4: Common surgical problems in children (notes)

Question 1

What are common presentations requiring paediatric surgery?

Answer 1

Vomiting child

Acute abdomen

Acute scrotum

Question 2

What factor influences the presentations you see in paediatrics?

Answer 2

Age

Question 3

When does pyloric stenosis usually occur?

Answer 3

around 6 weeks

Question 4

What happens in pyloric stenosis?

Answer 4

pyloric stenosis causes OBSTRUCTION and abdominal muscle contracts trying to push it into duodenum

Question 5

What is the result of pyloric stenosis?

Answer 5

abdominal mass, vomiting after eating/drinking

Question 6

what happens histologically in pyloric stenosis?

Answer 6

abdominal muscle hypertrophies around pyloric stenosis and can be measured on ultrasound

Question 7

what causes the stenosis of pyloric stenosis?

Answer 7

hypertrophied circular muscle layer of stomach

Question 8

what is the surgical treatment for pyloric stenosis?

Answer 8

pyloromyotomy

Question 9

what age does intusseption occur usually?

Answer 9

around 6 months

Question 10

describe the symptoms of intussuseption

Answer 10

abdominal pain (pulling legs up) > limpness

pale

struggling to pass stool (which is bloody)

Question 11

what does the abdominal mass look like in intussuseption?

Answer 11

hard “sausage-shaped”

“Target sign” (kidney bean laterally) on ultrasound - layers of bowel on top of one another

Question 12

what differentiates intussuseption from colic?

Answer 12

paleness, in colic they’re pink

Question 13

where does intussuseption occur?

Answer 13

​Occurs around iliocaecal junction and travels along large bowel

Question 14

how is intussuseption treated?

Answer 14

air enema

Question 15

Explanation of intussceception

Answer 15

bowel is “telescoping” on itself, swelling, then obstructing

Question 16

what age do children suffer from appendicitis?

Answer 16

6 years and older

Question 17

what type of pain is associated with appendicitis?

Answer 17

peritonitis

Question 18

symptoms and signs of appendicitis

Answer 18

hand on abdomen

bent over in pain

cant jump and pain on movement (ask about journey)

low grade fever

Question 19

what can happen in a viral infection if a viruse is swallowed and accumulates at appendix?

Answer 19

mesenteric lymphadenitis

Question 20

symptoms and signs of mesenteric lymphadenitis

Answer 20

right inguinal pain like in appendicitis but they can jump!

kids may describe their pain as abdominal and then have pneumonia

Question 21

important question to ask kids with abdominal pain

Answer 21

can they pee normally?

Question 22

what colour is bile when nenonates vomit it?

Answer 22

green due to the digestion by stomach acid

Question 23

what happens in malrotation?

Answer 23

duodenum and caecum aren’t fixed in normal places

allows rotation of large bowel around duodenum (where the bile duct enters)

so bile can enter the stomach and be vomited up

(also the blood supply is cut off and bowel starts to die off due to ischaemia)

Question 24

what to assume in a newborn vomiting bile (green)

Answer 24

MALROTATION

Question 25

what are the 3 things that most commonly cause acute scrotum in children?

Answer 25

testicular torsion

epidifymitis

mullerian duct remnants

Question 26

what happens in mullerian duct remnants?

Answer 26

blue dot and less pain than torsion

Question 27

what are the symptoms of idiopathic scrotal oedema?

Answer 27

red, swollen, itchy scrotum, rash on groin and perineum

Question 28

is closed foreskin normal?

Answer 28

yes it can be

Question 29

what is the diagnosis which requires circumcision?

Answer 29

BXO

Question 30

what to do if swelling is ridiculous

Answer 30

squeeze it

Question 31

most common congenital abnormality of male genitalia?

Answer 31

hydrospadias

Question 32

what happens in hydrospadias?

Answer 32

urine exits below penis rather than through head - UG tracts are separate

Question 33

what can be msitaken for hydrocele using transillumination?

Answer 33

bowel herniating into scortum

Question 34

what to do in apparent undescended testicles?

Answer 34

apply soap - “pop” - groin surgery to move it down

no pop - laparoscopic approach to rule out testicular tumour (testicle may be absent or malignant up in the abdomen)