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My Work As a Practitioner

What is Pediatric Surgery?

     A pediatric surgeon is the doctor that specializes in the evaluation and treatment of pathologies that require surgical procedures in infants, children, teenagers and young adults until they turn 21 years old.

A typical day for a pediatric surgeon practitioner.

     My experience as a practitioner shadowing Dr. Astrid Soares showed me many aspects about the duties of a pediatric surgeon. On Mondays  and Wednesday, I would go to the office around 8:30 am  for consult days.  At about 9:00 am I go with Dr. Sores to pass visits to the patients in the pediatric Ward and see how postoperative patients admitted were doing. After that we would go to the office and see patients for consults and evaluations. In the office our day mainly consisted of evaluating patients, determining if they needed a surgical procedure or other type of treatment, and conducting post-operative consults. The most common cases that were seen in the office were pectus excavatum and pectus carinatum which are both thoracic malformations due to cartilage excess production in our floating rib bones. With these patients we would adjust their devices and see if the treatment was working correctly. In the office we also conducted minimal invasive procedures like frenotomy that is caused by lingual frenulum also known as tongue-tie on babies up to 6 months. If there was an emergency, I would go with Dr. Soares to visit the emergency room to provide a pediatric surgery evaluation to the patient and determine if surgery was required. Normally on Mondays and Wednesday our day would end about 4pm to 4:30pm. On Friday at 7:30am we started with the Schedule surgeries, which for a normal day consisted of doing circumcision, herniorrhaphy, Frenelectomy and others. We would be in surgery until about 1:30 pm. The most memorable thing I witnessed in the pediatric surgery OR was a fecal unpacking, it was impactful because I didn't know the surgeons conducted that process. The fecal unpacking is done manually and it is not that commonly seen but it is an easy procedure.  Throughout my Shadowing experience in my CO-OP practice with Dr.Soares I have gotten the chance to learn new things that I never even imagined could exist, like Pectus Excavatum, Pectus carinatum and common warts. But the most satisfying experience was that of seeing the family members of the patient faces of relief after each procedure was concluded and knowing we helped that patience. My role as a practitioner was to observe the conducted procedures in the office and learn how to examine patients, learn how sutures are made, attend to the doctor, learn how to take pulse, weight, hear the heart beats, assist in the OR, assist in laparoscopic procidures, learn about neonatal fiscal exams, learn the surgical instrumentation and most importantly learn from all the lessons Dr. Soares was teaching me by taking notes.

Glossary Illustrated

I. Instruments and equipment commonly used:

1. Operating Room (OR)- A specially designed room in a hospital where surgical procedures are performed.  This room is sterilized before each procidure.         

2. Surgical Table- It is a specialized table used for surgical procedures that can be adjusted to different positions, depending on the surgery.

3. Biohazard Waste Bin- A bin used for the safe disposal of medical waste that is contaminated with potentially infectious material.

4. Vitals Monitor- A screen that displays the vital signs of a patient, such as heart rate, blood pressure, and oxygen levels, to help doctors monitor their condition during and after surgery.

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5. ​Surgical Scissors- Sterile scissors are used to cut tissue and sutures during surgical procedures.

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6. Mosquito Forceps- A small surgical instrument used to clamp blood vessels and control bleeding during surgery.

7. Scalpel- A surgical instrument used for making incisions in the skin and other tissues during surgical procedures.​​

8. Cautery- An instrument used to burn or destroy tissue and control bleeding during surgical procedures.​

9. Trocar- surgical instrument used in laparoscopic procedures. It features a pointed tip that is inserted into the patient's abdomen to introduce gas, a camera, surgical tools, and to remove tissues​.

10. Richardson Separator- A surgical instrument used to separate and hold back tissue during a surgical procedure, typically used to clear the area where the surgeon works and to widen incisions.

11. Allis forceps- A surgical instrument used to grasp and hold onto tissue during surgery, with interlocking teeth to provide a secure grip on the tissue

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12. Dissecting forceps- A surgical instrument used to hold, grasp, and manipulate tissue during surgical procedures, typically used to dissect or separate tissues.

13. Laparoscopic tower- A device used in laparoscopic surgery that contains a monitor for the surgeon to view the interior of the body, as well as devices that regulate the introduction of air into the peritoneal cavity and the image quality

14. Laparoscopic instruments- A set of surgical tools used to perform minimally invasive laparoscopic surgeries, typically inserted into the body through small incisions made in the patient. These instruments can include small blades, scissors, forceps, and other tools.

15. Camera- A medical device used to capture and display visual images during a surgical procedure, typically inserted through small incisions in the body and used in laparoscopic surgeries to visualize the area being operated on.

16. Doctors office- A medical facility or room where a doctor conducts medical examinations and consultations with patients.

17. Stetoscope- A medical device used to listen to sounds made by the heart, lungs, and other organs in the body, typically consisting of a small disk-shaped resonator and two tubes connected to earpieces.

II. Materials and Medications commonly used:

18. Exam Gloves-Gloves used for examining a patient that are made of latex or synthetic material and are not sterile.

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19. Sterile Gloves-Gloves used for surgery that are made of latex or synthetic material and are specially designed to maintain a sterile environment during the operation.

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20. Surgical Cap-A head covering worn by medical personnel in the operating room to prevent hair from falling into the surgical field.

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21. Face Mask- A mask worn over the mouth and nose to prevent the spread of germs during medical procedures.

