Fiser ABSITE Ch.43 Pediatric Surgery Exam With
Complete Solutions
What are characteristic findings on chest x-ray of a child with esophageal atresia?
Coiled nasogastric tube in an air-filled esophageal pouch, possible gasless abdomen or
gas-filled ͑due to fistula͞.
What is the most common type of tracheo-esophageal fistula?
Type C: Occurs in 85% of affected cases. Characterized by blind ended esophagus and
distal tracheo-esophageal fistula.
What are the associated abnormalities found in patients with TE fistulas (2/3rds of the
time)?
VACTERL:
Vertebral anomalies
Anorectal malformations (imperforate anus)
Cardiac defects
TE fistulas
Renal
Limb deformities
What is the standard approach for a child with a tracheo-esophageal fistula? How does
that change if the patient has transposition of the great vessels (or a right-sided aorta) ?
Right thoracotomy. If an altered aorta patient will get a LEFT thoracotomy.
What anatomic landmark often is found near a TE fistula?
Below the azygous vein.
,What are the characteristic clinical presentation of a patient with pyloric stenosis?
Non-bilious projectile vomiting within minutes of feeds. Possibly a palpable olive on
physical exam.
Lab Findings
What are the common lab findings of a patient suffering from pyloric stenosis?
Hypochloremic, hypokalemic metabolic ACIDosis due to increased aldosterone. Goals
of resuscitation include a serum bicarbonate level of < 30 mEq/L.
X mL/hr D5 0.9% NaCl + 20 mEq/L KCl solution (If K <4)
Fluid Maintenance in Children (28 days - 18 yo)
The ideal solution in pediatric resuscitation should be isotonic dextrose AND potassium
containing to avoid ketosis and hyponatremia in children-higher risk for SIADH inpatient
.
NaCl solution without dextrose can be used as a resuscitative fluid in adults.
X mL/hr D5 0.9% NaCl + 20 mEq/L KCl solution
Trauma Resuscitation in Peds
20cc/kg x2 of D5 0.9% NS
THEN, 10cc/kg of blood
Calculation of Fluid Maintenance in Children
, The fluid rate should be approximated according to the 4:2:1 rule as noted above: 4
mL/kg for the first 10 kg, 2 mL/kg for the next 10 kg and 1 mL/kg for the remaining
weight.
What is Ramstedt-Fredet Procedure?
OPEN approach to pyloric stenosis, with a RUQ incision and delivery of the pylorus.
What is the Surgical finding in a patient with malrotation?
Small bowel suspended from a narrow pedicle containing the SMA and vein, at risk of
twisting in a clockwise rotation. There are also aberrant peritoneal attachments, Ladd
bands, between the malpositioned cecum and abdominal sidewall that can obstruct the
duodenum.
What is the diagnostic procedure of choice for an infant with bilious emesis, now over
one week out, with concern for malrotation and volvulus?
Upper GI series, to be done in ALL infants who present with bilious emesis.
What are the components of a Ladd's Procedure?
1. Evisceration of bowel w/ reduction of the volvulus (if present), via 270˚
counterclockwise rotation (you COUNTER the malrotation w/ counterclockwise
movement).
2. Division of Ladd's bands
3. Widening of the narrow mesenteric pedicle
4. Appendectomy
When finished the small bowel is positioned in the RIGHT abdomen and cecum
positioned in the LUQ.
Complete Solutions
What are characteristic findings on chest x-ray of a child with esophageal atresia?
Coiled nasogastric tube in an air-filled esophageal pouch, possible gasless abdomen or
gas-filled ͑due to fistula͞.
What is the most common type of tracheo-esophageal fistula?
Type C: Occurs in 85% of affected cases. Characterized by blind ended esophagus and
distal tracheo-esophageal fistula.
What are the associated abnormalities found in patients with TE fistulas (2/3rds of the
time)?
VACTERL:
Vertebral anomalies
Anorectal malformations (imperforate anus)
Cardiac defects
TE fistulas
Renal
Limb deformities
What is the standard approach for a child with a tracheo-esophageal fistula? How does
that change if the patient has transposition of the great vessels (or a right-sided aorta) ?
Right thoracotomy. If an altered aorta patient will get a LEFT thoracotomy.
What anatomic landmark often is found near a TE fistula?
Below the azygous vein.
,What are the characteristic clinical presentation of a patient with pyloric stenosis?
Non-bilious projectile vomiting within minutes of feeds. Possibly a palpable olive on
physical exam.
Lab Findings
What are the common lab findings of a patient suffering from pyloric stenosis?
Hypochloremic, hypokalemic metabolic ACIDosis due to increased aldosterone. Goals
of resuscitation include a serum bicarbonate level of < 30 mEq/L.
X mL/hr D5 0.9% NaCl + 20 mEq/L KCl solution (If K <4)
Fluid Maintenance in Children (28 days - 18 yo)
The ideal solution in pediatric resuscitation should be isotonic dextrose AND potassium
containing to avoid ketosis and hyponatremia in children-higher risk for SIADH inpatient
.
NaCl solution without dextrose can be used as a resuscitative fluid in adults.
X mL/hr D5 0.9% NaCl + 20 mEq/L KCl solution
Trauma Resuscitation in Peds
20cc/kg x2 of D5 0.9% NS
THEN, 10cc/kg of blood
Calculation of Fluid Maintenance in Children
, The fluid rate should be approximated according to the 4:2:1 rule as noted above: 4
mL/kg for the first 10 kg, 2 mL/kg for the next 10 kg and 1 mL/kg for the remaining
weight.
What is Ramstedt-Fredet Procedure?
OPEN approach to pyloric stenosis, with a RUQ incision and delivery of the pylorus.
What is the Surgical finding in a patient with malrotation?
Small bowel suspended from a narrow pedicle containing the SMA and vein, at risk of
twisting in a clockwise rotation. There are also aberrant peritoneal attachments, Ladd
bands, between the malpositioned cecum and abdominal sidewall that can obstruct the
duodenum.
What is the diagnostic procedure of choice for an infant with bilious emesis, now over
one week out, with concern for malrotation and volvulus?
Upper GI series, to be done in ALL infants who present with bilious emesis.
What are the components of a Ladd's Procedure?
1. Evisceration of bowel w/ reduction of the volvulus (if present), via 270˚
counterclockwise rotation (you COUNTER the malrotation w/ counterclockwise
movement).
2. Division of Ladd's bands
3. Widening of the narrow mesenteric pedicle
4. Appendectomy
When finished the small bowel is positioned in the RIGHT abdomen and cecum
positioned in the LUQ.
