What are abdominal wall defects?

Abdominal wall defects are congenital defects involving the stomach, intestines or other organs. During the development of the fetus, the stomach and intestines begin to form outside the abdomen, and later stay uncovered (gastroschesis) or stay enclosed in the amniotic membranes (omphalocele). Occasionally, problems occur and wither they remain outside or squeeze through the abdominal wall.

How is it treated?

This condition can be treated with a surgical recreation of the abdominal wall with advanced tissue advancement techniques. It is generally apparent when a baby is born with this condition. Either the base of the umbilical cord will bulge or actually contain the baby’s internal organs.

Is my child a candidate?

Most children born with this problem require immediate and urgent care.

What does abdominal wall defects surgery involve?

The newborn’s exposed intestines are covered with a sterile dressing, while fluids and antibiotics are being administered intravenously. Surgery is then required to replace the intestines in the abdomen and close the opening. Prior, the skin of the abdominal wall often must be stretched to ensure there is enough tissue to cover the opening. If the skin can’t be enlarged enough to compensate, skin flaps are created. If the intestine sticking out is large, it is wrapped in a silo and moved back into the abdomen in a staged process over several days or weeks. When all the intestines are back in the abdomen, the opening is surgically closed.

What is abnormal skull shape?

The skull is made up of several bones that come together and join at specific points. As the brain grows, the skull makes room and expands with the brain. In some instances, the skull may grown and develop abnormally due to several potential issues resulting in an abnormal skull shape. At Palm Beach Children’s Surgical Specialists we are experienced in the diagnosis and treatment of various skull conditions.

What are some of the conditions included in abnormal skull shape?

There are multiple conditions that encompass abnormal skull shape. These conditions include:

• Plagiocephaly – this is a condition where a portion of a baby’s skull becomes flat due to continued pressure in a specific location usually from too much time in one position. This normally occurs within the first few months after birth but it can occur within the womb during pregnancy.
• Craniosynostosis – this involves premature closing of one or more of the skull plates, or the premature adjoining of the skull bones. This can result in the brain growing in a different direction causing an abnormal skull shape.

What are the treatment options for abnormal skull shape?

Treatment options for abnormal head shape vary depending on the condition and severity of the condition. In some cases, conservative treatment options may be recommended while in other cases, surgery may be required.

With plagiocephaly treatment options can include repositioning exercises and in some cases, therapy. In some instances, with more severe cases, helmet therapy may be recommended to reshape the skull.

Craniosynostosis, unlike plagiocephaly, is a birth defect and may affect pressure on the brain. Treatment options to correct craniosynostosis often involves surgical options. Depending on the specific case, a procedure may be performed either endoscopically or through open surgery to reshape the skull.

At Palm Beach Children’s Surgical Specialists, we are committed to providing advanced treatment options for your little ones.

What is Biliary Atresia?

Atresia is a rare disease that affects infants two to eight weeks after birth. The baby’s bile flow from the liver to the gallbladder is blocked, causing the bile to be trapped in the liver. This results in scarring and damage to the liver, which can cause it to fail.

What causes atresias?

The answer to this question isn’t fully clear. For some children. it seems to occur with improper formation to the womb. Others seem to be impacted by the body’s immune system or a viral infection that occurs after birth.

Is my child a candidate?

The younger the infant is at the time of surgery, the more likely the surgery will be successful. By the time the baby is 4 months old, the surgery can prove to be ineffective. Other determinants include the extent of liver damage, number and size of ducts, etc.

What does biliary surgery involve?

Babies with this condition undergo a Kasai procedure or hepatoportoenterostomy, which re-establishes bile flow from the liver into the intestine. The surgery focuses on removing the damaged ducts outside of the liver, while identifying smaller ducts that are still open and draining bile. The intestine is then attached to this portion of the liver, so that bile can flow directly from the remaining healthy bile ducts into the intestine.

What is recovery like?

Following surgery, infants usually remain in the hospital for a couple of weeks to manage the work up and the surgery. Patients need to undergo long-term antibiotic therapy to reduce the risk of infection. Other medications may also be prescribed to encourage a successful follow-up with bile drainage and decreased jaundice. There is no cure for this condition however, this procedure encourages better health for several if not many years and optimizes the baby’s flow of bile. If this procedure doesn’t work, liver transplantation is necessary.

Atresia of the Intstines

Atresia of the intestines is a condition where there is not continuity in a segment of the intestine. This can be either because the intestinal lumen is separated by an extra wall or web or because the two ends are not connected at all and each ends in a blind pouch. This condition exists prior to the birth of the infant. For this reason, many of these atresias can be diagnosed prenatally. Babies with this condition undergo surgery where intestinal continuity is restored either by removing the web or connecting the two separated ends.

What are brain and spinal cord cysts?

Cysts are fluid-filled sacs that develop within the body, in this case on the spine, known as syringomyelia (spinal cord cyst) or in the brain (brain cyst). Depending on the size and location, the cysts may cause damage or can elicit symptoms.

What are the different forms of brain and spinal cord cysts?

There are two main types of spinal cord tumors:

• Congenital syringomyeli – This form of a spinal cord cyst occurs from a congenital condition. Usually, a spinal cord cyst is caused by Chiari malformation which can allow for the cyst to develop in the neck area.
• Acquired syringomyelia – This form of a spinal cord cyst develops after birth. This can be caused by spinal cord injury, meningitis, arachnoidits, tethered cord syndrome, spinal cord tumor and bleeding into the cord.

The types of brain cysts include:

• Arachnoid cyst – This occurs between the brain and the arachnoid membrane which is one of the protective coverings of the brain.
• Colloid cyst – This is gel-filled cyst that usually forms in one of the four ventricles of the brain that hold cerebral spinal fluid.
• Dermoid cyst – This is a rare cyst that forms when skin cells become trapped when the brain and spinal cord are forming during pregnancy. These cysts can contain sweat glands and hair follicle cells.
• Epidermoid cyst – This also occurs when tissue is trapped when the brain and spinal cord form however, they do not contain sweat glands or hair follicles.
• Pineal cyst – This occurs in the middle of the brain on the pineal gland. They rarely cause issues but can occasionally affect vision.
• Brain abscess – This can happen anywhere in the brain and is usually caused by a bacterial infection but can also be caused by parasite or fungus.
• Neoplastic cyst – This occurs as a result of a benign or malignant tumor.

