Archive for the ‘Pediatric surgery’ Category

Bowel  :

The small intestine takes up a large part of the abdomen ironically and is likely to be damaged in penetrating injury. Gas within the abdominal cavity seen on CT is understood to be a diagnostic sign of bowel perforation; however intra-abdominal air can also be caused by pneumothorax (air in the pleural cavity outside the lungs that has escaped from the respiratory system) or pneumomediastinum (air in the mediastinum, the center of the chest cavity). Bowel injury may be associated with complications such as infection, abscess, bowel obstruction, and the formation of a fistula.

The parenchyma are the functional parts of an organ in the body. This is in contrast to the stroma, which refers to the structural tissue of organs, namely, the connective tissues.

In cancer, the parenchyma refers to the actual mutant cells of a single lineage, whereas the stroma is the surrounding connective tissue and associated cells that support it.

Liver :

The liver, the most vulnerable abdominal organ to blunt injury .Liver injuries present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity. In children, the liver is the most commonly injured abdominal organ. The liver may be lacerated or contused, and a hematoma may develop. If severely injured, the liver may cause exsanguination (bleeding to death).

Spleen:

 Spleen is the most common damaged organ in blunt abdominal trauma. The spleen is the second most commonly injured intra-abdominal organ in children.  A laceration of the spleen may be associated with hematoma. The spleen, pancreas and kidneys do not present as much of an immediate threat of shock unless they lacerate a major blood vessel supplying the organs, such as the renal artery.

Pancreas :

 The pancreas may be injured in abdominal trauma, for example by laceration or contusion. Pancreatic injuries, most commonly caused by bicycle accidents (especially by impact with the handlebars) in children .

Kidneys :

The kidneys may also be injured; they are somewhat but not completely protected by the ribs. Kidney injury, a common finding in children with blunt abdominal trauma, may be associated with bloody urine. Kidney lacerations and contusions may also occur.

Organ Parenchyma
Brain Neurons & Glial Cells
Heart Myocytes
Kidney Nephrons
Liver Hepatocytes
Lungs Alveolar Tissue
Pancreas Islets of Langerhans & Pancreatic Acini
Spleen White & Red Pulps
Placenta placental villi, including the fetal vessels, and the maternal intervillous space
  1. Penetrating abdominal trauma (PAT)
    • Gunshot Wounds
    • Stab Wounds
  2. Blunt abdominal trauma (BAT)

