Children's surgery
Welcome to the Pedoatric Surgery Department rotation at dr A. Jurasz University Hospital No.1 in
Bydgoszcz. For many of you, this rotation will be your first exposure to the surgical care of children.
By the end of your stay, you should have a comprehensive understanding of the common surgical
problems in the pediatric age group.
During the course in Pediatric Surgery Department you will participate in multimedially conducted
seminars which give you broad view on many topics in Pediatric Surgery as well as you will work
closely with the resident to ensure effective clinical understanding of surgical problems in newborn,
infants and other pediatric age groups.
Teachers:
Dr Irena Daniluk-Matraś
Dr Magdalena Chrzanowska
Lek. Przemysław Gałązka
Lek. Małgorzata Pacholska
Lek. Estera Rodziewicz
Lek. Jarosław Rogacki
Contact: kikchirdz@cm.umk.pl
Syllabus
I.
Name of the unit: Chair and Department of Pediatric Surgery, Ludwik Rydygier Collegium
Medicum in Bydgoszcz; Nicolaus Copernicus University in Toruń; Dr A. Jurasz University Hospital
No.1; in Bydgoszcz, 85-094 Bydgoszcz, M. Sklodowskiej-Curie 9 (4th and 5th floor)
II.
Head of the Department: Irena Daniluk-Matraś, M.D.
III.
Faculty of Medicine, Medical Program, year 6
IV.
Course coordinator: Przemyslaw Galazka, M.D.
V.
Form of Classes: seminars, exercises
VI.
Form of crediting: Credit with grade, 3 ECTS points
In order to get credits for the pediatric surgery course, medical students have to:
... be present at all seminars and tutorials during the course.
... pass written test, concerning area of pediatric surgery including programm of seminars, tutorials
and suggested topics.
... be present at 2 emergency duties at the Pediatric Surgery Department (3pm–8pm according to the
schedule)
... confirm passing of practical skills exam with attending resident (card of required practical skills +
prepared case presentation and short review of related clinical problem included in the Self Study
Topics Section)
...the number of students in one team with resident depends on the total students number in the
group.
VII.
Number of hours: seminars (20h), exercises (40h)
20 hours of seminars in lecture room facing Secretariat of Pediatric Surgery Department and 40 hours
of tutorials at the Pediatric Surgery Ward with the attending Resident.
VIII.
Aim of the Pediatric Surgery Course:
To become familiar with the recognition, natural history and treatment of those pediatric surgical
conditions one would expect to encounter in a general surgery practice in a community without
immediate availability of a pediatric general surgeon.
To familiarize one’s self with the essentials of the pathophysiology of these conditions and the
specific response of the child to trauma and surgery.
To learn to provide emergency treatment for the unstable child with complex surgical problems
requiring transport to a specialized center for definitive treatment.
To become familiar with the diagnosis and treatment of common surgical conditions of infants and
children.
To reinforce educational experiences obtained from adult General Surgery training in conditions
common to both age groups (e.g., appendicitis, bowel obstruction, cholelithiasis).
IX.
Topics of Seminars for each day of the course:
Day:
1st Introduction- newborn, infant, child as a surgical patient; groups of congenital anomalies in
newborn.
2nd Abdominal wall defects and hernias. Common acute surgical disorders of the digestive tract:
ileus, appendicitis, peritonitis, intususception, Meckel`s diverticulum, GI bleeding.
3rd Head: congenital cranial anomalies, cleft palate. Neck: anomalies of larynx and trachea,
lymphadenitis, lymphangioma, hemangioma, dermoid cyst, thyroglossal duct cyst, branchial cleft
cyst.
4th Thorax: Thoracic wall deformities, pleural empyema, pneumothorax. Pathologies of
mediastinum, esophagus, diaphragm, pulmonary sequestration, bronchogenic cysts.
5th Digestive tract: GERD, gastric and duodenal ulcer, hypertrophic pyloric stenosis, digestive tract
duplications, Hirschsprung disease, ulcerative colitis, Crohn disease, colonic polyposis, anorectal
anomalies.
