Ped Surg

Question 1

Alvarado score for appendicitis

Answer 1

• migratory R iliac fossa pain
• nausea/vomiting
• anorexia
• RLQ pain
• RLQ rebound
• fever
• leukocytosis
• left shift, neutrophils

Question 2

Differential diagnosis of appendicitis

Answer 2

• GI: gastroenteritis, lymphadenitis, colitis/IBD, Meckel’s, cholecystitis, cholangitis
  -GU: UTI, pyelonephritis, renal calculi
  -OB-Gyn: ectopic pregnancy, ovarian torsion,
  ovarian cyst, tubo-ovarian abscess/PID
  -Other: DKA, HSP, omental torsion, RLL pneumonia, porphyria,

Question 3

What is imaging of choice of for investigation of Intussecpition?

Answer 3

ultrasound

other tests: contrast enema

Question 4

Contraindications for reduction by air enema

Answer 4

Peritonitis

Persistent hypotension Free air/pneumoperitoneum

Question 5

Deckle’s diverticulum Rule of 2’s

Answer 5

ž -2% of population
ž- 2:1 M:F
ž -2-6% symptomatic, complicated
ž-50-75% symptomatic by age 2 years
ž-within 2 feet of ileocecal valve
ž -2 inches long
ž-2 types of heterotopic mucosa: gastric, pancreatic

Question 6

Imaging for Meckel’s

Answer 6

-99Tc (Meckel’s) scan detects
gastric mucosa
-give ranitidine before to suppress gastric acid secretion to increase sensitivity

Question 7

Differential of bilious vomiting

Answer 7

ž 1. Midgut volvulus
ž 2. Malrotation
ž 3. Duodenal or other atresias ž 4. Hirschsprung’s disease
ž 5. Ileus

Question 8

Features of Gastroschisis

Answer 8

Defect R of umbilicus
ž Defect usually small
ž No peritoneal sac
ž “Angry” bowel
ž 10% associated with atresias & volvulus
ž No other system anomalies
ž Prolonged ileus/gastro- intestinal dysfunction

Question 9

Features of omphalocele

Answer 9

ž Defect thru umbilicus
ž Defect can be “giant”
›Contains liver or >5cm
ž Peritoneal sac
ž Normal bowel
ž 50% associated with other anomalies, especially cardiac
ž Prompt recovery of bowel function

Question 10

Indication for contralateral exploration for inguinal hernia

Answer 10

• infant with a history of prematurity
• Only 5-8% of children develop contralateral hernias
• but moot point for laparoscopic

Question 11

Complications of inguinal hernia repair

Answer 11

ž-Scrotal swelling/hematoma – resolves within 10-14 days
ž-Iatrogenic undescended testicle – 0.2%
ž-Recurrence – up to 0.8% all comers › 15% in premature infants
› 20% if incarcerated
ž-Injury to vas deferens – 0.2%
-Testicular atrophy – 2.3%

Question 12

Timing of surgical referral of undescended testis

Answer 12

by 9 months