common surgical problems in paeds

Question 1

6 wk old with lumps on abdomen and projectile vomiting of mlk, what could b the problem

Answer 1

pyloric blockage (stenosis?))

Question 2

on USS the muscles surrounding the pyloric has thickened, what is problem and how is it fixed

Answer 2

pyloric stenosis 
pyloric myonotomy (surgery)

Question 3

6mnths old vomiting first food over past few days, then yellow and green substance, lethargic, lumps on patients left side of abdomen (sausage like mass), redcurrant jelly tinge of faecal matter in nappy, what could it be

Answer 3

segmoid volvulus (unlikely - older) 
intususseption

Question 4

USS shows ‘bullseye/target sign’
another USS ‘kidney bean’ (pseudokidney)
what does this suggest?

Answer 4

intususseption

Question 5

how to explain intususseption to patients

Answer 5

telescope imagery
intestinal intercourse
rolling up sleeve

Question 6

how is intususseption treated

Answer 6

air blown up rectum

gas filleds round bowel, unravels and pushes back (70/80% cases, others will require surgery)

Question 7

peritonitis - how to test in children

Answer 7

ask them to jump

Question 8

blood supply from midgut is from

Answer 8

superior mesentary atery

Question 9

child throws up green vomit, where is obstructon and what is producing the green

Answer 9

high gut - duodenum?

from gall bladder/bile source

Question 10

baby with gren vomiting, middle of night, what is worst case scenario

Answer 10

malrotation of midgut

will kill gut + then child