3. Paeds [Surgery and Urology] Flashcards
Top 5 causes of bilious vomiting in a baby:
- Malrotation +/- volvulus until proven otherwise
- NEC
- Atresia
- Hirschprung’s disease (aganglionic colon)
- Meconium disease
Describe the typical presentation of Hirschprung’s disease in a newborn vs later presentation.
Newborn; failure to pass meconium in first 24 hours, due to intestinal obstruction.
+ bilious vomiting, abdo distension and ?enterocolitis.
Upon rectal exam, narrow segment and release of liquid stool on exit.
Older; chronic constipation + abdominal distension + ? faltering growth
What is Hirschprung’s disease and what causes it?
Aganglionic segment of bowel extending from rectum, due to developmental failure of Auerbach’s and Meissner’s plexuses.
Failure of parasympathetic neuroblasts to migrate from the neural crest to the distal colon, resulting in developmental failure of the parasympathetic system.
What is the impact on bowel function of Hirschprung’s disease?
Aganglionic colon –> uncoordinated peristalsis –> bowel obstruction
How do you investigate for suspected Hirschprung’s disease?
AXR
Full thickness rectal biopsy
Describe the epidemiology of Hirschprung’s disease, including MvsF.
M:F = 3:1
30% of patients with Hirschprung’s also have Trisomy 21
State both the immediate and definitive management for Hirschprung’s disease.
Initial; irrigation and wash out
Definitive; surgical. Initial colostomy, then anastomosis of normally innervated bowel to anus.
What type of muscle is the pyloric muscle?
Circular
What is pyloric stenosis?
Hypertrophy of the pylorus muscle resulting in gastric outlet obstruction.
At what age does pyloric stenosis present?
2-8 weeks, regardless of gestation at birth
M:F ratio of pyloric stenosis?
4:1
Clinical features of pyloric stenosis (3):
Non-bilious vomiting that becomes more violent and eventually projectile.
Feeds normally after vomiting until dehydration leads to loss of interest in feeding.
Weight loss if picked up late.
What is the gold standard imaging for pyloric stenosis?
Abdominal Ultrasound
What is the management of pyloric stenosis?
Correct acid base disturbance
Pyloromyotomy
What acid base disturbance occurs in pyloric stenosis?
Hypochloraemic, hypokalaemia metabolic alkalosis + hyponatraemia
What examination findings may you discover in a patient with pyloric stenosis?
VISIBLE gastric peristalsis seen L to R across abdomen.
Pyloric mass in RUQ.
*stomach usually overdistended with air and often must be drained via NG before examination.
Outline the common presentation of oesophageal atresia.
Choking and cyanotic episodes post feeding due to aspiration of milk +/or stomach acid.
Oesophageal atresia has VACTERL associations. What is meant by this?
The condition is associated with other conditions that are remembered in the mnemonic VACTERL.
Vertebral
Anorectal
Cardiac
Tracheo-
oEsophageal
Renal
Limb
Complications of oesophageal atresia (3):
GORD
Chronic cough
Oesophageal dilatation may be required in infancy or childhood
90% of oesophageal atresia cases also have a what present?
Tracheo-oesophageal fistula
What features may you pick up at antenatal screening if the baby has oesophageal atresia?
Polyhydramnios
Absent stomach bubble
Discuss the management of oesophageal atresia.
If suspected before birth; pass large feeding tube after birth and check position on x-ray.
Continuous suction to remove aspiration of saliva and secretions.
SURGERY is definitive.
What happens to result in hypospadias?
Failure of ventral closure of the tissue of the penis.
What is the incidence of hypospadias?
1/200
