Pedatric Surgery

Question 1

What’s workup for FAP

Answer 1

labs, colonoscopy/flex sig if asymptomatic, genetic testing for APC mutation

FAP screening starting age 12 w flexible sigmoidoscopy

Total proctocolectomy at age 20, get CT c/a/p before surgery to rule out mets.

Check incontinence before offering pouch

can skip proctectomy if no rectal polyp w proctoscopy q2y

If desmoid not resectable and not symptomatic, treat with sulindac or tamoxifen

Question 2

What’s surveillance after FAP?

Answer 2

q6month History/PE
DRE for anal transition zone cancer
EGD every 1-6 years for duodenal adenoma,
Annual neck ultrasound to screen for thyroid cancer

Question 3

Pyloric stenosis findings

Answer 3

US: Pylorus > 3 mm thick, longer than 14-15 mm, no passage of liquids from stomach to duodenal

Question 4

Treatment for intussusception

Answer 4

US shows target sign
Water or air contrast enema (100-120 mmHg)

Question 5

Workup/Tx for TEF?

Answer 5

Use APGAR to guide intubation
VACTERL: Vertebra, anal atresia, cardiac anomaly, TEF, Renal anomalies, limb anomalies
Bronchoscopy, EGD, CXR
If <3 vert spaces between ends of esophagus, can anastomose
If >3 spaces, spit fistula/G-tube then re-eval at 3-4 months

Check for aortic arch and thoracotomy other side