General Surgery Flashcards
Findings for malrotation with volvulus on AXR, US, and UGI?
AXR = double bubble sign US = whirlpool sign UGI = dilated duodenum, corkscrew sign
Intussception - age range, etiology, presentation, imaging findings, and management
Age = 3 months to 3 years Etiology = idiopathic (peyer's patches) or leadpoints (polyps, Meckel's, CF, IBD, lymphoma) Presentation = acute colicky abdo pain, currant jelly stools, bilious emesis, sausage mass Imaging = AXR (obstructive), US (target lesion) Management = enema reduction (if stable), surgical
Definition, management, + most common associated abnormality for hypospadias
= congenital defect where urethral opening is located on the ventral side of the penis
- Mgmt: Surgical correction 6-12 months of age, avoid circumcision until then (as may use the tissue)
- Chordee: fibrous band of tissue on ventral side causing curvature
Clinical presentation of intussception
- Classic triad (only 20%) = colicky pain, emesis, red currant bloody stool
- Other = toxic, shock, dehydration, RLQ mass, distention
Umbilical hernias: (a) approximate size when unlikely to spontaneously close and (b) what age to intervene if not closed?
(a) >1.5-2.0cm
(b) 5 years of age
Phimosis - definition + possible treatment
=narrowing of distal foreskin that prevents retraction over the glans penis
- Normal adhesions in the newborn
- May require circumcision
Paraphimosis - definition, complication, management steps
=incarceration of retracted foreskin behind the glans
- Progressive edema –> ischemia
- Ice, anesthesia, manual reduction –> surgical
Most common associated abnormality to gastroschisis?
intestinal atresia
Important initial steps in management of a neonate born with gastroschisis
- Wrap bowel in sterile/saline dressings + plastic wrap
- Maintain normothermic
- Fluids
- IV Abx
- OG for decompression
- Surgical intervention
What is the most common congenital anomaly of the GI tract?
Meckel’s Diverticulum
Rule of 2’s for Meckel’s Diverticulum
- 2% of the population
- 2:1 of M:F
- 2-6% symptomatic, complicated
- 50-75% symptomatic by age 2
- Within 2 feet of ileocecal valve
- 2 inches long
- 2 types of heterotropic mucosa - gastric, pancreatic
x3 main complications/presentations of Meckel’s Diverticulum
- Bleeding = most common, painless
- Diverticulitis
- Obstruction
What is the investigation (+what does it detect) for Meckel’s Diverticulum?
99Tc Meckel’s scan = gastric mucosa
US findings for pyloric stenosis
- Length >14mm + thickness >4mm
- Shouldering
Metabolic derangement in pyloric stenosis
- HypoCl metabolic alkalosis
- Paradoxical aciduria
x3 cardinal features of Hirschsprung’s disease
- Failure to pass meconium within 24 hours of birth
- Abdo distention
- Bilious emesis
Infectious complication of Hirschsprung disease, including symptoms
Hirschsprung-associated enterocolitis
-acute diarrhea, explosive stools, abdo distention
Important management steps for Malrotation
- Surgical center
- NG to LIS
- IVF resus
- IV Abx
- Surgical Ladd’s procedure
Top x5 diagnoses for bilious emesis
- Malrotation with midgut volvulus
- Duodenal or other atresia
- Annular pancreas
- Hirschsprung’s disease
- Ileus
Where is the level of obstruction if (a) no abdo distention vs (b) abdo distention?
(a) proximal
(b) distal
Reasons to repair an umbilical hernia early (x2)
- Bowel incarceration
- Hernia size = controversial
x3 risk factors for an inguinal hernia in children
- Prematurity
- VP shunt
- Peritoneal dialysis
Incarcerated inguinal hernia - rate of incidence (+ inc if prem)
~8%
-x2 greater if prem
If no clear reason for a hydrocele, what must you think about?
Secondary hydrocele - think of testicular pathology
