Common Surgical Problems in Paediatrics

Question 1

What is the suspected cause for a 6 week old baby who is projectile vomiting?

Answer 1

Pyloric stenosis

Question 2

What is the appropriate investigation to investigate a potential case of pyloric stenosis?

Answer 2

USS

Question 3

Which surgical procedure can be used to cure pyloric stenosis?

Answer 3

Pyloromyotomy

Question 4

What exactly does a pyloromyotomy involve?

Answer 4

1. Single incision made in pylorus wall
2. Lining of the pylorus bulges through the incision
3. Channel opened from stomach to small intestine

Question 5

“Redcurrent jelly” faeces is associated with which condition?

Answer 5

Intussusception

Question 6

What is intussusception?

Answer 6

“Telescoping” of the bowel in on itself causing obstruction

It usually involves invagination of the terminal ileum into the caecum and can go through the ascending colon and in rare cases out the anus

Question 7

How does intussusception present clinically?

Answer 7

1. Babies around 6 months
2. Clear pain
3. Brings legs up in pain then goes limp after
4. Baby may be pale

Question 8

How does intussusception differ clinically from just colick?

Answer 8

Colick does not present with the classical features:

1. Redcurrent jelly faecaes
2. Brings legs up in pain and then going limp
3. Paleness

Question 9

How does intussusception present on USS?

Answer 9

Classical “target” sign

(from side it may look like a kidney bean)

Question 10

How is intussusception treated?

Answer 10

Air is blown into the anus pushing the invagination outwards and back into the normal position

(surgery is rarely used)

Question 11

Why is it essential that intussusception is treated as the diagnosis is made?

Answer 11

May lead to venous obstruction and bowel-wall oedema

Further progression can lead to:

1. Bowel necrosis
2. Bowel perforation
3. Death

Question 12

If a child present with severe abdominal pain on any movement and cannot jump, what is a likely diagnosis?

Answer 12

Peritonitis

Question 13

What typically causes peritonitis in children?

Answer 13

Bacterial infection

Question 14

Generally, pain from acute appendicitis is localised to the _____, but in severe cases it may be ________

Answer 14

Generally, pain from acute appendicitis is localised to the RLQ, but in severe cases it may be diffuse

Question 15

Usually, appendicitis will present with a ____ grade fever

Answer 15

Usually, appendicitis will present with a low grade fever

(unless it is severe and/or associated with perforation)

Question 16

In children with abdominal pain, it is always important to screen for what?

Answer 16

UTI

(with dipstick test)

Question 17

If a child is admitted vomiting green bile, what is the likely diagnosis?

Answer 17

Malrotation (volvulus) of intestine

Question 18

In a child, malrotation of the intestine is generally a ________ problem

Answer 18

In a child, malrotation of the intestine is generally a congenital problem

Question 19

Which artery supplies the mid-gut and will befome occluded in the event of malrotation of the mid-gut?

Answer 19

Superior mesenteric artery

Question 20

What should be the two furthest points of the intestines in the abdomen?

Answer 20

Duodenum and caecum

Question 21

What does the bile vomited during malrotation resemble?

Answer 21

Fairy liquid

Question 22

Which diagnostic tests can be used for malrotation?

Answer 22

1. Contrast
2. CT scan

Only used in ambigous cases - there is no time to wait in severe cases!