Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS 3: Pediatrics > Common Paediatric Surgical Problems > Flashcards

Common Paediatric Surgical Problems Flashcards

1
Q

Name surgical diseases of the newborn?

A
  1. Common surgical causes of respiratory distress
  2. Intestinal obstruction
    - Necrotizing enterocolitis
  3. Anterior abdominal wall defects
  4. Hydrocephalus
  5. Genito-urinary problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Post neonatal surgical problems?

A
  1. Acute abdominal pain
  2. Abdominal masses
  3. Scrotal swellings
  4. Anterior abdominal wall hernia’s
  5. Pyloric stenosis
  6. Surgical infections
  7. Trauma
  8. Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Surgical causes of respiratory distress?

A
  1. Abdominal distension
  2. Neck masses compressing the trachea
    e.g. cystic hygroma
  3. Esophageal atresia and trachea-esophageal fistula
  4. Congenital hernia diaphragmatica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of esophageal atresia with tracheo-esophageal fistula?

A
  1. esophageal atresia
  2. esophageal atresia + proximial TE fistula
  3. esophageal atresia + distal TE fistula
    - most common
  4. esophageal atresia + proximal and distal TE fistula
  5. TE fistula without esophageal atresia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Esophageal atresia with tracheo-esophageal fistula is associated with?

A

congenital anomalies
VACTERL
1. vertebral anomalies
2. anorectal anomalies (ana atresia)
3. cardiac anomalies
4. tracheo-esophageal fistula or atresia
5. renal anomalies
6. limb anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of esophageal atresia with TE fistula?

A
  1. May cause respiratory distress because of aspiration of saliva which can not be swallowed or reflux of gastric content
  2. If feeding is attempted aspiration is very likely and results in severe pneumonia.
    NB: Passing a nasogastric tube will fail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnosis of esophageal atresia with TE fistula?

A
  1. Passing a nasogastric tube will fail
  2. Early diagnosis is possible if foaming of saliva is observed and passing of an NG tube is not possible because of obstruction
  3. Investigation: plain chest X-ray and abdominal X ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a diaphragmatic hernia?

A

a birth defect in which there is an abnormal opening in the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the diaphragmatic hernia?

A
  • Mostly left sided
  • Respiratory problems due to space-occupying effect of abdominal viscera in the chest
  • Shift of the mediastinum / apex beat
  • Be careful with bag and mask ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of diaphragmatic hernia?

A

Placement of a naso-gastric tube in the stomach helps to minimize distension of this organ
Note: Bagging via a face mask is dangerous as some of the air will end up in the stomach and compound the problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common manifestation of congenital diaphragmatic hernia?

A
  • The Bochdalek hernia, also known as a postero-lateral diaphragmatic hernia, - accounting for more than 95% of cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the Bochdalek hernia?

A
  • In this instance the diaphragm abnormality is characterized by a hole in the postero-lateral corner of the diaphragm which allows passage of the abdominal viscera into the chest cavity
  • The majority of Bochdalek hernias (80-85%) occur on the left side of the diaphragm, a large proportion of the remaining cases occur on the right side. - To date, it carries a high mortality and an active area of clinical research.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is necrotizing enterocolitis?

A

inflammation of the intestine leading to bacterial invasion causing cellular damage and cellular death and necrosis of the colon and intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When do we usually see necrotizing enterocolitis?

A
  1. respiratory distress
  2. prematurity
  3. infection
  4. septicemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathogenesis of necrotizing enterocolitis?

A

Ischaemic infarction of intestinal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical manifestation of NEC?

A
  1. Vomiting
  2. blood in stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of NEC?

A
  1. Preferably conservative management
  2. Surgery when perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Investigations in NEC?

A

Pneumatosis intestinalis characteristic finding on abdominal X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes intestinal obstruction?

A
  1. proximal bowel obstruction
  2. distal bowel obstruction
  3. anal atresia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is proximal bowel obstruction?

