Pediatric surgery clinical

Dr.OSAMA AL-MUSHHADANY MRCS(ENGLAND) IRAQI BAORD PEDIATRIC SURGERY Nineva medical college

What is pediatric surgery?

Are pediatric patients are just small adult?

What are the main physiological and anatomical differences between adult and pediatric?

How you prevent hypothermia during surgery?

Thermoregulation
Warming device

Neonatal/infant physiology

Weight

Anesthetic equipment

*Oropharyngeal airway Range in size from 000 to 4 ( 4 to 10 cm in length ). *Nasopharyngeal airway During induction/recovery of some congenital airway problems or obstructive sleep apnea. *Facemasks Clear plastic with inflatable rim , round and tear-drop shape and transparent design provide excellent seal for ventilation , easier to position and allow for observation of cyanosis/regurgitation and the presence of breathing . *Laryngeal mask airway ( LMA ) and Intubating laryngeal mask airway ( ILMA ) is available in size 3 which is potentially useful for older children. .

Anesthetic equipment

Oropharyngeal airway

Anesthetic equipment

Facemasks

Anesthetic equipment

Laryngeal mask airway ( LMA ) and intubating laryngeal mask airway ( ILMA )

Anesthetic equipment

Laryngoscopes

Anesthetic equipment

Tracheal tubes

Thermoregulation

Warming device

What are the Diffrential diagnosis?Timing of operation?

What is the diagnosis?

Classifications

87.5%
7.5%
3.5%
0.5%
1%


What are the Cardinal features of neonatal intestinal obstruction? Give Out lines about the management?



No
2
1

What is the diagnsis?

Sacrocoxygeal teratoma
Proper time of surgery? Tumer marker?

1-what is the diagnosis?2-what are the differences

1
2

X-rays?

Slide 191- what is the test?2- what is the most diagnosis?

Slide 3؟1- What we call this instrument2- Give 2 indications for its use

Slide 41- What is the finding in this x ray?2- Give 2 deferential diagnoses

Slide 141- What is the intraoperative finding?2- Enumerate two common presentations

Slide 151- What is the diagnosis?2-outlines the management ?

Slide 161- What is the diagnosis?2- Do you prefer circumcision before repair?

Slide 181- What is the function of balloon in this device?2- How you inscert it?

Slide 171. Describe this plain film.2. List 2 options of treatments.

A 3 month old infant born with this congenital abnormality. On examination the mass was not tender with fluctuation1. What is the diagnosis ?2. What is the cause behind it ?3. What are the modalities of treatment ?


A 4 week old boy presents with vomiting. The pictures show the investigation and the operative findings.1. What is the diagnosis ?2. What is the investigation shown in slide A ?3. How do you treat ?4. What is the character and contents of vomitig in this pathology?5. What are the other methods of diagnosis?


C


A 2 week old boy presents with history of constipation, abdominal distension and bilious vomiting. The pictures show the operative findings and radiographic investigation done for him.1. What is the diagnosis?2. What is the underlying pathology for this condition?3.Describe the findings in all slides.4. What other investigations used to reach the diagnosis?5. What are the steps of management for this condition?


B

Esophageal replacement 

Background Indications The most common indications in pediatric population for esophageal replacement are:- 1- long Esophageal Atresia without fistula. 2- Strictures related to reflux or corrosive injury.

Esophageal replacement 

Background The colon was the first conduit used as esophageal replacement and remains the most commonly used technique in practice today The alternatives include gastric tube, gastric transposition, and Jejunal interposition graft.

Esophageal replacement 

BackgroundRegardless of the conduit used, there are several principles that are important. First, the esophagus is the best conduit and should be preserved at all costs, provided it functions relatively normally and has no malignant potential (e.g., Barrett’s esophagus).


Esophageal replacement 
Background Second, a short straight tract is best because esophagoscopy and dilatations are frequently required. Almost all conduits function as passive tubes rather than by means of intrinsic peristaltic activity. A retrosternal tunnel is often the shortest and straightest route. Third, the prevention of reflux into any conduit is important.

Esophageal replacement 

Background Colon interposition is a relatively straightforward procedure, and the colon is readily placed into the thorax without causing respiratory compromise. Disadvantages of this approach include the need for three anastomoses and an increased risk for anastomotic leak, strictures at the esophagocolic anastomosis, and tortuosity or redundancy of the graft over the long term

THE GROSS FEATUERS OF HIRSCHSPRUNG ‘S DISEASE