Chapter 9: Pediatric Surgery

DISEASES AND CONDITIONS

• Hypertrophic pyloric stenosis (c), pyloromyotomy (c)

• Malrotation with volvulus and Ladd’s procedure (c)

• Intussusception (c)

• Duodenal atresia

• Jejunoileal atresia

• Gastrointestinal bleeding (c), Meckel’s diverticulum (c)

• Inguinal hernia (c)

• Umbilical hernia (c)

• Tracheoesophageal malformations (a)

• Necrotizing enterocolitis (a)

• Gastroschisis and omphalocele (a)

• Meconium disease of the newborn (a)

• Hirschsprung disease (a)

• Anorectal malformations (a)

• Biliary atresia (a)

• Congenital diaphragmatic hernia (a)

• Cryptorchidism (a), orchiopexy (a)

• Thyroglossal duct cyst, brachial cleft anomalies (a)

• Aerodigestive tract foreign bodies (a)

• Chest wall deformity repair (a)

GENERAL PEDIATRIC SURGERY TIPS

• - There are many potential pediatric surgery topics—focus on the core topics first and then expand your studying from there.

• - In a neonatal patient with emesis, it is important to determine if it is bilious or nonbilious as this can help guide you toward the correct diagnosis.

• - Abdominal x-rays are frequently used to evaluate intra-abdominal processes in neonates. It may be helpful to have supine AP and lateral decubitus views.

• - Bilious vomiting in neonate is a surgical emergency!

  • Bilious emesis indicates an obstruction distal to the ampulla of Vater with a differential including:

    • Malrotation with midgut volvulus

    • Hernias with bowel incarceration

    • Duodenal atresia

    • Jejunoileal atresia

    • Meconium disease of the newborn

    • Hirschsprung’s disease

    • Anorectal malformations

    • Small left colon syndrome

  • You must rule out malrotation with volvulus

  • Up to 50% of neonates with bilious emesis end up requiring surgical intervention.

• - Abdominal mass is listed as a core topic on the curriculum. The most common pediatric malignant intra-abdominal masses are neuroblastoma, nephroblastoma, and hepatoblastoma. The management of these masses is very nuanced and most likely too detailed for the boards, so we will just provide the basic information on these topics:

  • Neuroblastoma

    • Most common intra-abdominal solid tumor in children

    • May present with HTN, abdominal pain, diarrhea, weight loss, failure to thrive, racoon eyes, unsteady gait, usually <2 yo

    • Will have elevated urine catecholamines (VMA, HVA)

    • Treat with surgery if resectable

  • Nephroblastoma (Wilm’s Tumor)

    • May present as abdominal mass, hematuria, HTN

    • “Claw sign” on CT with replacement of renal parenchyma

    • Treat with nephrectomy if resectable

  • Hepatoblastoma

    • May present as rapidly enlarging abdominal mass

    • AFP (elevated)

    • Treat with surgery if resectable