A

at or above the level of the jejunum
- The more distal the obstruction, the greater the distension and vice versa.
NB: It needs emergency treatment as the infant loses fluids and electrolytes and can not be fed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Clinical signs of proximal bowel obstruction?

A
  1. vomiting
    - bilious: obstruction is post-ampullary
    - clear: obstruction is above the ampulla of Vater
  2. can have passed meconium
  3. distended upper abdomen
    - associated with epigastric fullness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Investigations in proximal bowel obstruction?

A

abdominal x-ray
e.g. duodenal atresia shows fluid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is distal bowel obstruction?

A

Obstruction at level of distal jejunum, ileum, colon and ano-rectal level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical signs of distal bowel obstruction?

A
  1. vomiting
  2. distended abdomen
  3. no stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Causes of distal bowel obstruction?

A
  1. ano-rectal atresia’s
  2. Hirschsprung’s disease
    - Although Hirschsprung does not need to present in the neonatal period, may present later even as a toddler
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Investigations in distal bowel obstruction?

A
  1. Abdominal X-ray
    - may not always be conclusive about the level of obstruction
  2. barium enema
    - this will show at which level the obstruction is
    e.g. In anal atresia air can be used as a contrast and an inverted X-ray can be done – the level of the air and the distance between the anus and the air level will indicate the level of the obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe anal atresia?

A
  • Most common problem
  • Sometimes in combination with fistula (especially in girls)
  • Fistula usually low lesion
  • Associated with other congenital malformations (VACTERL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of anterior abdominal wall defects?

A
  1. omphalocele
  2. gastroschisis
  3. ectopia vesicae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is an exomphalos/omphalocele?

A
  • the herniation of abdominal organs through a central abdominal wall defect
  • it has a membrane that covers the abdominal contents
  • associated with congenital abnormalities or part of a syndrome
30
Q
A
31
Q

Features of gastroschisis?

A
  • no sac
  • lateral to umbilical cord
  • Chemical peritonitis
  • Associated abnormalities uncommon
31
Q

Management of gastroschisis and exomphalos?

A
  1. Ensure that sac of exomphalos doesn’t rupture, becomes dry and infected
  2. Prevent fluid loss from exposed viscerae
  3. Wrap in sterile moist gauze
  4. Surgical repair?
31
Q

Describe features of exomphalos/omphalocele?

A
  • most common
  • due to failure of the abdominal viscerae to return to the abdomen from the yolk sac
  • mass protruding from the abdomen through a central defect covered by a sac
  • No peritonitis
  • Associated congenital abnormalities common
32
Q

What is gastroschisis?

A

birth defect where the baby’s intestines exit their body from a 2-5 cm hole beside their belly button during fetal development

33
Q

What is ectopia vesicae?

A
  • absence of the anterior abdominal wall of the bladder and the part of the rectus muscle ant.
  • symphysis pubis is widely separated
  • exposing the posterior bladder wall and the ureteric orifices
34
Q

What is pyloric stenosis?

A

narrowing of the pyloric canal as it exits the stomach

35
Q

Features of pyloric stenosis?

A
  1. projectile vomiting
  2. olive sized bulge below right costal margin
36
Q

Management of pyloric stenosis?

A

pylorotomy

37
Q

Causes of acute colicky abdominal pain?
With mass?

A

Groin
1. obstructed hernia
Abdomen
1. intussusception
2. ascaris bowel obstruction

38
Q

Causes of acute abdominal pain?
No mass?

A

sickle cell crisis

39
Q

Causes of continuous acute abdominal pain?
Localized?

A

acute appendicitis

40
Q

Causes of continuous acute abdominal pain?
Generalized?

A
  1. fever precedes pain
    - perforated typhoid
  2. pain precedes fever
    - perforated appendix
41
Q

What is intussusception?

A

telescoping of a portion of the intestine into the lumen of the immediately adjoining part of the
- mostly ileo - coecal

42
Q

Epidemiology of intussusception?

A
  • peak between 4 and 12 months
  • male : female ratio is 3 : 2
43
Q

Features of intussusception?

