Paediatric Surgery

1.During acquisition of the study course a resident acquires basic knowledge on the most common anomalies in paediatric surgery and conditions, their aetiology, pathogenesis, clinical expressions, diagnostic testing algorithms and treatment principles.

1.Following acquisition of the study course the resident will be able to carry out examination and evaluation of the objective surgical condition based upon the age of the child, to order additional examination methods (urography, cystoscopy, radiological examinations), to interpret the acquired results, to apply local anaesthetics, to prepare for application of intravenous infusion, to comply with and apply in practice the basis of aseptics and antiseptics, as well as to provide emergency aid when necessary.

1.Upon successful completion of the study course the resident acquires mandatory competence of a certified paediatrician. The necessary level of competence varies for various cases of paediatric surgical conditions and is provided in the table below. The competence levels are as follows: 1st level: acquired knowledge complies with general concept of the subject matter, allowing the practitioner to understand the situation by reading literature or when coming across in practice, by engaging in purposeful search for necessary additional information and referring the patient to a specialist, when necessary. 2nd level: acquired knowledge on the particular matter is sufficient for understanding its nature, to diagnose the problem and provide emergency aid, when necessary, refer to a specialist, as well as to carry out diagnostics, treatment and prevention under the supervision of a specialist. 3rd level: acquired knowledge allows the practitioner to solve the particular problem independently. Urological diseases in new-borns and children 1. Congenital kidney abnormalities 2 2. Urinary tract infections 2 3. Vesicoureteral reflux 2 4. Urinary tract obstruction 2 5. Bladder abnormalities 2 6. Neurogenic bladder 2 7. Emptying dysfunction 2 8. Urethral and male genitalia abnormalities 2 9. Acute testicular disorders 2 10. Genitourinary tract trauma 2 11. Urolithiasis 2 Paediatric gynaecological problems 1. Vulvovaginitis 2 2. Bleeding 2 3. Mammary gland disorders 2 4. Development abnormalities 2 Bone and joint diseases Orthopaedics 1. Legs and feet 1.1. Metatarsus adductus 1 1.2. Pes calcaneovalgus 1 1.3. Congenital vertical talus 1 1.4. Hypermobile flat foot 1 1.5. Osteohondrosis 1 1.6. Feed deformations 2 1.7. Footwear 2 2. Angular deformities 2.1. Genu varum 2 2.2. Genu valgum 2 2.3. Congenital tibia and fibula angular deformities 1 3. Uneven length of legs 2 4. Knees 4.1. Poplietal cyst 2 4.2. Osgood – Schlatter disease 2 5. Hip 5.1. Congenital hip dysplasia 2 5.2. Legg – Calve – Perthes disease 2 5.3. Juvenile epiphysiolysis 6. Spine 6.1. Scoliosis 2 6.2. Back pain in children 2 7. Neck 7.1. Torticollis 2 8. Upper extremities 8.1. Shoulder dislocation 1 8.2. Polydactyly 1 8.3. Syndactyly 1 9. Arthrogryposis2 10. Fractures 10.1. Peculiarities of fractures in children 2 10.2. Collar bone fracture 2 10.3. Proximal humerus fracture 2 10.4. Distal radius and ulna fracture 2 10.5. Fracture of phalanges 2 10.6. Surgical therapy 1 11. Genetic skeletal dysplasia, diagnosis and examination 1 12. Osteochondrodysplasia 1 13. Congenital osteoporosis 2 13.1. Osteogenesis imperfecta 1 Nervous system 1. Congenital CNS abnormalities 1 1.1. Neural tube defects 1 1.2. Spina bifida occulta 2 1.3. Meningocele 2 1.4. Mielomeningocele 2 1.5. Encephalocele 2 1.6. Anencephalia 2 1.7. Hydrocephalus 2 1.8. Craniosynostosis 2 2.Head injury 2 3. Acute conditions 2. 3.1. Intracranial hemorrhage 2 3.2. Other causes 4. Brain abscess 2 5. Brain tumours in children 2 6. Spinal cord diseases 2 7. Spinal cord tumours 2 8. Spinal cord injury 2 9. Diastematomyelia 1 10. Syringomyelia 2 Principles of surgical treatment of neoplastic diseases and tumors 2 Respiratory system 1. Diagnostic procedures 1.1. Endoscopy 1 1.2. Thoracocentesis 1 1.3. Lung biopsy 1 1.4. Microbiology 3 1.5. Contents of blood gas 3 1.6. Lung function test 3 2. Foreign body in larynx, trachea and bronchi 2 3. Larynx injury 1 4. Larynx cancer 1 5. Atelectasis 2 6. Emphysema 1 6.1. Lobar emphysema 7. Bronchiectasis 2 8. Lung abscess 2 9. Pleural disease 9.1. Pleuritis 2 9.1.1. Serofibrinous pleuritis 9.1.2. Purulent pleuritis (empyema) 10. Pneumothorax 2 11. Hydrothorax 2 12. Pectus excavatum 2 13. Kyphoscoliosis 2 14. Abnormalities of ribs 2 Digestive system 1. Oesophagial atresia and tracheoesophageal fistula 3 2. Other damages of