1. What are the main mechanisms of injury of the abdomen?
2. Classification of injuries of abdominal trauma.
3. The main symptoms of damage to parenchymal organs.
4. The main symptoms of damage to hollow organs.
5. What additional methods are most informative in injuries of parenchymatous and hollow organs of the abdominal cavity?
6. What are the indications for emergency surgery for bleeding, which continues as a result of damage to parenchymatous and hollow organs of the abdominal cavity?
7. What are the indicators of clinical and laboratory tests (ACT, heart rate, the overall analysis and biochemical blood tests) show hemorrhagic syndrome and bleeding in the abdominal cavity?
8. What are the main clinical signs of bleeding from the upper and lower parts of the digestive system.
9. What are the main causes of bleeding in the digestive system in children?
10. Rate of gastric contents and feces, depending on the height of the source of bleeding.
11. Give the interpretation of general principles of treatment of gastrointestinal bleeding.
12. What special monitoring of clinical course of bleeding from the digestive tract to determine the indications for surgical treatment?
13. Describe the indications for conservative and surgical treatment of gastrointestinal bleeding, standardizes its capacity and efficiency.
14. Give a basic list of surgical diseases in children that cause inflammation of the abdominal cavity.
15. What are the clinical signs and symptoms of local inflammation of the abdominal cavity?
16. What are the clinical signs and symptoms characterized by local inflammation of the abdominal cavity in newborns?
17. Clinical features of acute appendicitis in young children (up to 3 years).
18. Differential diagnosis of acute appendicitis in children.
19. Complications diagnosis of acute appendicitis in children and their prevention.
20. What are the indications for conservative treatment and its character with peritonitis in neonates?
21. Features of preoperative preparation with widespread peritonitis.
22. What are the clinical signs and ancillary diagnostic methods specific to destructive forms of cholecystitis?
23. General principles of treatment of cholecystitis and indications for surgical treatment.
24. What are the main causes of acute pancreatitis?
25. Describe the indications for conservative and surgical treatment of acute pancreatitis, its scope and methods.
26. Classification of acquired intestinal obstruction in children.
27. Identify the main causes of intussusception, adhesive, obstructive and dynamic obstruction.
28.  List the main symptoms of acute intussusception.
29. What are the methods of diagnosis and treatment of acute intussusception?
30. Features and term of successful and rewarding preoperative preparation to pursue for intestinal obstruction.
31. Identify the basic features of viability of obstructed bowel.
32. What methods of surgery performed in case of intussusception?
33. Principles of treatment of early and late intestinal obstruction.
34. Select the classification of dynamic obstruction.
35. The main stages of conservative treatment of dynamic obstruction.
36. What form of acute destructive pneumonia do you know?
37. What forms of acute destructive pneumonia related to lung?
38. What forms of acute destructive pneumonia related to pulmonary-pleural?
39. What is atelectasis and lung collapse, their causes?
40. What is was, differential diagnosis?
41. Clinical and diagnostic pyothorax?
42. What is the X-ray picture at pneumothorax?
43. What is the X-ray picture of pulmonary atelectasis?
44. Which different X-ray picture of a tense pyothorax atelectasis of the lungs?
45. In which acquired pathology of the lungs, a mediastinum shift towards the place of pathology, is seen on plain film of the chest?
46. Explain pathology of lung abscesses according to location and stage of development.
47. In which place of the chest wall do we conduct a diagnostic pleural puncture?
48. What is the technique of pleural puncture?
49. What indicates the liquid level in the lung abscess?
50. When is percutaneous puncture performed in case of abscesses?
51. When is postural position used in case abscesses?
52. What purulent sputum indicates in children with acute destructive pneumonia?
53. What do you know about aspiration of the pleural cavity?
54. How is the X-ray picture, on plain film, in pyothorax, pneumothorax?
55. What indicates the location of gas drainage from the pleural cavity in acute destructive pneumonia?
56. What are the clinical symptoms in case perforated esophagus?
57. What is the most informative radiological method to diagnose damage to the esophagus?
58. What methods of examination used in the trauma of the chest cavity?
59. What are the indications for surgical intervention at hemothorax?
60. What are the diagnostic methods used in the damage of the esophagus?
61. What are the main factors that can lead to the development of urolithiasis?
62. What are the most typical clinical manifestations of urolithiasis?
63. What justification is based upon preliminary diagnosis in case of urolithiasis?
64. Differential diagnosis of renal colic?
65. Why is it important to show not only nosological form of the disease, but also its course and complications in the clinical diagnosis?
66. What is important to determine the formation of treatment strategy in patients with urolithiasis?
67. What are diagnostic methods for urolithiasis?
68. What diseases are grouped as edematous scrotum syndrome?
69. What is needed to identify the patient with swollen scrotum syndrome?
70. Why is it important to know the sequence of complaints in syndrome swollen scrotum?
71. What are the main diseases, which is necessary to distinguish the syndrome of swollen scrotum?

