Common surgical problems in children - part 1 Flashcards

1
Q

What is pyloric stenosis ?

A

Narrowing of the opening from the stomach to the first part of the small intestine known as the duodenum, due to enlargement of the muscle surrounding this opening

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2
Q

What are the signs/symptoms of plyoric stenosis ?

A

Presents usually at 3-8 weeks - typically 6

Kid will have vomiting (projectile) that is milky in colour, occurring after feeds. On palpitation a olive sized mass can be felt. Often has a metabolic alkalosis. Possibly malnourished and dehydrated

Distinguished from other causes of vomiting by:

  • No bile in vomit as obstruction high up
  • No diarrhoea
  • Vomiting characteristically mins after feed.
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3
Q

What are the investigations done to diagnose pyloric stenosis ?

A

It is difficult but can be felt on palpation (due to the characteristic olive sized mass) but if not then US is done to diagnose it.

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4
Q

What is the management of pyloric stenosis ?

A

Management is surgery:

  • Correct electrolyte distrubances
  • Ramstedt’s pyloromyotomy (pyloroplasty) - first choice
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5
Q

What is intussusception ?

A

Most common cause of intestinal obstruction in kids - where a part of the intestine invaginates (folds into) into another section of intestine, similar to the way the parts of a collapsible telescope retract into one another.

Result is obstruction

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6
Q

What are the signs/symptoms of intussusception?

A
  • Vomiting
  • Temp
  • Pain that comes in waves
  • Sausage shaped mass in the abdomen - right sided, usually RUQ
  • Might see red currant jelly in the faeces
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7
Q

What is the investigation of choice to diagnose intussusception?

A

US

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8
Q

What is the management of intussusception ?

A

First-line - US with reduction by air enema (least invasive)

Second-line - reduction by laproscopy or laparotomy

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9
Q

What is appendicitis and who is it most common in ?

A

Inflam of appendix - most common in young people 10-20

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10
Q

What are the signs/symptoms of appendicitis ?

A

Usually presents with intermittent umbilical pain which travels to your RIF becoming constant and severe.

Additional symptoms:

  • Feeling/being sick
  • Loss of appetite
  • Diarrhoea
  • High temp and a flushed face
  • Rebound tenderness
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11
Q

What are the tests/examminations for suspected appendicitis ?

A
  • On examination have the kid hop - if they cant then appendicitis unlikely
  • US imaging is useful
  • In women of child bearing age pregnancy test is needed to rule out ectopic pregnancy
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12
Q

What is the management of appendicitis ?

A

Appendectomy (laproscopic surgery)

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13
Q

What is a severe complication of appendicitis ?

A

Peritonitis - due to appendix bursting

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14
Q

What is peritonitis and its symptoms ?

A

Inflam of peritoneum caused by infection

Symptoms:

  • Rigid abdomen
  • Nausea
  • Vomiting
  • Minimal urine output.
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15
Q

What is malrotation?

A

Congenital anomaly of rotation of the midgut

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16
Q

What is the potentially life-threatening complication of malrotation?

A

Volvulus - where the bowel twists so the blood supply to that part of the bowel is cut off.

17
Q

What are the signs/symptoms of malrotation/volvulus ?

A
  • Swollen abdomen that’s tender to the touch.
  • Diarrhea and/or bloody stools (or sometimes no stools at all)
  • Irritability or crying in pain, with nothing seeming to help.
  • RapidHR and breathing.
  • Little or no urine because of fluid loss.
  • Fever.
18
Q

What is the characteristic sign of malrotation/volvulus ?

A

Vomiting bile (this is GREEN)

19
Q

When does malrotation usually present ?

A
  • 60% of cases in 4-6 weeks
  • 90% of cases by 1 year
20
Q

What is the investigation of choice to rule out malrotation/volvulus ?

A

Upper GI contrast with follow

21
Q

What is appendix testis torsion?

A

Its when the appendix testis (left over female part) torts

22
Q

What are the signs/symptoms of appendix tortis ?

A
  • Pain at the top of the testicle
  • Sometimes a blue dot over the area