Common Surgical Problems Flashcards
Describe Jejunal Atresia
Incomplete formation of part of the small intestine.
List some symptoms of Jejunal Atresia
- Vomiting
- Swollen abdomen
- Constipation
- May be jaundiced
How is Jejunal Atresia diagnosed?
- Signs of obstruction
- X-ray contrast which cannot pass through blockage
What is meconium
The first stool that a newborn passes
What is meconium ileum?
When bowel obstruction occurs due to thicker and sticker meconium.
Symptoms of Meconium ileus
- Vomiting
- Not opened bowels
- Distended Abdomen
- Abdomen feels doughy
How do you diagnose meconium ileus?
Solid contract on X-ray - soap bubble sign
What causes an inguinal hernia?
Patent processus vaginalis
Symptoms of inguinal hernia
- Swelling in the groin area
- Loop of bowel projecting as a bulge
What is Malrotation?
Abnormality where the intestine does not form properly.
What is a volvulus?
Caused by malrotation where the intestine loops around itself resulting in obstruction
Symptoms of malrotation?
- Frequent vomiting
- Swollen abdomen
- Pale colour
- Poor appetite
- Blood in stools
What is necrotising enterocolitis?
Inflammatory bowel necrosis where the tissue becomes inflamed resulting in damage and kills intestinal tissues.
Symptoms of Necrotising enterocolitis?
- Abdominal distension
- Tenderness
- Bloody bowel movements
How to diagnose necrotising enterocolitis
Presence of gas or air bubbles in the wall of the intestine.
3 Causes of obstruction
- Something in the lumen
- Something affecting the wall
- Compression from the outside
What causes pyloric stenosis?
Thickening of the pylorus which does not permit the passage of milk through.
Symptoms of pyloric stenosis
- Vomiting around 6-8 weeks after birth
- Projectile vomiting
- Bumps in the abdomen
- No diarrhoea
- Constipation
Diagnosing pyloric stenosis?
- Ultrasound
- Check metabolic state of baby
Treatment of pyloric stenosis?
Ramstedt’s Pyloromyotomy
What is intussusception?
Where part of the bowel slots into another part like a telescope.
When does intussusception present?
Around 6 months
If intussusception is suspected, describe what you would feel on palpation?
Sausage like mass
What would you see on USS if intussusception was the diagnosis?
Target lesion and pseudo-kidney sign
Management of intussusception
Air blown up bottom to try and push intussusception out
What is Peritonitis?
Inflammation of the peritoneal cavitys
What causes peritonitis?
Infection or chemical irritation by organic fluid
Symptoms of peritonitis?
- Pain made worse by jumping and bumps
- Moderate temperature
- +/- vomiting
What is a volvulus?
Bowel twists on itself and the blood supply may be compromised
Symptoms of a volvulus?
- Green vomit (bilious)
- Passage of blood (indicated mid gut necrosis)
How to diagnose a volvulus
Contrast bowel and if swims = malrotation
What happens in testicular torsion?
Spermatic cord and testes become twisted around each other. Can compromise blood supply
What are some signs/symptoms of testicular torsion
- acute onset of pain
- classical blue dot sign
- atrophy if blood supply cut off >6 hours
- Change in scrotum colour
What is the ‘blue dot sign’?
Hydatid of Morgagni
What is idiopathic scrotal edema?
Acute scrotal edema and erythema
What is idiopathic scrotal edema caused by
Allergy related release of histamine
Two Classical sign of idiopathic scrotal edema
- Erythema on both testes, extending up into the groin
2. Fountain sign on USS due to hypervascularity
Does idiopathic scrotal edema require surgery?
No - resolves pithing 3-5 days
What is balanitis Xerotica Obliterans?
Chronic inflammatory disease - male genitalia variant of lichen sclerosis
How does Balanitis Xerotica Obliterans present?
- foreskin not able to be pulled back
- pain
- itchiness
- difficulty passing urine
What is Paraphimosis?
When the foreskin gets stuck behind the head of the penis.
How can paraphimosis be treated?
- Manually work the foreskin loose
- Squeeze the penis to push the fluid out and foreskin can return to normal place
What is Hypospadias?
A congenital abnormality where the urethra does not open up in the normal position.
What does a patent process vaginalis cause
An abnormal communication between peritoneum and scrotum
How does patent process vaginalis present?
- swollen scrotum
- intermittent bulge
What is a hydrocele?
Fluid filled sac within the testes which causes swelling
How can a hydrocele be identified?
- transillumination of scotum displays fluid
- silk glove sign
Can hydroceles spontaneously resolve in infancy?
Yes - so can be left alone in some cases