What are the symptoms?

Symptoms of brain and spinal cord cysts can vary depending on the size and location of the cysts.

Symptoms of spinal cord tumors can include:

• Muscle weakness
• Loss of reflexes
• Headache
• Reduced sensitivity to pain and temperature
• Back, shoulder, arm and leg stiffness
• Neck, arm and back pain
• Scoliosis

What are the treatment options?

Treatment options for brain and spinal cord cysts can vary depending on the size, location, severity and progression of the cysts. In some cases, if there is a lack of symptoms, monitoring may be recommended. For those who are symptomatic, surgery is usually recommended. At Palm Beach Children’s Surgical Specialists, we are committed to providing advanced treatment options for your child.

What is a brain and spinal cord tumor?

A brain or spinal tumor occurs when abnormal cells form in the tissues of the brain or spinal cord. These tumors can be either malignant (cancerous) or benign (noncancerous). Benign brain tumors normally grown and press on a specific area off the brain and rarely spread to other tissues while a malignant brain tumor is likely to grow and spread into other tissues.

Depending on where the tumor is located, it can affect certain brain or motor functions.

What are the symptoms of a brain or spinal cord?

The symptoms of a brain or spinal tumor can vary from child to child depending on multiple factors including its size, location, how quickly the tumor is growing and the age of the child.

Some of the symptoms of a brain tumor can include:

• Headaches in the morning or headaches that dissipate after vomiting
• Nausea/vomiting
• Vision, hearing or speech problems
• Difficulty walking or balance issues
• Unusual fatigue
• Personality changes
• Seizures
• Increased head size

Symptoms of a spinal tumor can include:

• Back pain
• Changes in bowel habits/difficulty urinating
• Leg weakness
• Difficulty walking

Additional symptoms for some children can also include difficulty reaching some growth development milestones including sitting up, waling and speaking in sentences.

What are the treatment options?

If a brain tumor is suspected, a biopsy may be conducted to test the cells. In most cases, surgery may be performed to remove the tumor. At Palm Beach Children’s Surgical Specialists, we are committed to providing quality advanced care your little ones.

What are Bronchogenic Cysts?

This congenital condition involves abdominal growths found mostly in the portion of the chest cavity separating the lungs. The cysts generally have thin walls and are filled with fluid.

What are the symptoms?

The symptoms of bronchogenic cysts are often non-existent until they become infected later in life. Many times they are diagnosed incidentally when testing for something completely different. If they become large, they can cause some respiratory problems, trouble swallowing and infections. other symptoms can include: wheezing, noisy breathing and chest pain.

How are they diagnosed?

When concerned about bronchogenic cysts, thoracic surgeons can identify them using various diagnostic tools, including: X-ray, esophogram, CT scan and MRI, as well as a bronchoscopy.

What does surgery for bronchogenic cysts involve?

When diagnosed, the patient has to be carefully evaluated for the most appropriate individual treatment. Symptomatic cysts should be removed surgically.

What is recovery like?

Usually, a chest tube is required after surgery to drain air and fluid from the chest cavity. Children should avoid strenuous activity for several weeks post-surgery. Wound care instructions should be followed carefully and pain medicine administered.

What is cerebral palsy?

Cerebral palsy is a group of disorders that affect movement, balance, muscle tone and posture. Cerebral palsy results from damage to or abnormalities within the brain as it develops, usually before birth. The word cerebral refers to the brain and palsy refers to an impairment or loss of motor function.

What are the symptoms of cerebral palsy?

The symptoms of cerebral palsy normally appear during infancy or preschool years and are associated with impaired movement.

The signs and symptoms can vary amongst children, however, some of the symptoms can include:

• Variations in muscle tone (too stiff or too floppy)
• Stiff or tight muscles and exaggerated reflexes
• Lack of balance
• Tremors
• Delays in reaching motor skills milestones
• Favoring one side of the body
• Difficulty walking (walking on roes, crouched gait or “scissored” gait)
• Difficulty swallowing/excessive drooling
• Difficulty sucking or eating
• Delays in speech development
• Fine motor skills difficulties

How is cerebral palsy treated?

Currently, there is no cure for cerebral palsy however, there are treatment options to help improve quality of life. Medications ca be used to lessen muscle tightness to improve functional abilities and treat pain. Therapies can also be recommended to assist in muscle training or increase flexibility and balance as well as improve speech capabilities depending on the type of therapy. In some, cases, surgery may be required to lessen muscle tightness and reduce pain.

What are chest wall deformities?

Chest wall deformities are conditions of the chest wall, also known as funnel chest, that cause the sternum and rib cartilage to protrude. The condition is more prevalent in boys and often becomes more pronounced during the adolescent growth spurt.

What are the symptoms?

For most patients, the only symptom of a chest wall deformity is a slight indentation in their chest. For some, this indentation worsens in early adolescence. If the case is severe enough to compress the lungs and heart, additional symptoms can include: coughing/wheezing, heart palpitations, chest pain, fatigue, heart murmur and decreased exercise tolerance.

How is it diagnosed?

Chest wall deformities can usually be diagnosed upon examination. If the doctor is concerned that your child might have other problems that are caused by this condition, tests such as a chest x-ray, CT, electrocardiogram, echocardiogram, lung function test or an exercise test may be ordered. We assess the severity of the deformity by imaging and examination to determine surgical options and timing.

What does treatment involve?

Treatment for chest wall deformities varies. For people with a mild issue, physical therapy to develop core musculature can suffice. By performing the correct exercises, patients can improve posture and increase chest expansion. For people with moderate to severe issues, the problem can be surgically repaired by shaping the chest wall. Pectus Carinatum or rib flaring are amenable to individualized bracing designed by doing 3D scanning of the child’s throax.

What is Chiari malformation?

Chiari malformation is a defect that occurs when a portion of the skull is smaller than normal. This causes a portion of the brain to extend into the spinal canal. This could cause pressure on the brain and spinal cord. Some noted conditions associated with Chiari malformation include:

• Headache
• Sleep apnea
• Hydrocephalus – buildup of fluid in the brain
• Neuromuscular issues

What are the types of Chiari malformation?

