Download Introduction to pediatric surgery

Alkhansah
ospital
Psc
Introduction to pediatric surgery
Dr.OSAMA AL-MUSHHADANY
MRCS(ENGLAND)
IRAQI BAORD PEDIATRIC SURGERY
Nineva medical college
Al-Khansaa Teaching hospital
Introduction to pediatric surgery
Pediatric surgery
Is a subspecialty of surgery involving the
surgery of fetuses, infants, children, adolescents
Pediatric patients includes different
age groups:-.
1-Fetus …….during pregnancy.
2-Neonate in the 1st month of life.
A-Preterm baby born before 37 weeks of
gestation.
B-Term baby born between 38-42 weeks of
gestation.
C-Post term baby born after 42 weeks of
gestation.
3-Infant in the first year of life.
4-Todller …………2 to 4 years of age.
5-Preschool age 4-6 year
6-School age child 6-12 year
7-Adoloscent 12-18 years.
Are pediatric patients are just small
adult?
No, because there is a lot of differences between
pediatric and adult which includes differences
in anatomy , physiology and physical and
psychological responses to illnesses.
Specific physiological problems of
newborn:-
A-Hypoglycemia:The fetus maintains a blood glucose level value
70-80% of maternal value by facilitated
diffusion across the placenta.
Clinical signs of hypoglycemia:Are non specific and may include a weak and
high pitch cry ,cyanosis ,apnea ,jitteriness
,apathy, seizures, abnormal eye movement
,temperature instability ,hypotonia ,and weak
suck .
When there is hypoglycemia ,Glucose level
generally below 40 mg /dl.
Treatment: - An hourly 1-2 ml of 10% glucose
is given intravenously.
Rarely hydrocortisone ,glucagon ,or
somatostatine is used to treat persistent
hypoglycemia.
B-Thermoregulation: Newborn have difficulty maintaining constant
deep body temperature because of
1-Their relatively large surface area.
2-Poor thermal regulation.
3-Small mass to act as a heat sink.
Infant produce heat by increasing their
metabolic activity by non-shivering
thermo genesis ,by using their brown fat
unlike adult.
Brown fat thermo genesis may render
inactive by vasopressors, by anesthetic
agents, and through nutritional
depletion.
What is the bad effect of hypothermia?
How we can prevent hypothermia in a newborn
baby during operation?
Hypothermia will cause •
destruction of body enzymes and
death
Measures to prevent hypothermia
during surgery:1-Keep the theater temp. between 24-28 C
2-Using special electrically heated Blanket .
3-Covering of extremities by cotton
4-Using worm I.V.F and Blood.
5-Using worm anesthetic gases.
C-Blood volume:Total RBC volume is at its highest point at delivery.
Estimated blood volume for premature infants is
85-100 mL/kg
Estimated blood volume for term neonate is 80- 85
mL/kg
Estimated blood volume for three month to adult
is 70 mL/kg
How much the blood
volume for 3 kg. neonate?
D-Fluid and electrolyte
Infants can retain water and sodium but cannot
excrete excessive water and sodium.
As a rule of thumb, the daily fluid requirements can
be approximated too:
Premature
120-150 cc/kg/24 hrs
Neonates (term)
100 cc/kg/24 hrs
Infants >10 kg
1000 cc+ 50 cc/kg/24 hrs.
High intravenous therapy can lead to :1-heart Failure
2-Patent dactus arteriosus
3- Bronchopulmonary dysplasia
4-Enterocolitis
5-Intraventricular hemorrhage.
Anatomical differences between infant
and older children and adult
A-Differences between abdomen of infant and that of
older children and adult:-
Characteristics of the abdomen of infant are
1-The shape of the abdomen is square if compared to the
shape of adults abdomen which is rectangular.
2-The compliant rib cage and wide sub costal angle facilitate
access to the upper abdominal organs and diaphragm.
3-The rectus muscle is wider and extends further
laterally.
4-The liver is relatively larger and occupies most of
upper abdomen and epigastrium.
5-The umbilicus is low and nearer the pubic
symphysis .
6-The bladder is intraabdominal and extend up to
umbilicus ,therefore there is limited space below
the umbilicus. While in adult is in the pelvis.
Therefore,Transverse supraumblical
inscion is suitable for most of
laparatomies in pediatric while
longitudinal inscion is suitable for
adult
Anatomical differences between trachea and thorax
of infant and that of older children and adult:Thoracotomy:In infants and young children differs from the
procedure in adults. The chest of the infant is
compliant and relatively short in its
longitudinal axis so a lateral transverse
incision, entering the chest through the fifth
intercostals space, is suitable for most
operations. It is not necessary to remove or
transect a rib. The posterior incision, which
curves upwards around the scapula, is rarely
required.
The trachea:The trachea of neonate is 5mm diameter only
which mean it may easily occluded( eg. By
thick mucus)
Fetal surgery:Advances in radiology and sampling techniques
have given clinician increasingly accurate
methods to make diagnosis of prenatal
anomalies.
There are many advantages of antenatal
diagnosis ,the out come of many conditions is
improved by prior Knowledge of the
congenital anomaly, and other anomaly is
corrected surgically (Fetal surgery)
How to access the fetus:Access to the fetus can be gained by one of three
general methods:1-US-guided percutaneous intervention.
2-Fetoscopically guided intervention.
3-Direct open hysterotomy.
The observation that the fetal incisions heal
without scarring has provided new insights
into the biology of wound healing and has
stimulated efforts to mimic the fetal process
postnatally.
Some common surgical cases
Inguinal hernias do not spontaneously heal •
and must be surgically repaired because of the
risk of incarceration. Generally, a surgical
consultation should be made at the time of
diagnosis, and repair (on an elective basis)
should be performed very soon after the
diagnosis is confirmed (within one week)