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22. Sterile Scrubs- Green-colored clothing worn by medical personnel in the operating room that have been sterilized to prevent the spread of germs.

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23. Surgical Gown- A garment worn by medical personnel in the operating room to create a sterile barrier around the surgical area.

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24. Shoe Covers- Protective coverings for shoes worn by medical personnel in the operating room to prevent the spread of germs.

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25. Surgical Drapes- Sterile cloths used to cover a patient once they have been cleaned to create a sterile area around where the surgery is taking place.

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26. Anesthesia- The use of drugs to put a patient to sleep before a surgical procedure to keep them safe and pain-free during the operation.

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27. Absorbable Suture- A type of suture that is used to close skin wounds and will dissolve on its own over time.

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28. Povidone-Iodine Solution- A topical antiseptic solution used to disinfect skin before surgical procedures.

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29. Sterile Gauze- Sterile cotton or other material used to dress wounds and absorb fluids during surgical procedures.

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30. Panadol-  Paracetamol pain killer medication given after surgery.

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31. Advil- Ibuprofen medication given after surgery to reduce inflammation.

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III. Most frequently performed procedures:

32. Circumcision- A surgical procedure in which the foreskin of the penis is removed.

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33. Appendectomy- A surgical procedure to remove the appendix, a small pouch attached to the large intestine that can become inflamed and infected causing appendicitis.

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34. Cholecystectomy- A surgical procedure to remove the gallbladder.

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35. Herniorrhaphy- A surgical procedure to repair a hernia, which occurs when an organ or tissue protrudes through a weak spot in the surrounding muscle or tissue.

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36. Vacumm bell- A non-surgical costume made treatment option for pectus excavatum patients. The vacuum bell is a device placed over the chest to apply negative pressure, which gradually corrects the deformity over time.

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37. Dynaic Chest Compressor- A non-surgical costume  treatment option for patients with pectus carinatum. The device applies pressure to the chest to gradually correct the deformity over time.

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38. Frenotomy (Frenulotomy)- A surgical procedure to cut or release the frenulum. Common frenulotomy procedures include tongue-tie and lip-tie releases.

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IV. Diseases and Conditions most frequently treated:

39. Hernia- A condition in which an organ or tissue protrudes through a weak spot in the surrounding muscle or connective tissue.

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40. Phimosis- A medical condition in which the foreskin of the penis cannot be fully retracted, leading to difficulty in urination and sexual intercourse.

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41. Appendicitis- An inflammation of the appendix. Appendicitis typically causes pain in the lower right abdomen, fever, and loss of appetite.

42. Cholecystitis- An inflammation of the gallbladder. Cholecystitis typically causes pain in the upper right abdomen, fever, nausea, and vomiting.

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43. Pectus Carinatum- Also known as "pigeon chest," pectus carinatum is a medical condition in which the breastbone cartilage protrudes outward, giving the chest a bird-like appearance.

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44. Pectus Excavatum- Also known as "funnel chest," pectus excavatum is a medical condition in which the breastbone sinks inward, giving the chest a sunken appearance.

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45. Lingual frenulum- A small band of tissue that connects the underside of the tongue to the floor of the mouth.

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46. Superior labial frenulum- A small band of tissue that connects the upper lip to the gum tissue above the front teeth.

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47. Common warts- A type of skin growth caused by a virus called human papillomavirus (HPV). Common warts typically appear as small, rough bumps on the hands or fingers and can spread from person to person through contact.

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V. Concepts of Human Anatomy and Histology:

48. Abdominal quadrants- The abdomen is divided into four quadrants: the upper right, upper left, lower right, and lower left, to help doctors locate and describe organs and symptoms.

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49. Digestive System- The digestive system is a group of organs and glands that work together to digest food and absorb nutrients from the body. This system is composed by the mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus, as well as associated glands such as the salivary glands, pancreas, and liver. In this system many disease can happen like cancer, appendicitis, cholecystitis, and hernias.

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50. Anatomy of oral cavity- It consists of several structures, including the lips, teeth, tongue, gums, hard and soft palates, uvula, and tonsils. In it we can see that all humans have frenulum.

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51. Cystic Duct- this duct is responsible for transporting bile from the gallbladder to the common bile duct through a tube.

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52. Common Bile Duct- this duct is a tube that carries bile produced in the liver and passed through the gallbladder and pancreas before reaching the intestine to assist with the digestion of fats.

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V. Technical vocabulary:

53. Elective Surgery- A planned surgical procedure that is not urgent or life-threatening and can be scheduled in advance.

54. Emergency Surgery- A surgical procedure that is required immediately to save a person's life or prevent serious harm to their health, such as after a traumatic injury or sudden illness.

55. Post-Operation Consult- A week after the surgery or after being discharged from the hospital patients attend a consult with the surgeon to check that everything is going well and that the wound is healing, most importantly because everybody reacts different to surgery.

56. Laparoscopic Surgery- Minimum invasive surgery where small incisions are made to complete the procedure.

57. Open Surgery- Invasive surgery in which a larger incision is made, allowing the surgeon to fully visualize the tissue and organs where the procedure will be performed.

58. Haller Index- The Haller index is the number calculated for pectus excavatum that determines the severity of the condition and if it requires a surgical procedure.

59. Chronic- A condition that develops over a long period of time and needs medical attention.

60. Fecal unpacking- procedure in were feces were removed from the patient in the OR.

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