Pediatric Surgery

Question 0

VACTERL

Answer 0

Vertebral deformities
Anal atresia
Cardiac findings
Tracheoesophageal fistula
Renal abnormalities
Limb abnormalities

Question 1

Newborn presents with excessive salvation and choking when first feeding is attempted – suspected diagnosis? Confirm diagnosis with?

Need to rule out? (How?)

Answer 1

Esophageal atresia; NG tube coils when placed

VACTERL (X-ray, ECHO, renal US)

Question 2

Esophageal atresia – management? If ideal management is delayed?

Answer 2

Primary surgical repair

Gastrostomy to protect lungs from acid

Question 3

Newborn presents with Imperforate anus – work up?

Answer 3

#Rule out VACTERL
#Look for nearby fistula (to vagina or perineum)

Question 4

Imperforated anus – what must be determined before management? management options?

Answer 4

Level of blind pouch, determined via upside down x-rays (So gas moves to top of pouch)

#Primary repair immediately if blind pouch is almost at anus
#Delay repair until further growth (but before toilet training time)
#Colostomy for high rectal pouches later repair

Question 5

Congenital diaphragmatic hernia – side affected? Real problem? Surgery when?

Management until surgery?

Answer 5

Left (bowel will be in chest)

Hypoplastic lung

3-4 days after birth to allow maturation

ET intubation, low pressure ventilation, sedation, and NG suction

Question 6

Gastroschisis versus omphalocele parentheses regarding cord and membrane)?

Surgical Management?

Supported care?

Answer 6

Normal cord and no protective membrane versus core defect and thin membrane

Construction of Silastic silo to protect bowel. Gradually push bowel into the belly over period of days.

PTN as bowels will not work for about a month

Question 7

Exstrophy of the urinary bladder ? Surgery when?

Answer 7

Abdominal wall defect over unfused pubis with exposed bladder mucosa

Must be within the first two days of life

Question 8

Color of vomit in the newborn that suggests a serious problem?

Answer 8

Green

Question 9

Green vomiting and double bubble picture on x-ray – differential? Management of each? Most dangerous?

Answer 9

#Duodenal atresia
#Annular pancreas
#Malrotation

All need surgery; malrotation worst (bowel can twist, cut off blood supply, and die)

Question 10

Diagnose malrotation in the newborn with?

Answer 10

1. Contrast enema (less sensitive)

2. Upper G.I. study (more risky)

Question 11

1. Newborn presents with multiple air fluid levels throughout the abdomen – likely diagnosis? Cause?
2. Newborn presents with clear double bubble sign – diagnosis?
3. Newborn presents with double bubble sign and air fluid levels?

Answer 11

1. Intestinal atresia (Vascular accident in utero)
2. Annular pancreas or duodenal atresia
3. Malrotation

Question 12

G.I. tract surgical problems that occur within the first two months of life?

Answer 12

#Necrotizing enterocolitis
#Meconium ileus
#Hypertrophic pyloric stenosis
#Biliary atresia
#Hirschsprung's disease

Question 13

Hirschsprung’s – also known as?

Answer 13

Aganglionic megacolon

Question 14

Premature infant has feeding intolerance, abdominal distention, dropping platelet count – likely diagnosis?

Medical management?

When surgery?

Answer 14

Necrotizing enterocolitis

Stop feedings, antibiotics, IV fluids/nutrition

#abdominal wall erythema
#Air in portal vein
#Intestinal pneumostasis (gas in bowel wall)
#Pneumoperitoneum

Question 15

Significance of a dropping platelet count in babies?

Answer 15

Sepsis

Question 16

Newborn with cystic fibrosis is more likely to develop what G.I. tract issue?

Imaging will show?

Diagnosed with? Treat with?

Answer 16

Meconium ileus

Multiple dilated loops of small bowel and groundglass appearance a lower abdomen

Gastrografin enema for DIAGNOSIS (microcolon and inspissated pellets of meconium in terminal ileum) and tREATMENT (I was moody osmotic diuresis dissolves pellets)