Pediatric Surgery
Pediatric Surgery tests congenital anomalies, pediatric trauma, oncology, and neonatal surgical conditions. Physiology differs by age, and congenital lesions present in predictable windows.
Core rules
- Esophageal atresia with tracheoesophageal fistula: polyhydramnios, choking with feeds, coiled nasogastric tube; avoid feeding, suction, and operate.
- Hypertrophic pyloric stenosis: 3–6 weeks, projectile nonbilious vomiting, hypochloremic hypokalemic metabolic alkalosis; ultrasound shows pyloric thickness >3 mm and canal >15 mm.
- Hirschsprung: delayed meconium, distension; rectal biopsy shows absent ganglion cells.
- Necrotizing enterocolitis: preterm, feeding intolerance, pneumatosis; stop feeds, give antibiotics, operate for perforation.
- Wilms tumor: abdominal mass, nephrectomy after chemotherapy; neuroblastoma: catecholamines, calcification.
Worked example: A 5-week-old boy has projectile vomiting after feeds, visible gastric waves, and a 3.5 mm pyloric thickness. Reasoning: pyloric stenosis causes loss of HCl and potassium; correct with 0.9% saline + KCl and urine output before pyloromyotomy. Do not give bicarbonate.
Traps: operating before correcting alkalosis; confusing bilious vomiting (malrotation) with pyloric stenosis; missing malrotation with volvulus; treating every NEC with surgery first.