7. GI vague

Question 1

What causes testicular torsion?

Answer 1

-Spermatic cord becomes twisted, cutting off flow of blood to attached testicle –> ischaemia + necrosis
-Peak incidence = 13-15

Question 2

What are the 2 main types of testicular torsion?

Answer 2

CONGENITAL
-Rare perinatal event, torsion outside tunica vaginalis
OUTSIDE PERINATAL PERIOD
-Abnormally mobile mesentery of the testes inside tunica vaginalis
-Gonad twists on its own vascular pedicle

Question 3

How does testicular torsion present?

Answer 3

-Sudden onset severe scrotal pain
-Tender testis retracted upwards
-Overlying scrotal skin red + oedematous
-ABSENT CREMASTERIC REFLEX + elevation does not ease pain
-Diagnosis confirmed on USS doppler + greyscale

Question 4

What treatment is recommended for torsion?

Answer 4

-Immediate scrotal exploration + fixation
-Fix contralateral testis as 50% chance of recurrence
-If >24h considered necrotic, likely removal

Question 5

What causes cryptorchidism?

Answer 5

= undescended testicle
-Testis does not descend through the inguinal canal into the scrotum (1st trimester)
-Often associated with preterm babies and inguinal hernia
-Spontaneous descent unlikely after 6 months

Question 6

How does cryptorchidism present?

Answer 6

-May be unilateral / bilateral, palpable / impalpable
-PALPABLE (70%)
–Can be brought down into the scrotum via inguinal incision
-IMPALPABLE
–May be intra-abdominal –> increased risk of malignancy
–May be inguinal
–May be absent

Question 7

How should undescended testes be managed?

Answer 7

-Consider for referral from 3 months
–Immediate if bilateral and non-palpable
-Ideally see urology before 6 months, surgery around 1 year
-Orchipexy = 1st line

Question 8

What occurs in retractile testes?

Answer 8

-Overactive cremasteric muscle so testes retract into groin
-Scrotum normally developed

Question 9

What is biliary atresia?

Answer 9

-One or more bile ducts are abnormally narrow, blocked or absent
-Very rare
-Leads to conjugated hyperbilirubinaemia –> persistent jaundice

Question 10

What is Hirschsprung’s disease?

Answer 10

-Absence of ganglion cells in bowel wall nerve plexus
-Prevents passage of bowel contents
-Usually presents in neonatal period with delayed meconium passage, abdominal distension, vomiting

Question 11

How is IBD managed?

Answer 11

CROHN’S
-Diet modification – exclusive enteral nutrition
-Sulphasalazine
-Anti-TNF drugs - infliximab
-Steroids
-Azathioprine, methotrexate
-Surgical resection for localised disease
ULCERATIVE COLITIS
-Oral / rectal mesalazine
-Steroid enemas
-Colectomy / immunosuppressants if severe

Question 12

What advice is given for toddler’s diarrhoea?

Answer 12

-Reassure - usually due to rapid gastrocolic reflex
-Reduce fruit juice and milk intake
-Ensure diet contains fat to slow transit