Common Surgical Problems Flashcards
6 week old baby
projectile vomiting of milk after feed
no wet nappies
large lumps in abdomen
pyloric stenosis
lumps are just the waves of peristalsis in the stomach pushing against the closed pyloric sphinctor
why is pyloric stenosis common at 6 weeks?
pyloric muscle thickens and can cause a physical obstruction
how is pyloric stenosis managed surgically?
pyloromyotomy
stereotypical presentation of pyloric stenosis?
6 weeks old
projectile vomiting milk
6 months old vomiting - began with food, then yellow, then green not been very well for a few days lumps in the lower abdomen - sausage like mass in the abdomen blood in the nappy (red currant jelly)
intussusception
can cause child to become very sick very quickly so need quick diagnosis
US image of intussusception?
target like appearance on cross section
kidney like appearance from side on view
description of intussusception?
where part of the tubing of the bowel telescopes into another causing a blockage
how is intussusception managed?
radiologically
child is fully resuscitated and then air is blown into the bowel via rectum
air travels backwards around large bowel and pushes intussuscepted bowel back out
works in most
surgery used is unsuccessful
6 years old
tummy pain
vomiting
journey to hospital - didn’t like the bumps on the road
peritonitis due to appendicitis
investigation of the 6 year old child with abdominal pain?
get them up and out of bed - ask if they can jump
- can distinguish whether peritonitis is present
US - if you can see the appendix then its probably inflamed
features of peritonitis in children?
cant jump
mild temperature
severe abdominal pain
vomiting
baby
vomiting green
could me malrotation with volvulus
medical emergency
what diagnosis must be excluded in a child which is vomiting green and how can this be done?
malrotation
clarify with parent whether vomit it yellow or green (often range of colours called “green”)
babies with malrotation vomit green due to obstruction just after where bile enters small bowel
what is the largest distance across the abdomen and what 2 points is this between?
what is the significance of this?
two fixed points between splenic flexure to beginning of ascending colon
supply to midgut (from superior mesenteric) is between these 2 points
gut hangs from these two fixed points
if these 2 fixed points are not in the right place and the distance between them is small, then all the blood supply comes between them and rest of mid-gut can be deprived of blood
the rest of the gut hanging from these two points can also become twisted if hanging from these 2 close fixed points
= malrotation
what are the risks of malrotation?
ischaemic bowel/death of bowel
main causes of acute scrotum?
testicular torsion - can cause ischaemia and death of the testical
infection/inflammation of the testicle (e.g inflamed epididymis)
torsion of the hydatid? - black dot on top of the testicle - must be removed
what is the most common acute scrotum presentation?
torsion of the hydatid
what is the (hydatid?)
remnants of the females parts
inflammation of scrotum spreading down over perineum and into abdomen?
idiopathic scrotal oedema
usually disappears with analgesia
balanitis xerotica (BXO)
white scarring around opening of the penis
managed with circumcision
hypospadias?
opening not on the penis but below it
penis is shortened and slightly bent
what can cause huge scrotal swelling in the scrotum in a baby?
herniation of the bowel into the scrotum
what is the management if a baby is born with a testicle in the groin and why?
remove testicle and place into scrotum
so the testicle can be examined
can have fertility issues
where is testicle likely to be found if not in the scrotum?
along the inguinal ligament
