GENERAL SURGERY UROLOGY SN Flashcards
What are common associated anomalies seen with omphalocele?
- Trisomy syndromes (30%) 2. Cardiac defects (20%) 3. Bladder extrophy 4. Beckwidth-Wiedemann syndrome
What are common associated anomalies seen with gastroschisis?
- Intestinal atresia 2. Cryptochordism 3. Malrotation
When should undescended testicles be repaired?
12 months of age or shortly after 75% of full-term infants and 90% of prem babies with cryptorchidism will have full testicular descent by the age of 9 months. After that spontaneous testicular descent is unlikely.
What are the clinical manifestations of testicular torsion? (4)
- Acute onset of scrotal pain 2. Nausea and vomiting (common) 3. Acutely tender, high riding and swollen testis 4. Absent cremasteric reflex
What is the differential diagnosis of testicular torsion? (4)
- Epididymitis: ask about dysuria, pyuria, discharge. Often caused by chlamydia or gonorrhea. History of STIs is suggestive. 2. Orchitis: usually slower in onset, other systemic symptoms (nausea/vomiting/fever) as a result of diffuse viral infection 3. Torsion of testicular appendix: sudden onset of pain, localized, isolate tender nodule at upper pole -blue dot sign (bluish discoloration) 5. Incarcerated hernia: acute onset; usually palpable inguinal mass, testes not painful, symptoms and signs of bowel obstruction
What is the Prehn sign?
Positive Prehn sign: relief of pain with elevation of the testis in epididymitis Negative Prehn sign: generally indicative of testicular torsion ***non-specific though
If complete testicular torsion has occurred, how long is it before irreversible changes develop?
4-6 hours
What is the difference between a communicating hydrocele and a non-communicating hydrocele? -Time course of hydrocele (small vs. large) -Possible complication of hydrocele
Communicating hydrocele: patent processus vaginalis and thus mass will be soft, fluctuant -risk for hernia formation Non-communicating hydrocele: closed processus vaginalis and thus mass will be tubular, firm Time course: small generally resolve by 9-12 months; large may not resolve Complication: if does not resolve, may cause vascular compromise and testicular atrophy
What are red flags pointing to an underlying surgical cause in children with abdominal pain?
- Children < 5 years old 2. Bilious vomiting 3. Return to ED with same pain within 72 hrs of discharge home 4. Previous abdominal surgery 5. Progression of pain 6. Pain far away from umbilicus 7. Vomiting without diarrhea 8. Disturbance in gait 9. No pain like this before
What age group is intussusception most commonly seen in? -If intussusception is seen in age < 3 mo or > 2 yo, what is the clinical significance of this?
80% occur in children < 2 yo (Highest incidence between 5-9 mo) -if outside of this age range, more likely to have a lead point (hyperplasia of intestinal Peyer’s patches, Meckel’s, polyps, Burkitt’s lymphomas)
What is the classic triad of intussusception? -in what percentage of children is this triad seen in? -classic exam finding? -diagnostic imaging? -definitive treatment?
- Colicky abdo pain 2. Vomiting 3. Bloody stools -seen in only 20% of intussusception presentation -classic exam finding: sausage shaped mass in RUQ (if ileocecal intussusception) -ultrasound is best imaging modality (99% sensitive, 90% specific) -definitive treatment: air enema (more effective at reduction than barium and less risk of perforation)
What are risk factors for developing pyloric stenosis aka in which groups does pyloric stenosis tend to occur in? (6)
- Males (4-6x more likely than females) 2. Offspring of mother with history of pyloric stenosis 3. Those with blood group B or O 4. Caucasian 5. History of erythromycin use (especially in the first 2 weeks of life) 6. Certain syndromes (ie. Apert, Trisomy 18, etc.)
What is the recurrence risk of intussusception in the first 24 hrs?
10% in the first 24 hrs -this is why all patients need to be admitted post-reduction via air enema
What is Rigler’s sign?
On an AXR, if you see air on both sides of the bowel wall, this is perforation or free intraabdominal air -may also see triangle of air
What is the most common type of intussusception? -what is the most common pathological lead point for intussusception? -what is the gold standard test for intussusception? -what is the treatment for intussusception? -which type of intussusception cannot be managed with the usual treatment?
Ileo-colic = 85% -most common pathological lead point: Meckel’s diverticulum -gold standard test for intussusception: ultrasound = see target sign, then do air enema once dx confirmed for treatment -cannot use air enema for jejuno-ileo intussusception because the air enema can’t create enough pressure to resolve a small bowel intussusception
What are absolute contraindications for air enema?
- Peritonitis 2. Persistent hypotension 3. Free air/pneumoperitoneum
What is the rule of 2s for Meckels?
2:1 male to female 2% population Present by 2 yo 2 types of tissue: gastric or pancreatic Within 2 feet of ileocecal valve 2 inches long
When does the repair for congenital diaphragmatic hernia occur? -what are the first 3 steps you take when a baby with CDH is born (aside from NRP)?
Only repair when the baby has been stable x 24-48 hr after birth -first two management steps: 1. Intubate on first breath so the stomach doesn’t get distended in the chest cavity 2. Put in NG for decompression asap 3. Need to get an ECHO to see if cardiac function has been compromised by the bowel in the chest and also, CDH is associated with cardiac abnormalities as well
WHAT ARE THE Steps in the Development of Male & Female
Internal Genitalia?
WHAT ARE THE Steps in gonaldal development?
ANH What are the Canadian Urology Guidelines on ANH?
CAP= Continuous Antibiotic prophylaxis
What are the clinical features of Daytime Urinary Incontinence
Idiopathic Overactive Bladder (OAB)?
ANH What are the investigations urologists order for ANH when patients are referred to them?
Daytime incontinence When to Consider other etiologies if not consistent with OAB?
What are the Ddx of Pelvic & Abdominal Masses based on probability?
