Patho 2 PDF - Congenital Diaphragmatic Hernia and More

Hernia S Congenital Diaphragmatic failure/malformation of posterior lateral portion of diaphragm prior to 8 weeks leaves opening btwn peritoneal + pleural...

Hernia S Congenital Diaphragmatic failure/malformation of posterior lateral portion of diaphragm prior to 8 weeks leaves opening btwn peritoneal + pleural pressures Treatment : intubate immediately , Nitric oxide to ↓ pulmonary hypertension Tracheoesophageal Fistula Defect w/ atresia of upper esophagus w/ communication to trached Diagnosis inability to pass catheter into stomach : management ventilate Keep upright 30 to to aspiration frequent suctioning : , , Pierre-Robin Syndrome Defect w/ mandibular hypoplasia. Meconium Aspiration Big tongue small Chin , short jaw , combination of undigested amniotic fluid t management : prone position , nasotracheal tube , trach epithelial cells contained in fetal bowel Results in : obstruction Air leak+, Choanal Atresia Inflammation RDS, retanded CO2 ↑ PVR , Defect of a blockage/absence of have due to congenital malformation persistent pulm hypertension. obstruction may be unilateral or bilateral hypoxemia + hypercarbiat Acidosis Diagnosis inability to pass suction catheter down naves : CXR : coarse asymmetric pattern management : make neo cry oral airway intubate , persistent pulmonary Hypertension (PPHN) Tracheomalacia + Tracheal Stenosis from Failure ofa PVR to fall after birth cartilage is weak or stenotic section of trachea Pulm arterial press remains elevated.. causes ↓ radius on insp cause Stridor + dyspnea. R=L Shunt through ductus arterious + former viewed w/ bronchoscope ovale Echo-Gold Standard Transient Tachypnea of Newborn (TTNB) "Wet lung, Type It respiratory distress ↑ fluid in to ↓ ↑ deadspace lung causes compliance Ve , + Signs: Grunting + ↑ WOB , retractions , nasal flaring RR above 140 + ↑ + management : CPAP , Heated high Flow , prone positioning CBG-M lactate , + RDS/HMD (Hyaline Membrane Disease S due to prematurity + insufficient lung Surfactant - v/Qmismatch leads to : ↑ alveolar surface tension = collapse : Atelectasis = ↓ compliance = hypoxia + ↑PVR + acidosis alveolar management : Oz , PPV , CDAP surfactant replacement (BLES or MIST) , Permissive hypercaphed , HFO + iNO for Y PVR , Bronchopulmonary Dysplasia (BPD) Chronic Lung Disease (CLD) chronic lung disease in infants treated w/ mechanical ventilation for a primary lung disease can be considered CLD/BPD W/ demonstrated ventilation / O2 dependence of 2 weeks or more or Oz dependent & 28 days management : lowest fil possible , It 4-6 m//kg , permissive hypercaphia , avoid ↑ SpOz , Wean to CPAP , HFO, iNO + surfactant therapy Pneumonial pneumonitis usually bacterial , Strep B most common Bronchiolitis-sticky crackles leads to : Alveolar infection , filling , pus formation , RDs , inflammation inflammatory disease of bronchioles, most common cause RSV Cresp syncytial. Pulmonary Interstitial Emphysema (PIE) Virus) need 02 + hydration - Enterocolitis (NEC) leakage of air into perivascular tissues of the lung from overdistention Necrotizing leads to ↓ pulm perfusion. + ↑ PUR = REL Shunting necrosis of colon + ileum caused by "bubbling" near hilar region intestinal ischemia management : minimal vent. support (CPAP) , prone Brunchietasis pulmonary Hypoplasia irreversible dilation+ distortion bronchial tree lung development wy too few cells Alveoli , or airways hernia SIDS common diaphragmatic in risk factors: prone smoking,6months management CPAD : , brain abnormalities in brainstem , upper airway Hyperbilirubinemia infection - supine to sleep AKA Jaundice or icterus either when breakdown of is I'd a t'd excretion of bili t'd enzyme activity that prevents breakdown Hgb , or of bili 2 form bilirubin : Conjugated water soluble zutero unconjugated fat soluble ,  S Cystic Fibrosis recessive exocrine gland disorder by excessive viscid secretions-wet cough caused by mutations in gene that encodes , : Staph Aureous Haemophilus influenza, pseudomonas multifunctional protein (CFTR) common pathogens , L Aeruginosa Diagnosis : Sweet Chloride test ( 60 mmol/L) main culprit Epiglottitis - no supine ! inflammation of epiglottis-Acute bacterial infection , cherry red epiglottis primary cause: Haemophilus influenzae type B - signs : drooling , Stridor CXR : thumb sign Croup/Laryngotracheobrochitis-steeple sign subglottic inflammation obstruction most or , common pathogen : parainfluenza type I Adenovirus , , RSV , Onset-6 month to 3 years signs barking cough stridor hoarsness : , , Systemic corticosteroids : dexamethasone + Racemic epinephrine"causes vasoconstriction Congenital Heart Disease RS & early deformation of the a itself or vascular structures associated w it. ↑ workload on > - Acyanotic disease : I'd pulm blood flow oxygenated blood is shunted from LER side of - Generally associated. , Cyanotic disease : I'd pulm blood flow deoxygenated blood is shunted from REL side of a resulting in severe hypoxemia. , + cyanosis central ↳ usually requires ASD , USD + /or PDA for survival Acyanotic Defects I'd pulmn blood flow , LER Shunt : ↳ DDA : LER Shunt , failure of ductus arteriosus to functionally close due to ↑ POL's + ↓ prostaglandins, LIVSDI Ventricular Septal Defect : LER Shunt, a communication in ventricular wall or failure of wall to close s , sound-lub (HoloSystolic , murmur ↳ (ASD) Atrial septal defect : LeR Shunt communication buth R + L Atria I'd press on LSD Split S2 Dub sound , , af or below site of ductus arteriosus his flow out of Aorta-need PDA Or USD , ↳ Coarctation of Aorta : constriction of aorta just , ↳ systolic press murmur,. ↑ in upper extremities than lower extremities ↳ Aortic Stenosis : narrowing of aortic. obstructs flow out of LV-IV Hypertrophy , CHF + MI need PDA - ↳ PulmonaryStenosis: pulmonic value defect-need PDA  S Cyanotic Defects I'd pulmn blood flow REL Shunt & : , ↳Tetralogy of fallot most common CHD 4 concomitant defects: 1 Pulmonary Stenosis : ,. , 2 RV. hypertrophy, 3. USD , 4.. Overriding Aorta "boot" X-ray ↳Tricuspid Atresia : REL Shunt no tricuspid value no connection btwn Ratrium + R ventricle need Patent foramen ovale (PFO) or , = - ASD ↳ Hypoplastic Left & syndrome: no systemic flow underdeveloped LV + severe narrowing of ascending Sorta-need PDA , ↳ Total Anomalous pulmonary venous return (TAPVR) : pulmonary venous return routed to R atrium instead of LA-need ASD arteries from LV-need PDA/VSD/ASD ↳Transposition of the great Arteries (TGA) : Aorta arises from RV + pulm. ↳ severe black/blue hypercyanosis w/ refractory hypoxemia ↳(XR : "egg on string" ↳Truncus Arteriosis : Single artery arises from ventricles carrying both pulmn. t systemic blood flow Vent strategies for most a pts poz's pCO2 + : 40's PH : 7 40. SpO2 : 70-80 prevent Acidosis ↓ pressures +to volumes