There are four types of Chiari malformations:

• Type I – this is the most common form of Chiari malformation and can often go undiagnosed until symptoms appear during childhood or even adulthood.
• Type II – this form of Chiari malformation typically exudes more severe symptoms that normally appear in childhood. Type II normally affects children born with spina bifida, specifically myelomeingocele, a form of spina bifida where the spinal canal and backbone do not fully close before birth.
• Type III – this form of Chiari malformation is extremely rare and serious. This occurs when a portion of the brain herniates, or stick out, through an opening in the back of the skull.
• Type IV – this form of Chiari malformation is very rare. This occurs when a portion of the brain is underdeveloped or missing.

What are the treatment options?

Treatment options for Chiari malformation can vary depending on the type and severity of the condition. In some cases, with very mild symptoms, treatment may not be necessary and the condition will be monitored as the child grows. Minor symptoms including pain or headache may be treated with medications.

For some cases, surgery may be required to ease symptoms or stop the progression of damage to the central nervous system. The neurosurgical treatment options can include:

• Shunt repair – Sometimes symptoms of Chiari malformation can be treated by repairing a malfunctioning shunt used to treat hydrocephalus or buildup of spinal fluid.
• Decompression surgery – When symptoms are severe, decompression surgery may be required. This will allow more space around the upper spine and lower brain by removing some bone to relieve pressure on the spinal cord. This will also restore normal spinal fluid flow.
• Syringomyelia surgery – In some cases, a fluid-filled cyst may develop on the spine. When this occurs, a shunt may be inserted to drain the cyst and relieve the pressure.

What are congenital lobar emphysema and lung lesions?

Congenital lobar emphysema is a rare respiratory disorder generally diagnosed in newborns or young infants, though occasionally found in adulthood. Patients breathe air in, but the air can’t escape, resulting in overinflation of the lobes of the lungs. If severe enough, the disorder can result in related heart problems.

What are the signs and symptoms of congenital lobar emphysema and lung lesions?

The major symptoms of this disorder are difficulty breathing or rapid respiration, an enlarged chest, compressed lung tissue in the section nearest to the diseased lobe. Sometime in severe cases bluish skin tones can result from a lack of oxygen in the blood.

How is this diagnosed?

Two types of tests are used to diagnose congenital lobar emphysema and lung lesions. First, radiological tests are employed to determine which part of the lung and which lobe is affected and how much. Doctors can order X-rays and CAT scans to diagnose this disease. The other type of test that is typically used is a lung function test. This also helps determine how impaired the child’s breathing is from the lesion and if surgery is required.

What does treatment involve?

Treatment of congenital lobar emphysema depends on the condition of the lungs. If lung damage is minimal, there may not be any adverse effects. If the condition affects the ability to breathe, the affected lobe of the lung – or even the whole lung – may need to be surgically removed.

What is dystonia?

Dystonia is a movement disorder that causes involuntary muscle contractions resulting in repetitive movement and twisting. This condition can affect one part of the body, adjacent parts or the whole body. It has no cure.

What are the symptoms of dystonia?

Dystonia can start in one place in the body, such as in the leg, neck or arm and then recur during a very specific action, such as when you write. It tends to get worse and more noticeable over time. Stress, anxiety and fatigue worsen the symptoms, as well.

What areas of the body can be affected?

Dystonia can affect the neck, eyelids, jaw or tongue, voice box, vocal cords, hands and forearms.

What causes dystonia?

The cause is unknown, and it may be an inherited condition. It can also be a symptom of many other conditions, such as: Parkinson’s disease, Huntington’s disease, Wilson’s disease, traumatic brain injury, birth injury, stroke, brain tumor, oxygen deprivation, infections, reaction to medication or heavy metal poisoning.

How is it diagnosed?

In the course of the medical exam, the doctor may recommend blood or urine tests to look for toxins, MRI/CT scan to identify brain abnormalities and EMG to see the electrical activity in your child’s muscles.

What are the treatments?

Treatments for dystonia can include a variety of medications that can help manage the symptoms. Physical, occupational and speech therapy are often recommended. There are also surgical treatments for patients with severe symptoms. Deep brain stimulation can be used to help control muscle contractions.

What is Tracheoesophageal Fistula?

Tracheoesophageal fistula (TF) is a birth defect that occurs as the fetus is developing in the mother’s uterus. The condition results in an abnormal connection between the esophagus and the trachea, in one or more places. These tubes, which are generally not connected, have separate functions – the esophagus carries food to the stomach and the trachea carries oxygen to the lungs. When a baby with a TF drinks, the fluid can get into the baby’s lungs.

What is Esophageal Atresia?

TF often occurs in combination with esophageal atresia, another birth defect. In this case, the esophagus forms in two parts, rather than one. One part connects to the stomach, and the other to the throat. Since they aren’t connected, food can’t get into the stomach to be used by the body.

Are some babies prone to these birth defects?

While these conditions aren’t known to be genetically based, they are more often seen in babies with other digestive tract, heart, kidney and urinary tract, muscular or skeletal problems, VACTERL syndrome, or Trisomy 13, 18, or 21.

What are the symptoms?

• Round, full abdomen
• Vomiting
• Frothy, white bubbles in the mouth
• Coughing or choking when feeding
• Difficulty breathing

How is it diagnosed?

After a small tube is inserted in the mouth or nose of the baby and guided into the esophagus, a chest X-ray is performed which demonstrates the tube is unable to be passed down through the esophagus to the stomach.

What is the treatment?

These problems need to be corrected surgically. Either open or minimally invasive surgery may be applicable, according to the opinion of the physician. Even with the surgery, about half of the children will still need to be treated for acid reflux long term.

What is gallbladder disease?

Gallbladder disease may occur when the flow of bile from the gallbladder is blocked by gallstones. Gallbladder symptoms can sometimes occur without the presence of gallstones and from very delayed emptying of the gallbladder after eating.

What are the symptoms of gallbladder disease?

The symptoms of gallbladder disease include:

• Right upper quadrant abdominal pain especially following fatty food
• Fever
• Jaundice

What are the causes of gallbladder disease?

Gallbladder disease is less common in children than adults, and often, there is no specific underlying cause. Some factors that may increase risk include: a family history of gallstones, obesity, taking certain medications and having certain inherited blood problems.

How is gallbladder disease diagnosed?

