Child health- Paediatric surgery Flashcards
what are the most common causes of surgery in children under 6 hours old?
duodenal GORD
malrotation
what type of vomiting does duodenal stenosis cause?
bilious
bright green
what blood gas and electrolytes would pyloric stenosis cause?
raised sodium from dehydration
reduced potassium as kidneys swap for H+ to maintain acid base
reduced chlorine
increased pH
BE increased
Hypochloraemic hypokaelaemic metabolic alkalosis
which age group is pyloric stenosis most common in?
6 weeks old
what are common surgical issues in 6 month olds
intussusception
common in 6 months to 2 years
describe intussusception
telescoping of the small bowel into the large bowel
most common at the ileocecal junction
what are the ‘food’ signs of intussusception?
sausage shaped mass in the abdomen
red currant jelly like stool
donut looking bowel on USS
is intussusception more common in boys or girls
boys!
which conditions are associated with intussusception
Concurrent viral illness
Henoch-Schonlein purpura
Cystic fibrosis
Intestinal polyps
Meckel diverticulum
what is the typical presentation of intussusception
Severe, colicky abdominal pain
Pale, lethargic and unwell child
“Redcurrant jelly stool”
Right upper quadrant mass on palpation. This is described as “sausage-shaped”
Vomiting
Intestinal obstruction
typical exam scenario of intussusception
child will have had a viral respiratory illness prior to symptoms of intestinal obstruction (vomiting, absolute constipation, abdo distention)
what is the initial investigation for intussusception?
Ultrasound Abdo
what is the management for intussusception
therapeutic enemas used to reduce (90% treated with air enemas)
surgical intervention (10%)
if the bowel is gangrenous or perforated then surgical RESECTION is required.
what are the complications of intussusception
Obstruction
Gangrenous bowel
Perforation
Death
what are the most common causes of surgery in children
appendicitis
hernias
describe hirschsprungs disease
congenital condition
nerve cells of myenteric plexus are absent in the distal bowel and rectum
what is the myenteric plexus responsible for?
stimulating peristalsis of the large bowelwh
what is the key pathophysiology of Hirschsprungs
absence of parasympathetic ganglion cells.
is there a genetic factor to Hirschsprung disease?
yes
family history is important
what are associated with Hirschsprungs disease?
downs syndrome
NF
waardenburg syndrome
multiple endocrine neoplasia type II
describe Balanitis xerotica obliterans (BXO)
chronic inflammatory condition affecting male genitalia
white scarring and inflammation of the foreskin, glands and external urethral meatus
what should not be done in a case of hypospadia
DO NOT circumcise
what does hypospadia have a similar appearance to?
congenital adrenal hyperplasia
too much testosterone in XX feotus
causes virilisation of external genitalia
increased production of cortisol which can dysregulate sodium and cause a crisis
describe hypospadia
opening of the urethra is on the underside of the urethral meatus, anywhere from the tip of the penis to the base of the penis
