Intro week- Paediatric surgery

Question 1

How common are inguinal hernias in babies?

Answer 1

Term: 3-5%
Pre term:9-11%

Classified as an emergency surgery as can cause incarceration

Question 2

What are the two types of inguinal hernias (and which one is more common)

Answer 2

Indirect: passes through inguinal ring and canal
Direct: passes directly though the abdominal wall (this is more rare?

Question 3

Who gets inguinal hernias more commonly M or F?

Answer 3

Males are more likely to get inguinal hernias (8:1)

Question 4

Who is most likely to get direct inguinal hernias?

Answer 4

Pre term babies and babies with connective tissue disorders

Question 5

What causes hydrocele?

Answer 5

Hydrocele is caused by the persistence of processus vaginalis

Question 6

how do you know if its a hydrocele?

Answer 6

• Bright light will illuminate testes surrounded by fluid

- You can ‘get above’ swelling (it is separate from the testicle)

Question 7

treatment for hydrocele

Answer 7

surgery-however often resolve by themselves

Question 8

prevalence of umbilical hernia?

Answer 8

incidence of umbilical hernia is 1:6

Question 9

who is more likely to get umbilical hernias?

Answer 9

Black:white 9:1

Question 10

What is the spontaneous closure rule? (umbilical hernias)

Answer 10

-if defect is 0.5cm at 2 years 96% will close spontaneously

Question 11

When would you treat? (umbilical hernias)

Answer 11

if its still there around 3/4 years you would repair for cosmetic reasons

Question 12

Symptoms of umbilical hernia?

Answer 12

rarely have symptoms, rarely obstruct and rarely incarcerate

Question 13

Incidence of undescended testes?

Answer 13

about 4% at birth

Question 14

What are extra risks for babies with undescended testes?

Answer 14

• decreased fertility (bringing them down to scrotum will reduce this risk
• risk of testicular torsion
• malignancy (if they are intra abdominal)

Question 15

when should you operate on undescended testes?

Answer 15

after they are 1 year old (some will have spontaneously descended before then)

Question 16

Whats the difference between physiological and pathological phimosis?

Answer 16

Pathological involves scaring

Question 17

what are some types of elective surgeries? (5)

Answer 17

• inguinal hernia
• phimosis
• umbilical hernia
• hydrocele

Question 18

What is the prevalence of appendicitis?

Answer 18

Lifetime risk 7-9%

Male: female 3:2

Question 19

How many patients present with appendicitis, already perforated?

Answer 19

1/3 perforated at presentation

Question 20

How common is Intussception?

Answer 20

Incidence 1-4:100

Question 21

peak age of intusseption?

Answer 21

9 months. Can happen around 5-18 months

Question 22

What can you see histologically with intusseption?

Answer 22

Inflamed/enlarged Peyer’s patches

Question 23

Symptoms of intusseption?

Answer 23

• Present with symptoms of bowel obstruction
• Not going to the toilet
• Red current stools (late sign of septic bowels)
• Vomitting
• Colicky abdo pain
• Inconsolable during the pain

Question 24

Diagnosis of Intusseption?

Answer 24

• Diagnose with an USS

- Target/donut signs can be seen

Question 25

Treatment of Intusseption?

Answer 25

• Treat with an air enema reduction (this works best for ileocolic intussception)
• Lots of children won’t tolerate this, need sedation

Question 26

A child has intusseption, what would make you think that the bowel might be perforated?

Answer 26

-If it’s a long history, chances of the bowel on the inside are perforated

Question 27

risk factors for Intusseption?

Answer 27

• Male
• 6-12 months
• preceding viral illness

Question 28

Symptoms of testicular torsion?

Answer 28

• Acute unilateral scrotal pain
• Systemic upset
• Scrotal swelling and erythema
• Abdomen might be painful (however might not, there WILL NOT be guarding
• High testacal
• Absent cremasteric reflx

Question 29

Risk factors for testicular torsion (4)

Answer 29

• teenage boy
• rugby/ contact sport
• Bell-clapper testes deformity
• torsion on the other tests (might as well operate on both at same time)
• PMH of undescended testicle

Question 30

Risk factors for adhesion obstruction?

What are the symptoms?

Treatment?

Answer 30

-History of previous surgery, 2% of all laparotomies

Symptoms
-Bile stained vomiting +/- abdominal distension

Treatment

• Drip and suck (nasogastric tube to decompress the bowel, and IV fluids) : rarely successful
• Give it 48 hours to see, but if they’re tender or have significant pain they may have a closed loop obstruction then don’t wait and operate straight away

Question 31

Symptoms of adhesion obstruction?

Answer 31

• Bile stained vomit

- abdo distension

Question 32

What is the conservative treatment for adhesive obstruction?
How long for?
How successful is it?

Answer 32

DRIP AND SUCK

• NG tube and Fluids
• Try for 48 hours- only quarter of kids will respond to this and the others will require surgery

Question 33

Investigation of testicular torsion?

Answer 33

• If obvious-straight to surgery ExLap

- If it is less obvious then can order an USS with doppler imaging

Question 34

Risk factors for pyloric stenosis

Answer 34

• First born male child
• 6 weeks old (irrespective of gestation)
• strong family relationship

Question 35

Symptoms of pyloric stenosis

Answer 35

• vomiting (PROJECTILE AND NON BILIOUS- will look lie milk, will never be green
• poor weight gain
• reluctant to feed
• visible gastric peristalsis
• olive shaped palpable mass

Question 36

Signs of pyloric stenosis

Answer 36

• Dehydration

- Hypochloraemic, hypokalaemic, hyponatraemic alkalosis

Question 37

Investigations for suspected pyloric stenosis?

Answer 37

• blood gas (metabolic alkalosis)
• Us and Es (low sodium)
• USS (hypertrophic pylorus)
• Test feed- give food and try observe peristalsis
• Abdominal X ray (enlarged stomach with trapped air behind it)

Question 38

Management for pyloric stenosis

Answer 38

• Resuscitate fluids and electrolyte correction
  (0. 45% saline with 5% dextrose and potassium supplementation)
• Surgery (pyloromyotomy)