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Pediatric Surgery (Pg 68-81) - page 12 / 33

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4.

peptic esophagitis which can lead to GI bleeding, stricture formation, or Barrett’s esophagus

Diagnosis:  So common that it is often diagnosed clinically.  Barium swallow can be used to rule out obstructive lesions.  Other tests include:  pH probe study, nuclear scintiscan of the esophagus and endoscopy.

Treatment:  Medical management most common: upright positioning, thickening of feeds, agents to promote gastric emptying (metoclopramide) and H2 blockers to treat esophagitis.

Surgery is indicated if medical management fails.  Nissen fundoplication, in which the gastric fundus is wrapped around the esophagus 360 degrees.  Complications include:  inability to vomit and gas bloat syndrome (patients unable to burp, so they become distended following feeding.

Recurrence more common in children that are neurologically impaired.  

Midline Neck Masses: Table 2-15

Thyroglossal duct cysts

Thyroid gland descends from tongue base embryologically.  Failure of thyroglossal duct to obliterate leads to thyroglossal duct cysts.

Appear between 2-10 yrs of age.

Presents as firm, round, midline neck mass that rises with swallowing or tongue protrusion.

Infection of cyst is common.

Must be removed with its tract and the center of the hyoid bone, or most will recur.

Ectopic Thyroid

Gland is arrested in its antenatal descent.

Presents as midline neck mass and is the patient’s only thyroid tissue.  

May be divided and moved bilaterally or excised.  Patient then receives thyroid replacement therapy.

Dermoid or Epidermoid Cyst

Arise from trapped epithelial elements.

More superficial than thyroglossal duct cyst.

Lymphadenopathy in midline may also appeal

Thyroid Masses

Uncommon in children.  Thyroid nodule in children more likely to be malignant.

Either lobectomy with biopsy or needle aspiration biopsy and an attempt at suppression with thyroid hormone is recommended.

Lateral Neck Masses

Acute Cervical Lympadenitis

Predominantly occurs in young children following URI with staph or strep

Child is febrile and swellings showing signs of inflammation including erythema and tenderness.

Antibiotics may be curative.  If mass is fluctuant because of abscess, I&D necessary.

Chronic Lymphadenopathy

Common in cervical region, often representing benign hyperplasia

Other causes include:  infections with mycobacteria, cat-scratch fever, and rarely lymphoma.

Lymphoma is more likely if nodes are hard or fixed, continue to grow, and if patient has systemic symptoms of fever, malaise, and weighty loss.

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