General Gastrointestinal diseases

[size=6]The abdominal radiograph below was obtained on an 11-year-old girl presenting with abdominal pain and a history of decreased appetite and a five pound weight loss over the past two weeks. What is the best next step in this child’s management? a Laparotomy b Enzymatic digestion c Upper endoscopy d Miralax [/size]

[size=6]A 3-year-old child had three episodes of severe esophageal variceal bleeding in the last year. An ultrasound demonstrates extrahepatic portal venous thrombosis with cavernous transformation. This wedged hepatic vein portogram was obtained. The most appropriate next step is: a Distal splenorenal shunt b Meso-Rex bypass c Liver transplantation d Transjugular intrahepatic portosystemic shunt e Aggressive variceal banding[/size]

A 16-year-old female is found to have celiac artery compression from median arcuate ligament syndrome on CT angiogram. She is active in volleyball and has chronic pain following eating and after exercise. She has lost 30 lbs over the last 6 months. She has been seen by a multi-disciplinary team and has been found to have elevated peak systolic velocities of the celiac artery on mesenteric duplex. A celiac plexus block did provide temporary relief of her symptoms. What is the best surgical option for the treatment of this patient? a Release of median arcuate ligament b Celiac artery bypass with prosthetic graft c Celiac artery bypass with vein graft d Release o…

[size=6]3-year-old boy has had 3 episodes of variceal bleeding in the past year. All were controlled endoscopically. His past medical history is significant for Tetralogy of Fallot repaired at birth. On exam, he has splenomegaly. Liver panel shows slightly elevated AST and ALT, and normal total and direct bilirubin. WBC is 4K, hct 24%, and platelet 90K. Portal venogram is shown below. What would you recommend for long-term control of this patient’s variceal bleeding? a Mesocaval shunt b Liver transplantation c Continue medical management only d Transjugular intrahepatic portosystemic shunt (TIPS) e Mesoportal shunt (Rex shunt)[/size]

An otherwise healthy 11-year old boy is diagnosed with severe gastroparesis manifested by nausea, vomiting, and weight loss. He has been unresponsive to dietary changes, medications and gastric electrical stimulation. His workup included an upper endoscopy and upper GI series that did not show anatomic narrowing of the gastric outlet. Which of the following surgical options would be considered most appropriate for his condition? a Intrapyloric botox injection b Permanent gastric electrical stimulation c Operative pyloroplasty d Gastrojejunostomy e Partial gastrectomy

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quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "running the bowel from the ligament of Treitz to the cecum. This is done more ergonomically by using two working ports and two monitors as shown in Fig. 30.1. The first half of the running should be done looking to the monitor on the left at the top of the patient, and the second half the surgeon has to switch places to the left of the patient and look to the other monitor usually moving to the patient’s lower body. It is important when running the bowel to visualize both sides of the bowel and the mesentery."

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A 9-month old girl with Trisomy 21 presents with acute non bilious emesis, worsening over 5 days. She has a history of intermittent vomiting and poor weight gain since birth, diagnosed and treated as gastro-esophageal reflux disease. Exam shows a deyhdrated, but non-toxic baby weighing 5.4 kg (15th percentile). Her abdomen is soft and non-tender. Laboratory tests show a severe hypokalemic hypochloremic metabolic alkalosis and hemoconcentration. A films is shown below. How would you proceed with this patient?

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see video link in second post 8 years old girl, presented with recurrent abdominal pain and vomiting. On Diagnostic Laparoscopy an enteric cyst was found. Resection anastomosis was done ​

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[size=20px]A four-month old girl is recovering after a truncus arteriosus repair. She is previously known to have a left-sided liver and right-sided stomach. Currently, she is tolerating oral feeds without difficulty and is passing stools normally. What is the next best step in management for this child’s likely intestinal rotational anomaly?​ A upper gastrointestinal series B diagnostic laparoscopy C prophylactic Ladd procedure D observation alone​[/size]