebound tenderness, pain on percussion, rigidity, and guarding (in the McBurney's point area). [elearning.sumdu.edu.ua]
Clinical symptoms of dysuria, increased urinary frequency, and hematuria are common. The presence of pneumaturia is a rare, although more specific, clinical finding. [pubs.rsna.org]
He denies dysuria, melena, hematochezia, or a history of similar symptoms. Yesterday, he reports he felt perfectly well. He has no significant past medical, surgical or family history. [quizlet.com]
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Dyspareunia
CASE REPORT A 43-yr-old woman presented with a 12-mo history of worsening menorrhagia and dyspareunia. She had no significant medical history and in particular no history of immunosuppression, diabetes, or hormonal therapy. [docksci.com]
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Urinary Hesitancy
A 3 year old boy is brought to the clinic with symptoms of urinary hesitancy and poor stream. Which of the following is the most likely underlying diagnosis? A. Benign prostatic hypertrophy B. Posterior urethral valves C. Neurogenic bladder D. [brainscape.com]
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Urinary Retention
Retention Last Updated January 18, 2018 [surgicalcore.org]
Workup
Other associated anomalies such as congenital heart disease, genitourinary tract malformations, and musculoskeletal disorders are common in these infants, and appropriate preoperative workup is necessary. [basicmedicalkey.com]
[…] appreciable amount of fecal mate- rial that may continue to pass for some time.5,6 RADIOLOGIC EVALUATION OF BOWEL OBSTRUCTION Plain Abdominal Radiographs The plain radiograph of the abdomen has tradition- ally been used as the first radiologic study in the workup [docsity.com]
[…] than 1 year Circumcised boys less than 6 months Lower threshold for prolonged fever or if accompanied by vomiting Term Indications for CXR Fever 38 C Tachypnea 0-6 months RR 59 6-12 months RR 52 12-24 months RR 42 Definition Term Fever without source - Workup [flashcardmachine.com]
Headaches presenting in patients with a history of melanoma need to be further workup to role out brain metastasis. [quizlet.com]
Treatment
Each full-color case begins with a patient presentation and proceeds through differential diagnosis, diagnosis and treatment, surgical procedures, postoperative management, and a case conclusion. [books.google.ro]
Treatment: primary abdominal wall closure, TPN; Silastic silo if unreducible Omphalocele (“good bowel, bad baby”) bowel hernia with peritoneal covering. [dailyabsitequestions.blogspot.com]
(a) Pre-treatment axial contrast-enhanced CT of the pelvis demonstrates the surgical anastomosis (arrows) prior to commencement of treatment, with mild pre-sacral soft tissue thickening (arrowhead). [ncbi.nlm.nih.gov]
Abstract The usual accepted mode of treatment of neonates with necrotizing enterocolitis (NEC) and pneumoperitoneum is surgical. However, in a select group of patients conservative treatment is feasible. [afrjpaedsurg.org]
Prognosis
This finding suggests that age at NEC onset may affect prognosis in full-term infants. [nature.com]
Uniformly, the prognosis has been grave with only 4 cases being diagnosed antemortem leading to surgical intervention and antifungal therapy and only 3 survived(3,5,9). [indianpediatrics.net]
Treatment and Prognosis Simple sliding hiatal hernias do not require treatment. Patients with symptomatic giant sliding hiatal hernias, paraesophageal, or mixed hernias should be offered surgery. [clinicalgate.com]
Clinical indicators of poor prognosis include development of acute renal failure and thrombocytopenia (, 39 ). [pubs.rsna.org]
Typhlitis, or inflammation of the cecum, is more frequently seen in immunocompromised patients and is characterized by marked thickening and hypervascularity; increased thickness of the wall may correlate with a worse prognosis[ 70, 71 ]. [wjgnet.com]
Etiology
Endometrial pneumatosis remains an enigmatic condition of uncertain etiology but it appears to be self-limited with no known pathologic sequelae. Departments of Histopathology (Y.J.C., C.J.R.S.) [dev-journals2013.lww.com]
The etiology of pneumatosis is not completely understood but 2 broad categories, infective and noninfective, are recognized. [docksci.com]
Definition / general Submucosal gas filled cysts within gastrointestinal tract Sites Entire gastrointestinal tract can be affected Etiology In infants, fulminant form is associated with necrotizing enterocolitis and may be fatal Also associated with cystic [pathologyoutlines.com]
Etiologies in humans may include bowel necrosis due to bowel ischemia, infarction, necrotizing enterocolitis, neutropenic colitis, volvulus, and sepsis. [vin.com]
The etiology of pneumatosis cystoides-like structures in ovarian teratomas is not clear. The first case of ovarian mature cystic teratoma with pneumatosis cystoides-like struc- tures was published in 1989 by Maudsley and Zakhour(9). [newslab.sk]
Epidemiology
Further understanding of the epidemiology of these infections and their sequelae are needed to formulate public health strategies. ( 2 )( 3 ) Objectives After completing the article, the reader should be able to: Appreciate the epidemiology and risk factors [pedsinreview.aappublications.org]
Balbaa Enzymes Characterization in Diabetes mellitus PPT Version PDF Version Borzenko Berta Georgiyevna Disoders of Purine and Pyrimidine Nucleotides Metabolism in Human Gastrointestinal Tract Cancer PPT Version PDF Version Tarek Mohmmed Tawfik Amin Epidemiology [omicsonline.org]
Google Scholar European Center for Disease Control and Prevention: Annual epidemiological report 2012. [bmcinfectdis.biomedcentral.com]
The epidemiology of perinatal mortality in multiple births. Bull N Y Acad Med 1990 ;66: 618 - 637 4. Ghai V, Vidyasagar D. Morbidity and mortality factors in twins: an epidemiologic approach. Clin Perinatol 1988 ;15: 123 - 140 5. [nejm.org]
The epidemiology and pathogenesis of necrotizing enterocolitis. Semin Neonatol 1997;2:231-8. [afrjpaedsurg.org]
Pathophysiology
Prematurity and low birthweight ( NEC is a multifactorial disease with an unclear pathophysiology. [hawaii.edu]
Draw your own conclusions, or at least think about the ramifications of our ability to salvage patients from what had historically been death sentences with advances in critical care and increased understanding of the pathophysiology of SIRS/multiple [buckeyesurgeon.com]
Current clinical and experimental data support the concept that the pathophysiology of NEC remains enigmatic and multifactorial. [basicmedicalkey.com]
PATHOPHYSIOLOGY Bowel obstruction causes distention of the gut through the accumulation of both gas and fluid. [docsity.com]
Prognostic value and pathophysiologic significance of the rim sign in cholescintigraphy. J Nucl Med 1987 ; 28:1679-1682. Medline, Google Scholar 14 Vingan HL, Wohlgemuth SD, Bell JS, III. [pubs.rsna.org]
Prevention
[…] a lack of clinical awareness and optimal diagnostic tests and limited means for therapy and prevention. [pedsinreview.aappublications.org]
Localised abdominal compartment syndrome: bladder-over-gastric pressure ration (B/G ratio) as a clue to diagnosis MALBRAIN MLNG, DE LAET IE, WILLEMS A et al. abstract details 107 - 114 - Are ACE-inhibitors or ARB's still needed for cardiovascular prevention [poj.peeters-leuven.be]
The elusiveness of the etiology of NEC has made it difficult to establish effective preventive measures. [hawaii.edu]
Identifying cases in which laparotomy can be avoided is important to prevent unnecessary surgery and its associated morbidity and financial costs. [signavitae.com]
The rationale for elective repair is to prevent the complications associated with incarceration. [basicmedicalkey.com]