Pediatric Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common pediatric surgical conditions, including congenital and acquired disorders.

2. Understand pathophysiology, clinical features, and complications in children.

3. Describe surgical interventions and post-operative care specific to pediatric patients.

4. Apply nursing and medical principles tailored to children for optimal outcomes.

 Key Glossary Terms

1. Congenital Anomalies

• Definition: Structural or functional defects present at birth.

• Common Types:

  • Cleft lip/palate

  • Hirschsprung’s disease

  • Congenital diaphragmatic hernia

  • Omphalocele/gastroschisis

• Management: Surgical correction, multidisciplinary care

2. Pediatric Appendicitis

• Definition: Inflammation of the appendix in children.

• Clinical Features: Abdominal pain, vomiting, anorexia, fever, RLQ tenderness

• Complications: Perforation occurs more rapidly in children

• Management: Appendectomy, IV fluids, antibiotics

3. Intussusception

• Definition: Telescoping of one part of the intestine into another, causing obstruction.

• Clinical Features: Intermittent abdominal pain, vomiting, “currant jelly” stools

• Management: Non-surgical reduction (air or contrast enema), surgery if unsuccessful or perforated

4. Pyloric Stenosis

• Definition: Hypertrophy of pyloric muscle causing gastric outlet obstruction

• Clinical Features: Projectile vomiting, visible peristalsis, dehydration, palpable “olive” in epigastrium

• Management: Surgical pyloromyotomy, preoperative fluid correction

5. Pediatric Hernias

• Definition: Protrusion of abdominal contents through a congenital or acquired defect.

• Types: Inguinal, umbilical, diaphragmatic

• Complications: Incarceration, strangulation

• Management: Elective repair, emergency surgery if complications

6. Hydrocele

• Definition: Fluid accumulation in the tunica vaginalis of the scrotum.

• Clinical Features: Painless scrotal swelling, transilluminates

• Management: Observation if small; surgical repair if persistent or symptomatic

7. Nursing & Medical Student Focus

• Nursing: Monitor hydration, vital signs, pain, wound care, growth parameters, patient/family education

• Medical Students: Recognize pediatric emergencies, perform age-appropriate assessment, plan perioperative care, interpret pediatric imaging

8. Pediatric Surgery Mnemonics

• “VACTERL” for congenital anomalies:

  • Vertebral defects

  • Anal atresia

  • Cardiac defects

  • Tracheoesophageal fistula

  • Esophageal atresia

  • Renal anomalies

  • Limb anomalies

• “CURRANT” for intussusception clues:

  • Crying episodes

  • Upset stomach (vomiting)

  • Red “currant jelly” stools

  • Rectal mass

  • Abdominal pain intermittent

  • Nausea

  • Tender abdomen

 Tables

Table 1: Common Pediatric Surgical Conditions

Table 2: Post-Operative Nursing Care in Pediatric Surgery