oesophagus 2 3. Achalasia 2 4. Hiatal hernia 2 5. Gastroesophageal reflux (chalasia) 3 6. Oesophagitis 3 7. Oesophageal perforation 2 8. Varicose veins in the oesophagus 2 9. Foreign bodies in the oesophagus 2 10. Stomach and intestines 11. Pyloric stenosis and other congenital stomach abnormalities 2 11.1. Hypertrophic pyloric stenosis 11.2. Congenital gastric outlet obstruction 11.3. Gastric duplication 11.4. Gastric volvulus 12. Atresia, stenosis and intestinal malrotation 2 12.1. Duodenal obstruction 12.2. Jejunal and ileal atresia and obstruction 12.3. Malrotation 13. Intestinal duplications, Meckel's diverticulum and formations in the omphalomesenteric duct 2 14. Motility disorders and Hirschsprung disease 2 14.1. Chronic intestinal pseudo-obstruction 14.2. Superior mesenteric artery syndrome 14.3. Hirschsprung disease 3 15. Ileus, adhesion, closed-loop obstruction 2 16. Foreign bodies in the stomach and intestines 2 17. Anorectal malformations 2 18. Ulcer disease 2 18.1. Primary (peptic) ulcer 2 18.2. Secondary ulcers 2 18.3. Zollinger – Ellison syndrome 2 19. Liver and biliary disorders 2 20. Repeated stomach aches inchildren 3 21. Acute appendicitis 2 22. Surgical pathologies of anus, rectum and colon 2 22.1. Anal fissure 22.2. Perianal abscess and fistula 22.3. Haemorrhoids 22.4. Rectal prolapse 22.5. Pilonidal sinus and abscess 23. Inguinal hernia 3 External function of pancreas 24. Pancreatitis, chronic pancreatitis 2 25. Pancreatic pseudocysts 2 26. Abscess of the liver 2 27. Cystic changes of liver and bile ducts 2 28. Gallbladder diseases 3 29. Portal hypertension and varicose 2 30. Ascites, chylous ascites 2 31. Peritonitis 2 31.1. Acute primary peritonitis 2 31.2. Acute secondary peritonitis 2 31.3. Acute secondary localised peritonitis 2 32. Diaphragm hernia 2 32.1. Morgani hernia 32.2. Paraesophageal hernia 32.3. Eventration The competences given below are important but not comprehensive (the scope of competences can be extended should there be preconditions for that during the studies), they should be acquired in relation to a patient of the respective speciality, his/her parents, activities of the health care specialists, and type of health care organisation:  To consult patients and their families • to gather anamnesis; • to carry out physical examination based upon the patient’s age; • to assess growth and development; • to perform dietary assessment; • to evaluate psychological condition; • to carry out clinical evaluation and make decisions; • to provide explanations and consultations; • to encourage and provide professional support.  To evaluate clinical exposure, order examination, set diagnosis and agree on a treatment plan • to recognise and evaluate severity of clinical exposure; • to create differential diagnosis; • to consider child protection issues; • to order necessary examination and to interpret the results; • to consult with multidisciplinary specialists; • to agree on an appropriate health management plan with patients and their caretakers.  To provide immediate healthcare to children in emergency situations, including first aid and resuscitation • to recognise and evaluate acute paediatric emergency problems; • to provide basic first aid; • to provide paediatric emergency care; • to provide cardiopulmonary resuscitation to neonatal and paediatric patients pursuant to the European guidelines currently in effect; • to provide basic information in case of injury pursuant to the European guidelines currently in effect.  To prescribe nutrition, medicinal products, liquid preparations and blood products • to clearly and precisely prescribe nutrition, medicinal products, liquid preparations and blood products • to coordinate nutrition, medicinal products, liquid preparations and blood products in clinical context • to reconsider adequacy of treatment and to evaluate possible gains and risks; • to treat pain and suffering.  To carry out practical activities A paediatrician is competent in performing various practical manipulations (see the list of manipulations) applied to infants, children and teenagers. In relation to any of these manipulations the resident shall prove his/her ability: • to provide respective information to the child and parents; • receive informed consent, when necessary; • to apply minimum possible invasive procedures; • to reduce pain and suffering; • to use appropriate hygiene and infection prevention activities; • to make respective records on manipulations in the medical documentation.  