Bhargava Muliudi

156 statements · 4 topics

Featured statements

Easy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis.
quote · Intestinal Rehab
Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30
guideline · Intestinal Rehab
Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus
guideline · Pyloric Stenosis
For mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall
clinical · Pyloric Stenosis

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Bhargava's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 39 statements

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Pyloric Stenosis

Quotation Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy. Open
Statement Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy Open
Statement Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age Open
Statement Pyloric stenosis is more common in males Open
Statement There is increased risk for first born infants with a positive family history Open
Statement Patients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life Open
Statement Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting Open
Statement Emesis in pyloric stenosis will progress until it is projectile Open
Statement Hyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation Open
Statement Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus Open
Statement Ultrasound is the gold standard for diagnosing pyloric stenosis Open
Statement Pyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater Open
Quotation Easy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic. Open
Statement The classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis Open
Quotation The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis. Open
Statement Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis Open
Statement The kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water Open
Statement In later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis Open
Statement In the US, pyloromyotomy is the standard of care for pyloric stenosis Open
Statement In some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90% Open
Quotation At Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs. Open
Statement Cincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis Open
Statement If chloride is less than 85, give 3 boluses separated by an hour and then recheck labs Open
Statement If chloride is between 85 and 97, give two boluses Open
Statement If chloride is greater than 97, give 1 bolus Open
Statement If bicarbonate is greater than 40, give 3 boluses Open
Statement If bicarbonate is greater than or equal to 33, give 2 boluses Open
Statement Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30 Open
Statement The proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus Open
Statement The distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction Open
Statement After the pyloromyotomy is completed, the submucosa should bulge into the myotomy site Open
Statement After adequate pyloromyotomy, each side of the pylorus should move independently Open
Statement Complications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias Open
Statement There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches Open
Statement For mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall Open
Statement Most infants can be fed immediately after pyloromyotomy Open
Statement Evidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates Open
Statement Small episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation Open
Statement Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter Open
Bhargava's statements about Intestinal Rehab 39 statements

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Pyloric Stenosis

Quotation Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy. Open
Statement Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy Open
Statement Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age Open
Statement Pyloric stenosis is more common in males Open
Statement There is increased risk for first born infants with a positive family history Open
Statement Patients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life Open
Statement Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting Open
Statement Emesis in pyloric stenosis will progress until it is projectile Open
Statement Hyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation Open
Statement Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus Open
Statement Ultrasound is the gold standard for diagnosing pyloric stenosis Open
Quotation Easy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic. Open
Statement Pyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater Open
Statement The classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis Open
Quotation The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis. Open
Statement Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis Open
Statement The kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water Open
Statement In later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis Open
Statement In the US, pyloromyotomy is the standard of care for pyloric stenosis Open
Statement In some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90% Open
Statement Cincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis Open
Quotation At Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs. Open
Statement If chloride is less than 85, give 3 boluses separated by an hour and then recheck labs Open
Statement If chloride is between 85 and 97, give two boluses Open
Statement If chloride is greater than 97, give 1 bolus Open
Statement If bicarbonate is greater than 40, give 3 boluses Open
Statement If bicarbonate is greater than or equal to 33, give 2 boluses Open
Statement Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30 Open
Statement The proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus Open
Statement The distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction Open
Statement After the pyloromyotomy is completed, the submucosa should bulge into the myotomy site Open
Statement After adequate pyloromyotomy, each side of the pylorus should move independently Open
Statement Complications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias Open
Statement There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches Open
Statement For mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall Open
Statement Most infants can be fed immediately after pyloromyotomy Open
Statement Evidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates Open
Statement Small episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation Open
Statement Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter Open
Bhargava's statements about Pyloric Stenosis 39 statements

Open the Pyloric Stenosis collection →

Pyloric Stenosis

Quotation Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy. Open
Statement Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy Open
Statement Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age Open
Statement Pyloric stenosis is more common in males Open
Statement There is increased risk for first born infants with a positive family history Open
Statement Patients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life Open
Statement Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting Open
Statement Emesis in pyloric stenosis will progress until it is projectile Open
Statement Hyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation Open
Statement Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus Open
Statement Ultrasound is the gold standard for diagnosing pyloric stenosis Open
Statement Pyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater Open
Quotation Easy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic. Open
Statement The classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis Open
Quotation The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis. Open
Statement Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis Open
Statement The kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water Open
Statement In later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis Open
Statement In the US, pyloromyotomy is the standard of care for pyloric stenosis Open
Statement In some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90% Open
Quotation At Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs. Open
Statement Cincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis Open
Statement If chloride is less than 85, give 3 boluses separated by an hour and then recheck labs Open
Statement If chloride is between 85 and 97, give two boluses Open
Statement If chloride is greater than 97, give 1 bolus Open
Statement If bicarbonate is greater than 40, give 3 boluses Open
Statement If bicarbonate is greater than or equal to 33, give 2 boluses Open
Statement Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30 Open
Statement The proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus Open
Statement The distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction Open
Statement After the pyloromyotomy is completed, the submucosa should bulge into the myotomy site Open
Statement After adequate pyloromyotomy, each side of the pylorus should move independently Open
Statement Complications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias Open
Statement There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches Open
Statement For mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall Open
Statement Most infants can be fed immediately after pyloromyotomy Open
Statement Evidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates Open
Statement Small episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation Open
Statement Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter Open
Bhargava's statements about Single Ventricle / HLHS 39 statements

Open the Single Ventricle / HLHS collection →

Pyloric Stenosis

Quotation Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy. Open
Statement Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy Open
Statement Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age Open
Statement Pyloric stenosis is more common in males Open
Statement There is increased risk for first born infants with a positive family history Open
Statement Patients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life Open
Statement Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting Open
Statement Emesis in pyloric stenosis will progress until it is projectile Open
Statement Hyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation Open
Statement Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus Open
Statement Ultrasound is the gold standard for diagnosing pyloric stenosis Open
Quotation Easy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic. Open
Statement Pyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater Open
Quotation The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis. Open
Statement The classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis Open
Statement Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis Open
Statement The kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water Open
Statement In later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis Open
Statement In the US, pyloromyotomy is the standard of care for pyloric stenosis Open
Statement In some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90% Open
Quotation At Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs. Open
Statement Cincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis Open
Statement If chloride is less than 85, give 3 boluses separated by an hour and then recheck labs Open
Statement If chloride is between 85 and 97, give two boluses Open
Statement If chloride is greater than 97, give 1 bolus Open
Statement If bicarbonate is greater than 40, give 3 boluses Open
Statement If bicarbonate is greater than or equal to 33, give 2 boluses Open
Statement Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30 Open
Statement The proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus Open
Statement The distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction Open
Statement After the pyloromyotomy is completed, the submucosa should bulge into the myotomy site Open
Statement After adequate pyloromyotomy, each side of the pylorus should move independently Open
Statement Complications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias Open
Statement There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches Open
Statement For mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall Open
Statement Most infants can be fed immediately after pyloromyotomy Open
Statement Evidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates Open
Statement Small episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation Open
Statement Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter Open