6th Liver and pancreas: hepatic insufficiency, portal hypetension, biliary atresia, cholelithiasis,
pancreatic ectopy, pancreatitis, pancreatic cysts, nesidioblastosis.
7th Urological problems: renal anomalies, VUR, hydronephrosis, bladder extrophy, urolithiasis,
phimosis, cryptorchism, hydrocele testis, hypospadias, epispadias, sex differentiation problems.
8th Orthopedic problems: head injuries, typical fractures, joint dislocations, posture defects,
pediatric traumatology, wounds, birth trauma, polytrauma, burns, shock.
9th Oncology and Transplantology: chest wall, abdominal wall, gonadal tumors, soft tissue tumors,
lymphoma, osteogenic tumors, differences between adult and childrens transplantology, renal,
hepatic tranplantation.
10th The end of the Pediatric Surgery Course- practical skills exam, written test.
After Seminars each day will take place tutorials with attending resident for each group of students –
including:
Attending rounds
Visiting Operating Rooms or seeing life-transmission from the minimally invasive surgery OR;
Participating in Pediatric Surgery and Radiology or/and Pediatric Oncology Conferences
Patients examination in the Pediatric Surgery Ward or Neonatal Care Unit or in the Pediatric Surgery
ambulatory setting.
Attending manometric studies in the esophagal / colonic dismotility laboratory.
X.
Self study topics:
Soft tissue infections.
Common surgical problems encountered in the emergency department (lacerations, burns, foreign
bodies).
Hernias – inguinal, umbilical, epigastric.
Pediatric surgical emergencies: acute appendicitis, intussusception, incarcerated hernia, the acute
scrotum, foreign body ingestion/aspiration, intestinal obstruction, midgut volvulus, esophageal
atresis.
Common neck and subcutaneous masses: lymphadenitis, lymphangioma, hemangioma, dermoid
cyst, thyroglossal duct cyst, branchial cleft cyst.
Disorders of the umbilicus: umbilical granuloma, vitelline/urachal remnants, Meckel’s diverticulum,
omphalitis.
Gastrointestinal bleeding (age and site specific cases).
Evaluation of the constipated child and the child with chronic abdominal pain.
Non-bilious vomiting: GER and pyloric stenosis.
Solid tumors of childhood: Wilms’, neuroblastoma, gonadal and extra-gonadal teratomas,
lymphoma, hepatoblastoma.
Common neonatal surgical conditions: intestinal obstruction, esophageal atresia, congenital
diaphragmatic hernia, omphalocele and gastroschisis, necrotizing enterolcolitis, imperforate anus,
congenital intra-abdominal cysts, biliary obstruction (biliary atresia and choledochal cyst),
hydrocephalus.
Thoracic disorders: pneumothorax, chest wall deformities, mediastinal masses, congenital lung
lesions.
Management of pediatric trauma including recognition and treatment of child abuse syndrome.
Fluid, nutrition, and pain management of the pediatric surgical patient.
XI.
Books:
Basic: O'Neill: Pediatric Surgery 2 vols (1998 or newer); Puri: Newborn Surgery (2003)
Additional: Grosfeld: Pediatric Surgery 2 Vols (2006); Gupta: Pediatric Surgery (2010)
XII.
List of required practical skills (to get credits for pediatric surgery course need to be
confirmed on the practical skills card by attending resident):
a)
Take a relevant history
b)
Perform an acceptable physical exam, concentrating on relevant areas
c)
Arrive at an appropriate differential diagnosis
d)
Order appropriate laboratory, radiologic and other diagnostic tests demonstrating
knowledge in the interpretation of these tests
e)
Arrive at an acceptable plan of management, demonstrating knowledge in operative
and non-operative management of the disease process
f)
Management of patients in the ambulatory setting, demonstrating knowledge of
common office procedures
h)
Provide a plan for patient management through in-hospital course and follow-up