• Bilirubin panel blood test.
• Gallbladder ejection fraction study: this nuclear medicine study measures the contraction of the gallbladder. A tracer is injected into a vein in the arm, A special camera follows the tracer as it goes through the liver, gallbladder and small intestine to see how well the gallbladder is functioning.
• An ultrasound and CT can be used to detect gallstones.

What is the treatment for gallbladder disease?

If the patient is asymptomatic, the gallbladder can be monitored periodically using ultrasound. Otherwise, cholecystectomy, or the surgical removal of the gallbladder, may be recommended. Consult your physician for more information.

What is gastroesophageal reflux disease?

Gastroesophageal reflux disease, or GERD, is a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the esophagus. This can cause a burning feeling behind the chest.

What are the symptoms of GERD?

A common symptom of GERD is heartburn. Other symptoms can include:

• Chest pain
• Hoarseness
• Wheezing
• Sore throat

What are the causes of GERD?

GERD can be caused by multiple factors including weakening of the lower esophageal sphincter where it enters the stomach, as well as a hiatal hernia which involves a portion of the stomach to push up through the diaphragm muscle.

What are the treatment options?

Treatment options for GERD involve life-style modifications including a change in diet and medications. If this fails, surgery may be necessary. A Nissen Fundoplication is a surgical procedure that corrects GERD by creating an improved sphincter mechanism at the bottom of the esophagus which prevents stomach acid from backing up into the esophagus.

Is my child a candidate?

Children with GERD that is causing complications, such as: inflammation and/or narrowing of the esophagus, failure to grow, recurrent pneumonia or GERD-related asthma and who aren’t responding to other appropriate treatments may be candidates for this procedure. Your doctor must evaluate each case individually.

What is hereditary spherocytosis?

In hereditary spherocytosis, gene mutations cause red blood cells to have an abnormal, spherical shape and decreased flexibility to move in vessels which causes stasis. The misshapen red blood cells have a shorter life than normal cells, resulting in a low level of red blood cells. This can result in hemolytic anemia, with tissues receiving less oxygen than normal.

What are symptoms of hereditary spherocytosis?

• Pale appearance
• Jaundice
• Fatigue
• Enlarged spleen
• Anemia
• Gallbladder problems

How is hereditary spherocytosis diagnosed?

In most cases, hereditary spherocytosis is diagnosed in children and young adults, since it runs in families. To diagnose this condition, the doctor will perform a full physical exam, including checking for an enlarged spleen. Having blood drawn and examined under a microscope will provide your doctor information for a diagnosis.

What does treatment for heredity spherocytosis involve?

Treatment for hereditary sperocytosis may vary. Treatment options include phototherapy, exchange transfusions for infants, partial or total splenectomy in children and folic acid supplementation in children and adults. Oftentimes gallstones develop and require patients to have their gallbladder removed. Since each patient’s case is unique, consult your physician for the appropriate treatment plan.

What is Hirschsprung’s disease?

Hirschsprung’s disease is a congenital condition that affects predominantly the large intestine. Missing nerve cells in intestinal muscular wall cause problems passing stool. Most of the time, this condition is diagnosed in newborns, though occasionally it can be first diagnosed in older children.

What are the symptoms?

The symptoms of Hirschsprung’s disease include:

• Swollen belly
• Vomiting
• Constipation
• Diarrhea
• Fatigue

How is it diagnosed?

In order to diagnose Hirschsprung’s disease, the doctor may recommend an abdominal X-ray using contrast dye, a biopsy of the intestinal mucosa or muscular wall, and in anal manometry test measuring control of the muscles around the rectum.

What does treatment of inflammatory bowel disease for Hirschsprung’s disease involve?

In order to treat Hirschsprung’s disease, surgery can be performed to bypass the portion of the colon lacking nerve cells. This can often be done using minimally invasive surgery. The surgeon strips away the lining of the diseased part of the colon and extends normal colon through from the inside to attach to the anus. Children with this condition are at risk of developing a bowel infection. Monitor the child to look for signs of infection, including: bleeding from the rectum, diarrhea, fever, swollen abdomen and vomiting.

What is hydrocephalus?

Hydrocephalus occurs when there is a buildup of cerebral spinal fluid within the brain. The buildup of this excess fluid causes the ventricles to increase putting pressure on the brain. Normally cerebral spinal fluid acts as a cushion for brain tissue but when there is a buildup of too much fluid, the pressure on the brain may be harmful.

What causes hydrocephalus?

Hydrocephalus can be congenital, meaning present at birth, which can be a result of a genetic issue or how the fetus develops throughout pregnancy. Hydrocephalus can also occur after birth, known as acquired hydrocephalus. Causes of this can include head injuries, stroke, infection, tumors and bleed in the brain.

What are the symptoms of hydrocephalus?

Symptoms of hydrocephalus can vary depending on the type of hydrocephalus. The main sign of congenital hydrocephalus is an unusually large head.

Symptoms of acquired hydrocephalus can include:

• Headache
• Blurry vision
• Nausea/vomiting
• Fatigue
• Seizures
• Balance issues
• Bladder control problems
• Memory or cognitive issues

What are the treatment options?

Treatment options of hydrocephalus normally involves the insertion of a shunt, or a drainage system. This involves surgically implanting a flexible tube with a valve to keep fluid in the brain flowing in the correct direction at the appropriate levels.

At Palm Beach Children’s Surgical Specialists, we are committed to provide advanced treatment options for your child.

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is the name of a category of disorders that cause swelling and sores in the tissue that lines the digestive tract. Types of IBD include: Crohn’s disease and ulcerative colitis. Crohn’s disease can occur anywhere in the digestive tract and can penetrate into the deep layers of the intestinal lining and wall. Ulcerative colitis usually affects the inner lining of the large intestine and rectum.

What are the symptoms?

Symptoms of both types of inflammatory bowel disease include:

• Abdominal pain and cramping
• Diarrhea
• Fever and fatigue
• Reduced appetite
• Unintended weight loss
• Blood in the stool

What is the cause?

The cause of inflammatory bowel disease is not completely known. One possible cause is an immune system disorder. Both diseases appear to have both hereditary and environmental risk factors and are impacted by dietary intake.

How is it diagnosed?

Diagnosing inflammatory bowel disease can be difficult, as the two conditions are often confused. An accurate diagnosis is important in determining the most appropriate treatment. There are a variety of tests that can be sued for diagnosis, including:

• Barium enema
• Flexible sigmoidoscopy and/or colonoscopy
• MRE – MRI with enterography to assess how much of the bowel is involved
• Blood tests: your doctor may order blood work to test for anemia and infection and may take a stool sample to do a fecal occult blood test

What is the treatment?