A
  1. sometimes polyp, Meckel’s diverticle
  2. pain - colicky
  3. vomiting
  4. blood per rectum - redcurrant jelly
  5. sausage shaped mass palpable
44
Q

Diagnosis of intussusception?

A

Diagnosis by abdominal ultrasound
– doughnut target or concentric ring and pseudokidney sign suggest intussusception

45
Q

Management of intussusception?

A
  1. rectal reduction if possible at X-ray – air enema
  2. If fails surgical
  3. If signs of peritonitis no air-enema, but surgery
    NB: Peritonitis suggests the presence of gangrenous intestines.
46
Q

What is appendicitis?

A

inflammation of the inner lining of the vermiform appendix

47
Q

Diagnosis of appendicitis?

A

target like appearance due to thickened wall and surrounding loculated fluid collection

48
Q

What is a hydrocele?

A

It is a collection of fluid in the tunica vaginalis
- Localized to the scrotum
Note: Fluctuation of the scrotal size during the day

49
Q

Types of hydrocele?

A
  1. communicating
  2. non-communicating
50
Q

What is a communicating hydrocele?

A

when the sac does not close the fluid around the testicle can flow back up into the abdomen
- the hydrocele looks smaller early in the day and larger in the evening

51
Q

What is a non communicating hydrocele?

A

no connection between the abdominal cavity and the sac around the testicle in the scrotum

52
Q

Diagnosis of hydrocele?

A
  1. transillumination
  2. pelvic ultrasound
53
Q

Management of hydrocele?

A

Observation for 1 to 2 years of age, before recommending repair hydrocele
Note: do not aspirate

54
Q

Most common inguinal hernia in pediatrics?

A

indirect hernia

55
Q

Epidemiology of indirect hernia?

A
  • Indirect 99%
  • 1% to 3% of all children
  • 3% to 5% in preterm baby
  • R 60%, L 30% Bilateral 10-15%
  • Males to female’s ratio is 6:1
56
Q

Features of an inguinal hernia?

A
  • Present as bulge in the groin, scrotum, or labia
  • A reliable history is sufficient to make the diagnosis, even if the hernia cannot identify
  • An incarcerated inguinal hernia presents as a mass in the labia or scrotum that does not reduce spontaneously
57
Q

What is hydrocephalus?

A

This refers to enlargement of the ventricles (hydrocephalus internus) or of the subarachnoid space (hydrocephalus externus) due to a disturbance in the flow of cerebrospinal fluid

58
Q

Causes of hydrocephalus?

A

congenital, such as
1. aqueduct stenosis
2. Chiari malformation
acquired,
1. after meningitis
2. intra ventricular haemorrhage

59
Q

Clinical presentation of hydrocephalus?

A

clinical presentation related to enlarged head and the pressure effects on intracranial structures

60
Q

Treatment of hydrocephalus?

A

VP shunt

61
Q

What is hydronephrosis?

A

This occurs following obstruction to urine flow at or distal to the pelvic-ureteric junction, with progressive dilatation of the calyces and pelvis and pressure on the adjacent renal parenchyma

62
Q

Features of hydronephrosis?

A
  1. a flank mass
  2. secondary infection from stasis
  3. Haematuria and pyuria are common presenting symptoms in older children
63
Q

Diagnosis of hydronephrosis?

A
  1. renal ultrasound
  2. CT
64
Q

What are posterior urethral valves?

A

obstructive membranes that develop in the urethra close to the bladder
- the valve can obstruct or block the outflow of urine through the urethra

65
Q

Epidemiology of posterior urethral valves?

A

usually in boys, uncommon in girls

66
Q

Features of posterior urethral valves?

A

Presents with urinary retention, poor stream

67
Q

Diagnosis of posterior urethral valves?

A

Diagnosis by voiding cystourethrogram, cystoscopy

68
Q

Treatment of posterior urethral valves?

A

endoscopic valve ablation

69
Q

Other common pediatric surgical problems?

A
  1. Trauma
  2. Burns
  3. Cleft palate
  4. Surgical infections
  5. ENT

MBBS 3: Pediatrics (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions