Common surgical problems in children - part 1

Question 1

What is pyloric stenosis ?

Answer 1

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

Question 2

What are the signs/symptoms of plyoric stenosis ?

Answer 2

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.

Question 3

What are the investigations done to diagnose pyloric stenosis ?

Answer 3

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.

Question 4

What is the management of pyloric stenosis ?

Answer 4

Management is surgery:

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

Question 5

What is intussusception ?

Answer 5

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

Question 6

What are the signs/symptoms of intussusception?

Answer 6

• Vomiting
• Temp
• Pain that comes in waves
• Sausage shaped mass in the abdomen
• Might see red currant jelly in the faeces

Question 7

What is the investigation of choice to diagnose intussusception?

Answer 7

US

Question 8

What is the management of intussusception ?

Answer 8

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

Second-line - reduction by laproscopy or laparotomy

Question 9

What is appendicitis and who is it most common in ?

Answer 9

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

Question 10

What are the signs/symptoms of appendicitis ?

Answer 10

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

Question 11

What are the tests/examminations for suspected appendicitis ?

Answer 11

• 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

Question 12

What is the management of appendicitis ?

Answer 12

Appendectomy (laproscopic surgery)

Question 13

What is a severe complication of appendicitis ?

Answer 13

Peritonitis - due to appendix bursting

Question 14

What is peritonitis and its symptoms ?

Answer 14

Inflam of peritoneum caused by infection

Symptoms:

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

Question 15

What is malrotation?

Answer 15

Congenital anomaly of rotation of the midgut

Question 16

What is the potentially life-threatening complication of malrotation?

Answer 16

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

Question 17

What are the signs/symptoms of malrotation/volvulus ?

Answer 17

• 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.

Question 18

What is the characteristic sign of malrotation/volvulus ?

Answer 18

Vomiting bile (this is GREEN)

Question 19

When does malrotation usually present ?

Answer 19

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

Question 20

What is appendix testis torsion?

Answer 20

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

Question 21

What are the signs/symptoms of appendix tortis ?

Answer 21

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