Abdominal Surgery

Question 1

What are the absolute contraindications to an enema for intusussception

Answer 1

Peritonitis

Shock

Free air

Perforation

Question 2

What is the most common anatomic region that is affected in intusussception

Answer 2

Ileocolic

Question 3

What age group do most children present with malrotation with volvulus?

Answer 3

75-85% within the first year, most within the first month

Question 4

What is the gold standard test to diagnose malrotation

Answer 4

Upper GI series

• should see normal C loop
• corkscrewing
• bird beaking -

Ultrasound is suggestive - looking for SMA/SMV relationship

-A is on the left, V is on the right

Abdominal x-ray

Question 5

How do you treat malrotation with Volvulus

Answer 5

Ladd’s procedure

• your colon will be on left side, your small bowel will be on the right
• cecum attached by thin stalk to RUQ
• disconnect cecum, and bring down cecum to LLQ
• remove appendix

Question 6

When do you need imaging for thyroid enlargement?

Answer 6

Solitary nodule

Question 7

What conditions (3) are associated with spontaneous peritonitis?

Answer 7

Ascites

Nephrotic syndrome/dialysis

Cirrhosis

Question 8

What are common bugs in peritonitis

Answer 8

Skin or GI bugs

-Pneumococci, GAS, enterococci, staphylococci, gram negatives (E.coli, Klebsiella pneumonia)

Question 9

How do you treat spontaneous peritonitis

Answer 9

Broad spectrum antibiotics, then targeted to your grown bug

(i.e. start cefotaxime and narrow)

Question 10

How do you treat peritonitis secondary to perforation

Answer 10

Antibiotics (amp, gent, flagyl)

IV fluid resuscitation

Question 11

What is the general management for umbilical hernias

Answer 11

• spontaneous closure expected up to 4-5y
• close if strangulated, increasing in size after 1-2y
• fascia less than 2cm likely to close on its own

Question 12

What are the metabolic derangements in pyloric stenosis

Answer 12

• hypochloremic - from persistent vomiting
• metabolic alkalosis - from persistent vomiting
• hypokalemic - from shifting of protons out of cells

Question 13

Criteria for surgery in pyloric stenosis (Cl, HCO3 and K)

Answer 13

Cl >95

HCO3 <28

K >3.5

Question 14

How can you differentiate gastroschisis from omphalocele on exam (2 things)

Answer 14

Gastroschisis - to the right of the umbilicus, no membrane covering

Question 15

What are the more common associated anomalies with gastroschisis

Answer 15

Gastrointestinal - i.e. malrotation, volvulus, atresia, stenosis

Question 16

What are the more common association with omphalocele

Answer 16

Beckwith Wiedemann

Trisomy 18

Trisomy 13

Other congenital anomalies - MSK, renal, CVS

Question 17

Most common adverse effects of gastroschisis repair?

Answer 17

Gastrointestinal - adhesions, dysmotility

Question 18

How do you manage congenital diaphragmatic hernia?

Answer 18

immediate intubation

gastric decompression with NG

stability prior to OR