PEDIATRIC SURGERY

Question 1

Congenital diaphragmatic hernia

Answer 1

Always on the left

Worry about the hypoplastic lung - wait 3-4 days for lung maturation

Question 2

Gastroschisis vs omphalocele

Answer 2

Gastroischisis - cord is normal and defect is to the right of the cord

Omphalocele - cord goes into the defect

Slowly push abdominal contents back in… Takes about a week
Need TPN for a month because the bowel is angry

Question 3

Malrotation

Answer 3

Green vomiting
Double bubble on X-ray

Bowel can twist on itself and cut off the blood supply and die

Diagnose with:
Contrast enema (safe but not always diagnostic)
Upper GI study (more reliable but unsafe)

Question 4

Necrotizing enterocolitis

Answer 4

Premature infants at first feeding

Feeding intolerance
Abdominal distention
Rapidly dropping platelet count

Question 5

Meconium ileus

Answer 5

Firstborn boys at 3 weeks old
Non bilious projectile vomiting

Visible gastric peristaltic waves
Palpable olive

Diagnose with US

Treat with rehydration and fix hypochloremic hypokalemic metabolic alkalosis then surgery (Ramstedt pyloromyotomy)

Question 6

Biliary atresia

Answer 6

6-8 weeks old
Progressive jaundice

Try to stimulate bile production with one week of phenobarbital

If it doesn’t work you need surgery and eventually a liver transplant

Question 7

Diagnosis of hirschsprung

Answer 7

Full thickness rectal mucosa biopsy

Question 8

Intussusception

Answer 8

6-12 months

Colicky abdominal pain that makes them double up and squat

Vague mass on right side of abdomen
Empty RLQ
Currant jelly stools

Barium or air enema

Question 9

Pediatric abdominal mass that moves up and down with respiration

Answer 9

Malignant liver tumor - hepatoblastoma or hepatocellular carcinoma

Alpha fetoprotein will be elevated

Question 10

Pediatric abdominal mass that is deeper and doesn’t move

Answer 10

Wilms tumor - comes from the kidney

Neuroblastoma - comes from adrenal