Treating inflammatory bowel disease involves reducing the inflammation that causes the disease’s symptoms and getting the patient into remission to lessen the chances of disease-related complications. The simplest course of action is to have your doctor recommend diet and lifestyle adjustments that can make these diseases more manageable. Drug therapies, including anti-inflammatory drugs, antibiotics and immune suppressors may be prescribed.

What is intraventricular hemorrhage?

Intraventricular hemorrhage occurs when there is bleeding in or around the ventricles in the brain. The ventricles are the areas that contain the cerebral spinal fluid. Intraventricular hemorrhage occurs most commonly in premature babies. This bleeding can put pressure on the nerve cells in the brain which can cause damage. Severe damage to the nerve cells can lead to brain injury.

What are the different levels of intraventricular hemorrhage?

There are different grades on intraventricular hemorrhage that vary depend on the amount of bleeding within the brain:

Grade 1 and Grade 2 are the most common occurring intraventricular hemorrhage and don’t normally involve long-term complications. Grade 3 and Grade 4 are more serious and can result in a long-term brain injury.

What are the symptoms of intraventricular hemorrhage?

Symptoms of intraventricular hemorrhage can include:

• Apnea – pauses in breath
• Bradycardia – low heart rate
• Pale or blue coloring
• Weak suck
• High pitched cry
• Seizures
• Anemia – low red blood cell count
• Swelling or bulging of the soft spots between the bones in the baby’s head

What is the treatment for intraventricular hemorrhage?

Currently, there is no specific course of treatment for intraventricular hemorrhage other than treating other health conditions that may worsen the hemorrhage. In some cases, surgery may be required to implant a shunt to drain the fluid.

What is hepatoplastoma?

Hepatoplastoma, though rare, is the most common malignant liver tumor in young children, primarily from infancy to five years of age. It is more common in premature and underweight infants.

What is hepatocellular carcinoma?

Also a rare disease in children, when diagnosed, it usually is found between the ages of 12 and 14, generally affecting patients whose livers have dealt with a great deal of stress due to infection, metabolic diseases or long-term drug use.

What are the symptoms of liver tumors?

• Mass, swelling and/or pain in the upper right abdomen
• Nausea and vomiting
• Loss of appetite/weight loss
• Fever
• Jaundice
• Early signs of puberty

How is it diagnosed?

Liver tumors are often discovered through an ultrasound. The doctor may also utilize a CT scan, MRI, biopsy and blood tests to confirm diagnosis.

What is the treatment

For a child with liver tumors, an individualized treatment plan is created by the child’s doctors, and is based on the stage of the cancer, the child’s age, and his or her overall health. Oftentimes, the first course of treatment is the surgical removal of the tumors in the liver and any other part of the body if the cancer has spread. If it is necessary to remove the entire liver, the child may need to be a part of a pediatric liver transplant program. Another potential treatment component is chemotherapy, which involves medications being delivered intravenously. Chemotherapy can serve as the main treatment, be used to shrink the tumor prior to surgery or be employed post-surgery to kill any remaining cancer cells. Sometimes Radiofrequency ablation is used if the tumor returns after treatment.

What is lymphangioma?

A lymphangioma is a congenital defect that causes the abnormal formation of lymphatic vessels. These malformations form a soft mass in the head or neck, although they can occur all over the body. Lymphangiomas are present at birth, but sometimes aren’t observed until later. Children born with chromosome abnormalities and genetic conditions like Downs syndrome and Turner syndrome may be more likely to be associated with a lymphangioma.

What are the symptoms?

The main symptom of lymphangioma is an obvious swelling which can occur anywhere in the body. Swellings can vary from small to large. Generally, these growths start as cosmetic issues and may fluctuate in size, especially with a viral illness if they are in the head and neck area. Medical complications can occur often later and include:

• Infection
• Pain
• Breathing problems from the growths pressing on the airway
• Bleeding
• Difficulty swallowing
• Wheezing and chest pain

How is it diagnosed?

Lymphangioma can sometimes be diagnosed before birth with a prenatal ultrasound. In infants, doctors diagnose lymphangioma upon a physical exam with identifying characteristics including their soft, fluid-filled appearance. In the work up of a vascular malformation we assess if there is a hemangioma (capillary lesions), lymphangioma (lymphatic vessels) or venous malformation (involvement of veins or arterial – venous malformations by assessing the physical and radiologic characteristics of the lesion.

What is the treatment?

Lymphangioma can be treated in a variety of ways, or can require no treatment, depending on the location, size, and symptoms of the mass or masses. Sometimes, depending on the extent of the tissue involvement and types of treatment, the swellings can reoccur. Your doctor or doctors will decide on the best treatment plan. This may include:

• Percutaneous drainage to drain fluid from lymphatic malformation prior to injecting sclerosants into the lesion to shrink it
• Surgery to remove it
• Sclerotherapy, which involves injecting a solution into the swelling to shrink it by interventional radiology

What is a Malrotation?

Malrotation is a birth defect that occurs in the tenth week of gestation when the intestines are supposed to migrate back into the abdominal cavity from their temporary location at the base of the umbilical cord. In cases of malrotation, intestinal fixation doesn’t occur, and the large and small intestines are located incorrectly and in a fashion that they are at a risk of twisting. As a result, blockages of the intestine occur, causing problems with digestion. Once a baby with this condition is born, because the bowel isn’t properly affixed, it can twist and cut off its own blood supply.

What are the symptoms?

The symptoms of malrotation and volvulus may include:

• Chronic abdominal pain
• Swollen abdomen
• Diarrhea/constipation
• Vomiting bile
• Rectal bleeding
• Bloody stool
• Failure to thrive

How is it diagnosed?

Oftentimes, malrotation isn’t evident until the child’s intestine becomes twisted or obstructed by Ladd’s bands. As the malrotation progresses and twists, the bowel becomes a volvulus. If the doctor suspects malrotation and volvulus the doctor may utilize various imaging tests to determine if bowel is positioned correctly and if there are any blockages. Some of the possible tests that may be ordered include:

• Blood tests
• Abdominal X-ray
• Upper GI imaging
• Barium enema
• CT scan

How is it treated?

