3. Surgery 1 Flashcards
what is thissss
strawberry naevus- common skin lesion in infants, natural history is to gradually involute by 5-8 years.
What is wrong with the eyes?
‘setting sun’ eyes- caused by hydrocephalus- stretching of quadrigeminal plate in 4th ventrical> dissociation between eyelids and eye muscles
Commonest cause of hydrocephalus?
intraventricular haemorrhage related to extreme prematured (healing after haemorrhage causes blockage of CSF pathways)
What dis? Why is it occurring here?
dermoid- along the fusion line between the fronto-nasal process and the maxillary process when the head and face is formed by folding of the embryonic disc> a few cells of ectoderm are caught beneath the fusion line and form into a cyst, which grows very gradually by peeling skin.
What’s this? what is it caused by and what is the main problem other than obvious cosmetic
Cleft lip and palate due to failed fusion between fronto-nasal and maxillary processes
> inability to suck
Likely diagnosis and differential diagnosis?
why does it need to be treated immediately?
Sacrococcygeal teratoma- rare but dangerous teratoma arising from notochord.
Needs to be treated immediately as malignant degeneration usually occurs shortly after birth.
differential: myelomeningocele over sacrum.
What is a teratoma?
A congenital tumour containing the 3 germ layers- ecto, endo and mesoderm
Likely diagnosis?
Why is the natal cleft missing?
Why is the anus patulous?
What are the different parts of the mass?
Lumbosacral myelomeningocele (spina bifida)
rare now (folate supp, U/S)
natal cleft is missing because of prenatal paralysis of muscles in this area> muscle turns into brown fat.
Anus is patulous (loose/open) due to paralysis of anal sphincter.
parts of mass:
yellow= exposed, unfused dysplastic spinal cord
grey= abnormal meninges
purple = dysplastic surrounding skin with vascular anomaly
Likely diagnosis?
Could it be reactive lymph nodes?
looks like matted and enlarged lymph nodes, which makes cancer (lymphoma) likely.
Reactive nodes are tender + signs of inflam: red, hot, painful, and are rarely larger than 3cm.
What would you do?
recognise that sexual development is incomplete and the baby should be immediately investigated for a disorder of sex dev (DSD) before gender is decided.
What 2 things are clearly abnormal and what would you do?
- no anal opening - ano-rectal malformation.
- Meconium extruding from and ano-cuatneous fistula along the ventral surface of the penis
Would assess for any other anomalies, immediate RCH referral for surgery.
First aid: nil orally, NG to prevent gaseous distension of gut, IV fluids
What is wrong and what do multiple anomalies mean?
shape of head abnormal, clavicles missing, slanted palpebral fissures. (cranio-cleid dysostosis)
Multiple anomalies (esp 3 or more) > ‘syndrome’ - once we know the sydnrome, can predict anomalies and futuer prognosis.
