Pediatric Surgery

Question 0

Treatment for high imperforate anus

Answer 0

Diverting colostomy followed by subsequent pull through procedure

Question 1

Treatment for low imperforate anus

Answer 1

Perineal operation only

Question 2

How is Hirschsprung disease diagnosed?

Answer 2

Congenital absence of ganglion cells – definitively diagnosed by full thickness rectal biopsy at least 2 cm above the dentate line

Question 3

Usually close spontaneously by the age of four do not need to be repaired

Answer 3

Umbilical hernia

Question 4

VACTERAL syndrome

Answer 4

Vertebral anomalies
Anal atresia
Cardiac defect - VSD
TE fistula
Renal 
Limb defects - radical dysplasia

occur in 1 in 5000 live births

Question 5

Treatment for ilial atresia?

Answer 5

Small bowel resection and primary anastomosis

Question 6

Treatment for duodenal atresia?

Answer 6

Enteroenterostomy, ie Duodenoduodenostomy

Question 7

Treatment for obstruction secondary to an annular pancreas?

Answer 7

Duodenoduodenostomy - bypass procedure
Partial resection of annular pancreas is often complicated by fistula and does not treat underlying problem.

Duodenoduodenostomy is more physiologic than gastrojejunostomy and does not require vagotomy to prevent marginal ulceration

Question 8

Treatment for ileocolic intussusception without evidence of peritonitis?

Answer 8

Hydrostatic reduction by air enema -> Air or barium contrast enema is diagnostic and therapeutic.

If signs of peritonitis or bowel ischemia are present, then surgical exploration either open or laparoscopic is indicated.

Question 9

m/c type of intussusception

Answer 9

ileocolic - appears as coiled spring on barium enema

Question 10

Tx for omphalocele?

Answer 10

broad spectrum prophulactic IV abx, prevention of hypothermia, cardiopulmonary resuscitation, gastric decompression.

Question 11

Pneumatosis intestinalis seen on radiologic findings within the first month of life.

Answer 11

Necrotizing enterocolitis - m/c GI emergency in the neonatal period. Prematurity is single most important risk factor.

Bowel rest with nasogastric tube decompression, fluid resuscitation, and broad spectrum abx.

m/c cause of short gut syndrome in children

Question 12

Earliest clinical manifestation of CF in a newborn

Answer 12

Meconium ileus

Question 13

Tx meconium ileus

Answer 13

water soluble contrast enema. Successful 75% of the time in relieving obstruction

Surgical - enterotomy through the dilated distal ileum then to irrigate the proximal and distal bowel with either warm saline for 4% and acetylcysteine for Mucomyst. Meconium milked into distal colon or removed thorugh enterotomy. Closed in 2 layers

Question 14

One-month-old female infant presents with persistent jaundice. A serum direct bilirubin is 4.0 mg/dL and an ultrasound of the abdomen shows a shrunken gallbladder and inability to visualize the extrahepatic bile duct. What is it? What is the most appropriate initial management for this patient?

Answer 14

Biliary atresia
Laparotomy with Kasai hepatoportoenterostomy.

Delay may lead to irreversible hepatic fibrosis.

Question 15

What is the management of a congenital diaphragmatic hernia?

Answer 15

– Cardiopulmonary stabilization prior to any operative repair – mechanical ventilation with low tidal volumes

Question 16

How do you diagnose coarctation of the aorta? What is the management?

Answer 16

Echocardiography
Administration of prostaglandins to reopen the ductus arteriosus which improves flow distal to the coarctation into the lower body

Question 17

A non-cyanotic today old child as a systolic murmur along the left sternal border; examination is otherwise normal. Chest x-ray and electrocardiogram are normal. What is it? Management.

Answer 17

Ventricular septal defect – account for 20% to 30% of all congenital cardiac anomalies. It may lead to cardiac failure and pulmonary hypertension if the defect is larger than 1 cm, or it may be a symptomatic of the defect small.

Surgery is not indicated for the asymptomatic patients with a small defect since a substantial number will close within the first year of life indication for surgery if the defect does not close by the age of five.