Pediatric Surgery

Question 1

1 cause of vomiting in infancy requiring surgery

Answer 1

pyloric stenosis

Question 2

pyloric stenosis: incidence? most common at what age range? male to female ratio?

Answer 2

3 per 1000 live births; usually 4-8 weeks but can happen as young as 2 weeks; 4-1 ratio, usually firstborn male

Question 3

what type of obstruction is pyloric stenosis? what does the emesis look like?

Answer 3

gastric outlet; non-bilious emesis

Question 4

what acid base disturbances (2) do you get with pyloric stenosis?

Answer 4

alkalosis and dehydration

Question 5

what is the best test to diagnose pyloric stenosis? pyloric sphincter muscle wall thickness should be more than ___ mm

Answer 5

US; 4 mm

Question 6

treatment of pyloric stenosis?

Answer 6

pyloromyotomy

Question 7

in pyloric stenosis, the hypertrophic smooth muscle is ________

Answer 7

fibrotic

Question 8

when doing a pyloromyotomy, its important to not violate the _______

Answer 8

mucosa

Question 9

what is the rule of 2’s for Meckel’s diverticulum?

Answer 9

1) . affects 2% of the population

2) . occurs about 2 feet away from ileocecal valve

Question 10

Meckel’s diverticulum is more symptomatic in what gender? when does it typically present?

Answer 10

males (3:1); typically presents within the first few years of life

Question 11

Meckel’s diverticulum: can present with what three things?

Answer 11

obstruction, inflammation or hemorrhage

Question 12

what is an omphalomesenteric band? how does this create Meckel’s?

Answer 12

also called vitelline duct, remnant during fetal development; Meckel’s diverticulum develops when incomplete obliteration of the vitelline duct occurs (can create a small bowel obstruction)

Question 13

what is Meckel’s diverticulum?

Answer 13

an outpouching or bulge in the lower part of the small intestine

Question 14

what is a physical characteristic of Meckel’s?

Answer 14

painless bleeding

Question 15

Meckel’s: __% of all lower GI bleeding in patients younger than 2

Answer 15

50%

Question 16

what is bleeding in meckel’s due to?

Answer 16

acid secreting ectopic gastric mucosa leads to ulcer formation (90%)

Question 17

what is used to diagnose Meckel’s? what has to be present to use this test?

Answer 17

technetium pertechnetate imaging; heterotopic gastric mucosa (HGM) is present

Question 18

what is the severity of Meckel’s?

Answer 18

inflammation to frank necrosis

Question 19

treatment of meckel’s?

Answer 19

depends on severity, could just staple/suture end off, or have to resect, especially if bleeding is present

Question 20

what is Intussusception?

Answer 20

part of the intestine slides into an adjacent part of the intestine

Question 21

Intussusception: peak presentation age range? what is the most common presentation?

Answer 21

5-10 months; cyclic crampy abd pain, abd distention, irritability, vomiting, currant jelly stools, lethargy

Question 22

what type of test might be positive for intussusception?

Answer 22

hemoccult stool

Question 23

how do you reduce an intussusception?

Answer 23

hydrostatic reduction with fluoroscopic control or surgery

Question 24

what is one of the late physical signs of intussusception?

Answer 24

current jelly stools

Question 25

appendicitis: at least __% present in perforated children

Answer 25

40%

Question 26

describe appendicitis presentation in children

Answer 26

variability, must have high index of suspicion

Question 27

when you have intussusception in a kid, what are three things you can also find there?

Answer 27

1) . mesenteric lymph nodes in terminal ileum
2) . duplication cyst near terminal ileum
3) . Meckel’s diverticulum

Question 28

what comes first for appendicitis presentation?

Answer 28

anorexia

Question 29

what 4 things of classic appendicitis presentation?

Answer 29

1) . vague periumbilical pain- awaken with pain**
2) . localizes to RLQ over 12-24 hrs
3) . associated symptoms: anorexia, fever (low grade), N/V
4) . pain almost precedes other symptoms
* *anorexia, pain, N/V- order Dr says**