Common Surgical Conditions in Childhood

Question 1

Intestinal Catastrophes Differential

Answer 1

General:

Intestinal Catastrophes Differential: midgut volvulus, incarcerated hernia, bowel obstruction, necrotizing enterocolitis

Symptoms: irritable, in pain, lethargic, bilious emesis (BAD), +/- change in stool

Investigations: X-ray

Management: ABCs+resus, +/- NPO or NG or Abx or surg consult

Question 2

Key symptoms: early bilious vomiting, scaphoid abdomen are all indications of a ____ bowel obstruction such as:

Answer 2

Proximal Bowel Causes: TEF, pyloric stenosis, duodenal atresia, malrotation, intestinal atresia

Question 3

late vomiting, gross abdominal distension are symptoms of ___ bowel obstructions such as:

Answer 3

: Ileal/colonic atresia, meconium ileus, Hirschsprung’s Disease

Question 4

key risk factors of necrotizing enterocolitis

Answer 4

Risk factors: prematurity, enteral feeds, congenital cardiac disease

Question 5

Midgut Volvulus

Signs and symptoms: any ___ vomiting in the neonate/infant requires urgent workup.

Assume an intestinal obstruction until proven otherwise.

Look for ____ SIGN

Answer 5

Midgut Volvulus

Signs and symptoms: any bilious vomiting in the neonate/infant requires urgent workup.

Assume an intestinal obstruction until proven otherwise.

Look for CORKSCREW SIGN

Question 6

Pyloric Stenosis

Definition: hypertrophy of the pylorus that is elongated or thickened, resulting in ___ ___ obstruction

Happens in first __ weeks of life, M>F

Etiology: __/hyperacid, __ __, genetics, __ antibiotics.

Classic findings: visible gastric __, palpable epigastric __, hypokalemia, hypochloremic, metabolic __, paradoxical aciduia.

Treatment: surgical management.

Answer 6

Pyloric Stenosis

Definition: hypertrophy of the pylorus that is elongated or thickened, resulting in gastric outlet obstruction

Happens in first 3-6 weeks of life, M>F

Etiology: hypergastrinemia/hyperacid, bottle feeding, genetics, macrolide antibiotics.

Classic findings: visible gastric peristalsis, palpable epigastric mass, hypokalemia, hypochloremic, metabolic ALKALOSIS, paradoxical aciduia.

Treatment: surgical management.

Question 7

diagnosis and treatment of Meckel’s Diverticulum

Answer 7

Diagnosis: Rule of 2’s: It is often referred to by the rule of 2’s; 2% of the population, within 2 feet of the ileocecal valve, 2 inches in length, tow types of heterotopic Mucosa, and presentation before the age of two.

Meckel’s diverticulum is a true diverticulum, containing all layers of the small bowel wall. They arise from the antimesenteric surface of the middle-to-distal ileum. The diverticulum represents a persistent remnant of the omphalomesenteric duct, which connects the midgut to the yolk sac in the fetus.

Treatment: diverticulectomy

Question 8

associated vomiting, pain intermittent, maroon stools

Answer 8

marroon stools– think about intussusception

Question 9

signon X ray for duodenal atresia

Answer 9

duodenal atresia.

• voluvlus will be biliary emesis because its likely to be further down. Will have more abdominal distension

duodenal atresia may not have biliary emesis because the blockage happens above the bile duct