A volvulus is considered life-threatening because the intestines can die without proper blood supply, and so immediate action must be taken with this diagnosis. A child may be given an IV with antibiotics to prevent infection, along with hydration. A nasogastric tube that goes through the nose and throat to the esophagus and stomach helps prevent further gas buildup. Surgery to repair the volvulus is most likely undertaken as soon as possible. Once untwisted, the intestine is replaced in the abdomen if it is healthy. If a part appears damaged, it is generally removed. If the section removed is too large and the parts that remain can’t be reattached, an ostomy may be done to allow the intestines to drain and heal.

What is Meckel’s diverticulum?

Meckel’s diverticulum is the most common congenital defect of the digestive system, with 2-3% of the population having it. Is is a remnant from the umbilical cord that causes a bulge in the lower part of the small intestine that is residual tissue from the embryonic development of the intestines. Many people never know they have Meckel’s diverticulum until it causes symptoms which occur only in a small number of the people who have it. However, for these patients, the secretion of acid by Meckel’s diverticulum may cause peptic ulcers in the lining. If the ulcers bleed or rupture, stool can leak into the abdomen, causing a dangerous infection called peritonitis. It also has the potential to cause intestinal obstructions.

What are the symptoms?

Symptoms of Meckel’s diverticulum can occur any time in a child’s development. The most common symptom in younger children is the passage of a large amount of dark red blood from the rectum. This is usually painless. If infection or obstruction occurs they can cause mild to severe abdominal pain.

How is it diagnosed?

Meckel’s diverticulum can be diagnosed using a variety of tests determined by the doctor. Some of the typical tests used for this diagnosis include:

• Blood test to determine if anemia or infection is present.
• Meckel’s scan: a radioactive substance indicates areas where acid-secreting stomach tissue exists outside of the stomach in other sites in the intestine.
• US or CT scan can identify the outpouching of intestine if it is causing a blockage or infection.
• Rectosigmoidoscopy: using a small, flexible tube with a camera on the end, the rectum and large intestine are evaluated for any GI bleeding.
• Barium enema and small bowel series: contrast is given to coat the interior of the intestine, and then it is viewed via X-ray as a way to rule out various causes of bleeding.

How is it treated?

Meckel’s diverticulum is typically treated by surgically removing the diverticulum and reattaching the intestines. If the patient has no symptoms, treatment may not be requires. Consult your physician to evaluate your child’s situation.

What is medulloblastoma?

A medulloblastoma is a malignant, or cancerous, brain tumor that occurs in the cerebellum. The cerebellum is located at the base of the skull which controls balance, coordination and other motor functions.

What are the symptoms of medulloblastoma?

The symptoms of medulloblastoma can vary depending on the size and location of the tumor. Some common symptoms can include:

• Headache
• Nausea/vomiting
• Dizziness
• Walking problems/imbalance
• Double vision
• Lethargy
• Fatigue

What are the treatment options?

Treatment options for medulloblastoma typically involves surgically removing as much of the tumor as possible in order to relieve the pressure in the skull. A shunt may be needed as well to help drain any excess cerebrospinal fluid buildup. In some cases, chemotherapy or radiation may be necessary after surgery.

What is moyamoya?

Moyamoya is a rare disease where the carotid artery, the blood vessel that supplies blood to the brain, becomes narrowed or blocked. This limits the flow of blood to the brain which can result in a stroke or recurrent transient ischemic attacks (TIA), also known as “mini-strokes”. Moyamoya is a progressive condition meaning, without treatment, the condition becomes worse over time.

What are symptoms of moamoya?

Though moyamoya disease may present at any age, symptoms are more common from ages 5 to 10 in children. In most cases, the first symptom of moyamoya disease is a stroke or TIA.

Other symptoms can include:

• Headache
• Seizures
• Face, arm or leg weakness, numbness or paralysis (commonly on one side off the body
• Visual disturbances
• Aphasia (difficulty speaking)
• Developmental delays
• Involuntary movements

With signs/symptoms of a stroke or TIA, seek medical attention immediately. To remember the signs of stroke, always think FAST –

• Face – Ask the person to smile – facial weakness/paralysis normally evident with an uneven smile or facial droop.
• Arms – Ask the person to raise both arms – arm weakness normally evident when one arm drifts downward or if one arm will not lift.
• Speech – Ask the person to repeat a simple phrase – speech irregularities normally evident if speech is slurring or strange.
• Time – If any of these signs are evident, dial 9-1-1 immediately.

What are the treatment options?

Treatment options can vary depending on the severity of the disease. In some instances, treatment can include medications or revascularization surgery. If the symptoms become worse or blood flow is reduced, revascularization surgery may be necessary to restore normal blood flow to the brain.

What is neuroblastoma?

Neuroblastoma is a type of cancer that commonly grows in the adrenal glands, but also can develop in the abdomen, neck and spinal cord. Most cases are diagnosed in children under five years of age – sometimes the disease can even begin before birth.

What are the symptoms?

Symptoms of neuroblastoma may include:

• A hard, painless mass in the neck
• Mass effect in the abdomen or thorax
• Stomach pain
• Decreased appetite
• Leg weakness
• Irritability
• Diarrhea or constipation
• Wheezing
• Drooping eyelids or unequal pupil size

How is it diagnosed?

To diagnose neuroblastoma, the doctor may use a variety of methods, including:

• A physical exam
• Urine and blood tests
• Imaging tests, which may include an X-ray, ultrasound, CT scan, MIBG scan and MRI
• Biopsy
• Removing a sample of bone marrow for testing

How is it treated?

Neuroblastoma treatment varies based on many factors, including how much the disease has spread. If the tumor is localized and can be completely removed, surgery may be the best course of treatment. For patients with an intermediate risk of recurrence, the doctor may attempt to shrink the tumor using chemotherapy. Once the prescribed course is complete, they can reevaluate next steps. Patients who are considered high risk based on the aggressive nature of the tumor, or if it is in multiple locations, follow a more aggressive course that may include: chemotherapy, surgery, radiation, stem cell transplant and immunotherapy. We are members of the Children’s Oncology Group so we are dedicated to delivering up to date oncologic care to children with cancer.

What are sarcomas?

