Pediatrics

SUGGESTED READINGS PEDIATRIC SURGERY

Current Surgical Diagnosis and Treatment, 12th Edition, pg. 1271-1328.

OBJECTIVES PEDIATRIC SURGERY

1. List how gastro-esophageal reflux may present in an infant or child, and describe its appropriate medical and surgical management. Discuss indications for surgical management.

2. Discuss the presentation and management of inguinal and umbilical hernias in children.

3. Describe the etiology and differential diagnosis for bilious vomiting in infants and children.

4. Describe the appropriate evaluation and management of malrotation with volvulus in infants and children. Discuss the embryological basis for gastrointestinal malrotation. (Hint: malrotation is referred to as “incomplete rotation) in Lange’s text.)

5. Describe the presentation and management of intussusception in children.

6. Describe the presentation, evaluation, and management of pyloric stenosis in infants. Discuss the fluid and electrolyte disturbances usually seen with pyloric stenosis and describe why they occur.

7. Describe the general management of solid intra-abdominal tumors in children.

8. Discuss the differential diagnosis of acute right lower quadrant abdominal pain in children, and discuss unique aspects of appendicitis in children compared to adults.

9. Describe the presentation and management of Hirschsprung’s disease.

10. Describe history, signs, and symptoms that are suspicious for child abuse, and discuss appropriate interventions.

CASE HISTORIES PEDIATRIC SURGERY

1. A 6-month old white male is referred to you for vomiting. The child has vomited frequently since birth. He was hospitalized for pneumonia at 4 months of age. An upper gastrointestinal radiograph was obtained during that admission, which showed esophagitis. The child was started on Reglan and Zantac without change in symptoms. The pediatrician is concerned because the child has dropped on the growth curve. Physical examination reveals a thin white male.

• What is the differential diagnosis in this case? • What approach would you take to make the appropriate diagnosis?
• What further medical therapy might be effective in this situation?
• What are the indications for surgical therapy?

2. A 3-day-old patient begins vomiting bright green vomitus in the newborn nursery. Physical examination reveals an irritable child. The abdomen is soft but tender to palpation.

3. A 10-month-old white female is presented to the Emergency Department with a 3-day history of diarrhea. The diarrhea was beginning to improve when the child developed vomiting and irritability. The mother describes the irritability as intermittent and reports that the stool has assumed the appearance of "strawberry jam." The physical examination reveals an irritable child. The abdomen is soft but slightly distended. The stool appears as the mother described.

4. The local pediatrician calls you about a one-month old white female who began vomiting one week ago. Thinking this was a formula intolerance; the formula was changed without effect. The non-bilious vomiting has progressed and become projectile. Physical exam is remarkable for lethargy.

5. A 5-year-old white female presents with complaints of nausea, vomiting, abdominal pain, and anorexia for the past 7 days. She was initially evaluated in the ER on the first day of her pain and had some diarrhea and was diagnosed with gastroenteritis. Her pain improved some after 3 days but now her pain has become more generalized and she has been spiking fevers to 39oC. She is ill-appearing, has peritonitis, and is most tender in the right lower quadrant. Her white blood count is 25,000.

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