72. Which symptoms can be detected in the swollen scrotum syndrome?
73. What justification is based upon preliminary diagnosis in case of diseases of swollen scrotum syndrome?
74. What is important to determine the formation of treatment strategy in patients with acute orhoepididimitom, torsion of hydatid of Morgagni, testicular torsion and acute edema shell eggs?
75. What complications can occur in acute disease of the testicles?
76. What is important to identify patients with traumatic injury to the urinary system?
77. What changes can be detected in lumbar trauma by palpation of kidneys?
78. What justification is based upon preliminary diagnosis in case of traumatic injury of kidneys?
79. What methods of diagnosis will help in the diagnosis of renal injury?
80. Features of survey of children with trauma of bladder and urethra.
81. Differential diagnosis between different types of bladder injuries?
82. Treatment of injuries of the bladder and urethra, complications.
83. What are the most likely methods of diagnosis to help in the diagnosis of injury urethra?
84. Features of physical examination of children with trauma scrotum.
85. What’s most important to determine the formation of treatment strategy in patients with traumatic injury to the urinary system?
86. What is the frequency of purulent-septic diseases in infants, their structure and principal causes?
87. What anatomical and physiological features of the structure of the skin and subcutaneous         tissue contribute to the spread of inflammation?
88. Explain the clinical manifestations of neonatal necrotizing cellulitis, depending on their form.
89. Medical management of neonatal necrotizing abscess.
90. Forms and clinical manifestations omphalitis in newborns.
91. Differential diagnosis of omphalitis
92. Features of omphalitis treatment depending on the form of the disease.
93. Complications and consequences arising from omphalitis a child.
94. When and what is related to neonatal mastitis?
95. Features of surgical intervention at newborns mastitis.
96. Causes of paraproctitis in newborns.
97. Operative intervention that is carried out at paraproctitis depending on the cause.
98. What are guidelines of treatment of purulent-septic diseases in newborns?
99. Principles of antibiotics in purulent surgical infection.
100. Bacteriological examination in purulent-septic diseases.
101. What are the components of treatment effects on the child with purulent-septic diseases?
102. What is a systemic inflammatory response syndrome?
103. What are the toxic forms of the disease according to International Classification of sepsis?
104. How is the circulation of bones in children?
105. When the formation of epiphyses of long tubular bones?
106. What is normal intraosseous pressure?
107. What are the features of special diagnostic puncture and intraosseous pressure measurements in children with suspected acute hematogenous osteomyelitis? How does the intraosseous pressure in acute hematogenous osteomyelitis?
108. Features of the structure of long tubular bones.

109. What are the clinical forms of acute hematogenous osteomyelitis.
110. Expand the thromboembolic theory of pathogenesis of acute hematogenous osteomyelitis.
111. Why metaepiphysial osteomyelitis occurs in infants and children less than 2 years of life?
112. What are atypical forms of osteomyelitis.
113. Clinic of acute hematogenous osteomyelitis.
114. Diagnosis of acute hematogenous osteomyelitis.
115. Features of immobilization and its duration in children with metaepiphyseal osteomyelitis.
116. List the complications associated with hematogenous osteomyelitis and when they appear.
117. Differential diagnosis of acute hematogenous osteomyelitis.
118. Clinic and treatment lymphadenitis in children.
119. Boil and carbuncle, clinic, treatment.
120. Etiopathogenesis of acute hematogenous osteomyelitis.
121. List the clinical manifestations of hemangiomas and lymphangitis.
122. Calling methods of conservative and surgical treatment of hemangiomas and lymphangiom.
123. Explain the clinical manifestations of pigmented tumors.
124. Medical management of pigmented tumors.
125. Clinic malignant and dermoid cysts.
126. Features of dermoid cysts removal.
127. Identify the clinical manifestations of melanoma.
128. Differential diagnosis and combined treatment of melanoma.
129. List the clinical manifestations of soft tissue malignant tumors (rhabdomyosarcoma, teratoblastoma).
130. Surgical and combined treatment of soft tissue malignant tumors.
131. Auxiliary methods of diagnosis of tumors in children and their role in the differential diagnosis.
132. Clinical manifestations and treatment of nephroblastoma in children.
133. Clinical manifestations and treatment of neuroblastoma in children.
134. Auxiliary methods of diagnosis of tumors of retroperitoneal space in children.
135. Clinic and diagnosis of tumors of the mediastinum.
136. Treatment of children with malignant and benign tumors of the mediastinum.