Sarcomas are a rare cancer that can occur anywhere in the body in any of the connective tissue, including: nerves, muscles, joints, bone, fat and blood vessels. The abdomen and limbs are common locations for sarcomas, and often they are located deep inside the body. Sarcomas can spread to nearby organs, forming secondary tumors.

What are the symptoms?

The symptoms of sarcomas vary greatly depending on where the tumor is located. Often, the first symptom of a sarcoma is a painless lump, which may occur on the trunk or on an arm, leg or elsewhere. As these tumors grow and press on nerves, blood vessels or organs, the child may experience pain, weakness, bloody stool or vomiting.

How are they diagnosed?

Diagnosing sarcomas can be complex because there are many different types. The doctor may employ a variety of imaging tests to determine the exact nature of this particular tumor. Tests that may be used to evaluated the tumor include:

• X-rays
• CT scans
• MRI
• PET scans

If there appears to be a sarcoma, the doctor may choose to perform a biopsy to determine the exact type of cancer present and to stage the best approach of multimodality therapy.

How is it treated?

Creating a treatment plan for sarcomas depends on many factors, including the size, type and location of the tumor. Treatment components typically include multimodality therapy: surgery, radiation therapy, chemotherapy and targeted drug treatment.

What are solid malignancies?

Solid malignancies are a broad category of cancers that excludes blood cancers. Blood cancers typically cover leukemias and lymphomas and we do assist in their care with biopsies and placement of ports to allow for the ease of chemotherapy.

Solid malignancies vary from bone and soft-tissue tumors to tumors of various organs, like the brain, liver or kidneys. Some types of solid malignancies include the following: Neuroblastoma, Wilms’ tumor, Germ cell tumors, Pancreatic tumors, Ovarian tumors, Osteosarcoma, Ewing sarcoma, Rhabdomyosarcoma, non-rhabdomyosarcoma soft tissue sarcomas, histiocytic diseases, hepatoblastoma (liver tumors) and many more.

What are the symptoms?

The symptoms of solid malignancies vary greatly, as there are different types of tumors and locations in the body where they can occur. Pain in a specific body part and unexplained fatigue and weight loss are symptoms common to many types of malignancies.

How is it diagnosed?

In order to diagnose solid malignancies, oftentimes a tissue sample is needed to determine the exact nature of the tumor. This is done through a biopsy.

How is it treated?

Solid malignancies are typically treated in a combination of ways. Patients can be treated surgically and/or with multi-modality therapy such as chemotherapy and radiation treatments. Other forms of treatment can include immunotherapy and targeted drug treatments.

What is spina bifida?

Spina bifida is a birth defect where the spine and spinal cord don’t develop properly. During prenatal development, the neural tube, the portion of a developing baby that becomes the brain, spinal cord and tissues surrounding them, forms. In those with spina bifida, a part of the neural tube either doesn’t close completely or does not develop properly which can result in spinal cord defects as well as defects in the bones of the spine.

What are the different forms of spina bifida?

There are different types of spina bifida:

• Spina bifida occulta – this is the most commonly occurring and mildest form of spina bifida. This occurs when there is a small gap in one or more of the vertebrae, or bones of the spine. In most cases, there are no symptoms or disabilities associated with this form of spina bifida.
• Closed neural tube defects – this involves various defects where the spinal cord contains malformations of fat, bone or the protective tissue called meninges. This form of spina bifida is associated with few or no symptoms. If symptoms do occur, they may involve incomplete paralysis with urinary and bowel dysfunction.
• Spina bifida meningocele – in this form of spina bifida a sac of fluid protrudes through an opening in the baby’s back however, the spinal cord is not in the sac. Some people with this form of spina bifida experience no symptoms while others can experience minor disabilities.
• Spina bifida myelomeningocele – this is the most severe forem of spina bifida. This occurs when the spinal cord does not develop properly and a part of the spinal cord protrudes through the back in a sac through an opening in the spine. The sac contains cerebrospinal fluid and blood vessels along with spinal cord. Babies with this form of spina bifida often have paralysis or weakness below the spinal lesion as well as problems with the bladder and bowel function.

What are the treatment options?

Currently, there is no cure for spina bifida. Treatment options can vary based on the type and severity of the condition. In some cases, monitoring the progression and associated symptoms in necessary. In other cases, surgery may be required and can help treat other conditions that can arise due to spina bifida including hydrocephalus and tethered spinal cord.

At Palm Beach Children’s Surgical Specialists, we are committed to working with you to find the treatment option for you and your little one.

What is splenomegaly?

Splenomegaly refers to an enlarged spleen. The enlargement can be caused by a variety of problems, including an infection, cancer, liver disease, blood disorders (i.e. spherocytosis), inflammatory diseases, trauma, cysts or other conditions. A large spleen can also be associated with a wandering spleen that is moving and dangling in the abdomen.

What are symptoms?

Spleen problems can cause no symptoms, or low platelets and brusing. An enlarged spleen may be discovered by a doctor during a physical examination. When there are symptoms, they may include:

• Pain or a feeling of fullness in the upper left abdomen, possible spreading to the left shoulder
• Full feeling with small amounts of food
• Hiccups
• Anemia
• Easy bruising
• Fatigue
• Frequent infections

How is it diagnosed?

Spleen problems are often discovered via a physical exam. If a spleen problem is suspected, the doctor may choose to order a complete blood count and/or use an imaging test to confirm the diagnosis. Tests such as ultrasound, X-rays, CT scan and MRI can be utilized. Once the doctor confirms the spleen is enlarged, the patient may need additional testing to determine the cause. This may include liver function tests and a bone marrow exam.

How is it treated?

If your child’s enlarged spleen is asymptomatic and a cause can’t be identified, the doctor may suggest a conservative approach. In this case, your child will be closely followed up to be reexamined. If your child develops any symptoms, he or she should be seen sooner. Infrequently, when there is no identifiable cause or the symptoms are severe, the spleen is surgically removed and examined to check for lymphoma of the spleen. One can live without a spleen, through one has to be cautious, given susceptibility to various infections, which can be life threatening. To avoid that your child will be given vaccines preoperatively to ensure your child’s immunity is intact for life.

What is tethered spinal cord?

Tethered spinal cord is a condition where the spinal cord is attached or “tethered” to tissue around the spine and most commonly occurs at the base of the spine. This results in a limitation on the movement of the spinal cord within the spinal column. This can cause abnormal stretching of the spinal cord which can cause nerve damage, pain and other symptoms. Tethered spinal cord often occurs in children with spina bifida however, it can occur in children that do not have spina bifida.