Ensure effective communication within the context of paediatrics • to communicate with infants, children and teenagers; • to communicate with caretakers and relatives; • to communicate with other multidisciplinary specialists; • to ensure continuity of healthcare; • to stop or reduce bad news, to skilfully explain such news; • to communicate with disabled children and teenagers; • to communicate with people requiring interpreter’s assistance; • to seek and receive informed consent, where necessary; • to communicate in written form, including medical records, phone and other means of communication; • to act adequately in cases of aggressive behaviour.  To apply ethical and legal principles in paediatric care • to apply ethical principles and analysis in clinical health care and research; • to apply national and EU laws and regulations in clinical healthcare and research; • to protect children’s rights pursuant to the United Nations Convention on the Rights of the Child and the laws of Latvia • to maintain confidentiality; • to evaluate patient’s ability to give consent; • to obtain and record patient’s informed consent; • to provide information regarding organ donation; • to confirm a death; • to write a request for autopsy.  To assess psychological and social aspects of a patient’s illness • to evaluate the impact of psychological factors on expressions of illness and the illness itself; • to evaluate the impact of social factors on expressions of illness and the illness itself; • to evaluate the impact of patient’s condition on education and school; • to determine stress caused by illness to children, their families and caretakers; • to detect alcohol and drug abuse and dependence; • to collaborate with respective colleagues in due time.  To apply evidence-based medical knowledge, principles, skills • to use evidence in practice; •to identify and perform search of respective literature; • to undergo a critical review of published medical literature.  To efficiently use information and information technologies within context of paediatrics • to complete clinical records in precise and complete manner and due time; • to be able to access international scientific information on paediatrics; • to save and obtain information.  To be able to apply scientific principles, methods and knowledge in practice and studies related to children • to apply scientific principles in paediatric practice; • to analyse and distribute research results; • to prove comprehension of research design and methodology, including statistical analysis.  To facilitate individual and public health and to effectively operate within the healthcare system • to comply with the national screening, monitoring and immunisation programs; • to apply measures to prevent spread of an infection; • undergo dietary assessment and provide useful advice and support on healthy nutrition, including ability to manage obesity and undernourishment cases; • to study the risks of illnesses and harm to children and manage them accordingly; • to promote safety of patients and prevention of accidents; • to ensure compliance with the professional certification; • to prove comprehension of the structure, organisation and operation of the healthcare system  To perform one’s duties in a professional manner Professional qualities: • honesty, decency and commitment to ethical practice; • commitment to maintain good practice and quality; • criticism and self-criticism, reflective practice; • empathy; • initiative; • interpersonal communication skills. Professional work: • to acknowledge the limits of one’s possibilities and to ask for help; • to work autonomously, when necessary; • to solve problems; • to pass decisions; • to work in multidisciplinary groups; • to contact experts, who do not represent disciplines of medicine; • to demonstrate leadership skills; • to be able to adjust to new situations and work in changing circumstances; • to be able to organise and plan, as well as to understand time management; • to make willful career choice, including specialisation in sectors of paediatrics.  To carry out functions of a paediatrician-expert • to be able to analyse and synthesise; • to be able to study (including life-long self-education) and to apply the knowledge in practice; • to demonstrate teaching skills; • to apply research skills.  To carry out paediatrician’s functions in a global context • to understand diversity and multiculturalism; • to understand various cultures and traditions of migrants; • to demonstrate proficiency in local language and culture; • to be able to work in an international environment; • to have responsive attitude towards environment and use of natural resources.