Pediatric Surgery Surgery Decury

Dr. Bayani Tecson

PEDIATRIC SURGERY TIPS FOR OSCE

Pediatrics: from fetal life up to 18 years old  Most on the GIT (appendicitis, intussusception)
CAUSES o Where is the most common site for this
 Chemicals condition?
 Environment o Most common presentation?
 Trauma o Pathognomonic sign?
 Surgical Infection o P.E. maneuver?
 Congenital Anomalies o Radiologic sign?
MAIN BULK: CONGENITAL ANOMALIES  Example: case: bilious vomiting with an X-ray finding
 Most of the time, they are from the low of this: (picture of an x-ray). What is your diagnosis?
socioeconomic groups (charity patients). *Please read Doc Tecson’s notes on pediatric surgery
 Teenage mothers or perimenopausal babies (mothers during midterms because all these are not well-discussed
of extremes of ages) during decury sessions.
 Genitourinary: Inguinal hernias, undescended testes,
hypospadias  TRANSILLUMINAITON TEST: a MUST in children (can
 GIT: appendicitis, intussusception also be done during IV insertion)
 Newborn: esophageal atresia, diaphragmatic hernia,
intestinal atresia, Hirchsprung’s disease, imperforate
anus(very common)

The most important things is the early recognition of the

anomaly. It will affect the subsequent growth and
development of the child, plus it is harder to correct when the
patient is already older.

COMMON ANOMALIES SEEN IN CHILDREN

1. BRAIN: most common anomalous organ; neurologic
2. Cardiovascular
3. GIT
4. Urologic
5. Musculoskeletal
HISTORY TAKING
 Important to take information from the primary
caregiver (e.g. babysitter)
 Establish rapport with the child
 If the patient was delivered via CS, ask the reason
why, number of checkups, how long was the delivery
(complete prenatal, natal, and post-natal history)
PHYSICAL EXAMINATION
 Examine while the baby is comfortable/sleeping
 Examine from non-invasive to invasive  Decompression: colostomy
 Examine form less painful to more painful  (+) rectal bleeding: always do DRE (most common
 Examine while the baby is being cuddled by the cause is rectal polyp (hamartomatous)
caregiver  Skin turgor/ dehydration:
 Must do to all: ANAL INSPECTION o Baby: fontanel
 Not all the time: DRE (unlike in adult patients, you o Older child: eye lips, capillary refill
only get a few data in doing DRE in a pediatric o Others: forehead skin, urine output, weight
patient) monitoring
 Pediatric patient’s skin is thin. You can do o Murmur is accentuated during
transillumination of solid/cystic tumors/ overhydration
 We usually do a thorough examination of the inguino-
scrotal area. ABDOMINAL WALL DEFECT
 Normal baby abdomen is slightly globular. If it is flat  Operate as soon as possible to prevent/lessen
or scaphoid abdomen, there is something wrong. infection
  Failure of the cephalic fold to close in the upper
abdomen/lower chest causes sternal defects (ectopia
cordis, omphalocele)
ectopia cordis- partial or complete displacement of
the heart outside the thoracic cavity
 Bladder exstrophy: repair of the neurogenic bladder
to make it functional
UMBILICAL HERNIAS
 CENTRAL MIGRATION: failure of the ring to close
leading to umbilical hernias
 UMBILICAL HERNIAs: they close spontaneously, but if
they fail to close by 4 to 5 years old, that’s the time we
start correcting them (we repair them before they go
to school; also prevents bullying among children)
PATENT URACHUS
 Umbilicus: with reddish polypoid mass, always red
 Examine first the outflow tract of the urine: urethra,
urinary bladder trigone. If there is an abnormality,
correct it first before closing, otherwise the baby will
not urinate (make sure that the outflow tract is
normal before closing).
URACHAL CYST
 Cyst between the umbilicus and urinary bladder
 Presents with a mass or abscess
 Excision is important
PATENT OMPHALOMESENTERIC DUCT
 Communication of the terminal ileum to the umbilicus
where the Meckel’s diverticulum is located (Meckels
diverticulum: remnant of the
omphalomesenteric/viteline duct)
OMPHALOCOELE
 Covered with amniotic sac (there is a covering unlike
gastroschisis)
 Omphalocoele: all the abdominal organs can be out.
 Gastroschisis: only the intestine is out
 Smaller
omphaloceles have more common associated
chromosomal anomalies (MC: cardiac). The bigger
ones usually don’t have chromosomal anomalies.
 Exstrophy of the cloaca
o The most complex caudal regression anomaly in
a child
o Most difficult to treat
 Cover with plastic to prevent heat loss and fluid
GASTROSCHISIS
 Intestine is exposed to the amniotic fluid
 The opening is small so there is some form of
ischemia
 Edematous
SURGERY 2: Pediatric Surgery 
PRUNE BELLY SYNDROME
 Abnormality in the elasticity of the muscle; wrinkled
appearance
 TRIAD: extreme laxity of the abdominal wall, dilated
urinary tracts, undescended testes
 Ureteral dilatation is the major urinary presentation
 Reconstruction done at 6-12 months
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HYDROCOELE
 Fluid instead of intestine
 Most of the time, regress by 2 years
 Important to transilluminate (in a dark room)
 Aspiration avoided: you might puncture important
structure inside

Note: Kindly supplement this lecture by reading our previous

pediatric surgery notes under Dr. Tecson. His decury lectures
were quite indefinite and unpredictable. Hehe. Thankyou. 

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Notetakers: Karla Parreno | Raquel Palma
Proofreader: Lianne Camille Sinagub
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SURGERY 2: Pediatric Surgery 

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