What are the symptoms of tethered spinal cord?

Symptoms of tethered spinal cord usually appear gradual and occur as the child grows. The symptoms of tethered cord can include:

• Bowel or bladder problems
• Pain in the back or legs
• Loss of leg or feet strength
• Abnormal walking pattern/deterioration in gait
• Unusual birthmarks or dimples on the back

What is the treatment for tethered spinal cord?

Treatment for tethered spinal cord involves surgery. A neurological surgeon can remove a portion of the spine to reach the spinal cord to access the “tethered” area. The tissue can be released to allow the free movement of the spinal cord.

Our team at Palm Beach Children’s Surgical Specialists is dedicated to providing quality care for you and your child.

What are thyroid disorders in children?

There are two main types of thyroid disorders in children: overactive thyroid and underactive thyroid. However a thyroid mass most often needs a resection if the work up suggests a concerning diagnosis. The thyroid is a small gland located in the front of the neck that produces hormones that are responsible for controlling metabolism. Proper thyroid function is key to a child’s growth and development and should be evaluated by an endocrinologist. That’s why, when it is over or underactive, there are major consequences for young patients. Thyroid nodules need to be addressed to ensure they are not hiding a malignancy that is so treatable with removal.

What are the symptoms?

The symptoms of thyroid disorders vary depending on whether the gland is over or underactive.

Symptoms of an overactive (hyper) thyroid include:

• Agitated, nervous
• Trouble sleeping
• Weight loss though still eating normally
• Sweat more than normal
• Heart palpitations
• Diarrhea
• High blood pressure
• Protruding eyes

Symptoms of an underactive (hypo) thyroid:

• Sluggish/tired
• Delayed puberty or early puberty
• Short stature
• Delayed bone age
• Weight gain though no change in eating habits
• No cold tolerance
• Constipation
• Depression
• Vision problems
• Headaches
• White breast discharge
• Dry skin

How is it diagnosed?

If thyroid disease is suspected, the first step is a physical exam in which the doctor feels the thyroid gland in the neck, checking to see if it is enlarged or if there are any nodules. The next step is to order blood work. Blood tests can check the levels of thyroid hormone and antibodies in the blood. An ultrasound can be taken to check the size of the thyroid and to see if it has any nodules on it. If there are nodules or any sort of mass, a fine-needle biopsy may be done to test for cancer.

How is it treated?

To treat hyperthyroid (overactive thyroid – possible Graves disease), the doctor may have your child take medicine everyday that blocks thyroid activity or take radioactive iodine to shrink the thyroid and lower the amount of hormone being secreted. If these options are not effective or applicable, the doctor may recommend surgical removal of the thyroid. Then your child will need replacement therapy to give a stable amount of the hormone.

To treat hypothyroid underactive thyroid), the doctor may prescribe a medication that provides the amount of thyroid hormone you are lacking. Thyroid hormone is necessary for growth and development, so it is important the child take it every day.

What are undescended testis?

An undescended testicle or testis describes the condition in which one or both testicles haven’t moved into place in the scrotum. During fetal development, infant boys’ testicles form in the abdomen, up near the aorta (the central vessels), but eventually descend through the groin into the scrotum.

What are the symptoms?

When, upon physical examination, you or your son’s physician discovers that the testicle(s) is missing from the scrotum.

What is the treatment?

An undescended testis is generally discovered when the baby is born and undergoes a through physical exam. Generally, this condition self-corrects, with the testicle(s) moving into place itself within the first few months of life. If, however, the problem remains present at four months, it is unlikely to self-correct and should be treated surgically. Undergoing this procedure could help protect his fertility and possible help prevent testicular cancer.

What are vascular malformations?

Vascular malformations are abnormal clusters of blood vessels that look like a blemish (discolored skin) or mass, they are a rare and complex congenital condition. These malformations occur due to improper development of blood vessels, lymph vessels, veins, arteries or a combination of these. They are usually present at birth and tend to grow with the child. In the work up of a vascular malformation we assess if there is a hemangioma (capillary lesions), lymphangioma (lymphatic vessels) or venous malformations (involvement of veins) or arterial – venous malformations by assessing the physical and radiologic characteristics of the lesion.

What are the symptoms?

Vascular malformations tend to be visible at birth or become visible as children grow. They appear to be a blemish or mass, although some types, like those of the brain, don’t appear obvious, but can cause headaches, seizures and strokes.

How are they diagnosed?

The diagnosis of vascular malformations greatly depends on where they are located. Those located on the skin can be identified during a physical. Those that are internal can be detected with MRI or ultrasound.

How are they treated?

Vascular lesions vary greatly from extremely simple to incredibly complex. Some lesions may not require any treatment as they can be expected to improve or resolve on their own. The more complex vascular lesions can be difficult to treat. Common treatment techniques include:

What is Wilms’ tumor?

Wilms’ tumor is the most common type of kidney cancer found in children, arising from immature kidney cells. It is rare, and generally affects children between the ages of three and four, becoming less common after age five. It can affect one or both kidneys.

What are the symptoms?

The symptoms for Wilms’ tumor vary, with some children being asymptomatic. But many patients experience at least one of the following symptoms:

• Hardness or swelling of the abdomen
• Nausea
• Stomach pain
• High blood pressure (hypertension)
• Blood in the urine
• Loss of appetite
• Fever

How is it diagnosed?

Wilms’ tumor may be diagnosed through a variety of methods. The doctor may begin with a physical exam to see if there are any signs of this disease. Blood and urine tests may be used to determine how well the kidneys are working. Imaging tests, such as MRI, ultrasound and/or CT scan can help the doctor see if there is a tumor present. We are members of the Children’s Oncology Group so we are dedicated to delivering up to date oncologic care to children with cancer.

How is it treated?

Wilms’ tumor is treated based on what stage the cancer is in. Radiologic imaging is critical in the initial steps of staging and diagnosis. Treatment often involves surgery to remove the tumor – or possibly even the entire kidney, if necessary. In more advanced stages of Wilms’ tumor, some of the tissue removed is sent to the lab to confirm the diagnosis if both kidneys are involved. Chemotherapy and radiation therapy may also be part of the treatment plan.