Intro week- Paediatric surgery Flashcards
How common are inguinal hernias in babies?
Term: 3-5%
Pre term:9-11%
Classified as an emergency surgery as can cause incarceration
What are the two types of inguinal hernias (and which one is more common)
Indirect: passes through inguinal ring and canal
Direct: passes directly though the abdominal wall (this is more rare?
Who gets inguinal hernias more commonly M or F?
Males are more likely to get inguinal hernias (8:1)
Who is most likely to get direct inguinal hernias?
Pre term babies and babies with connective tissue disorders
What causes hydrocele?
Hydrocele is caused by the persistence of processus vaginalis
how do you know if its a hydrocele?
- Bright light will illuminate testes surrounded by fluid
- You can ‘get above’ swelling (it is separate from the testicle)
treatment for hydrocele
surgery-however often resolve by themselves
prevalence of umbilical hernia?
incidence of umbilical hernia is 1:6
who is more likely to get umbilical hernias?
Black:white 9:1
What is the spontaneous closure rule? (umbilical hernias)
-if defect is 0.5cm at 2 years 96% will close spontaneously
When would you treat? (umbilical hernias)
if its still there around 3/4 years you would repair for cosmetic reasons
Symptoms of umbilical hernia?
rarely have symptoms, rarely obstruct and rarely incarcerate
Incidence of undescended testes?
about 4% at birth
What are extra risks for babies with undescended testes?
- decreased fertility (bringing them down to scrotum will reduce this risk
- risk of testicular torsion
- malignancy (if they are intra abdominal)
when should you operate on undescended testes?
after they are 1 year old (some will have spontaneously descended before then)
Whats the difference between physiological and pathological phimosis?
Pathological involves scaring
what are some types of elective surgeries? (5)
- inguinal hernia
- phimosis
- umbilical hernia
- hydrocele
What is the prevalence of appendicitis?
Lifetime risk 7-9%
Male: female 3:2
How many patients present with appendicitis, already perforated?
1/3 perforated at presentation
How common is Intussception?
Incidence 1-4:100
peak age of intusseption?
9 months. Can happen around 5-18 months
What can you see histologically with intusseption?
Inflamed/enlarged Peyer’s patches
Symptoms of intusseption?
- 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
Diagnosis of Intusseption?
- Diagnose with an USS
- Target/donut signs can be seen
Treatment of Intusseption?
- Treat with an air enema reduction (this works best for ileocolic intussception)
- Lots of children won’t tolerate this, need sedation
A child has intusseption, what would make you think that the bowel might be perforated?
-If it’s a long history, chances of the bowel on the inside are perforated
risk factors for Intusseption?
- Male
- 6-12 months
- preceding viral illness
Symptoms of testicular torsion?
- 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
Risk factors for testicular torsion (4)
- 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
Risk factors for adhesion obstruction?
What are the symptoms?
Treatment?
-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
Symptoms of adhesion obstruction?
- Bile stained vomit
- abdo distension
What is the conservative treatment for adhesive obstruction?
How long for?
How successful is it?
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
Investigation of testicular torsion?
- If obvious-straight to surgery ExLap
- If it is less obvious then can order an USS with doppler imaging
Risk factors for pyloric stenosis
- First born male child
- 6 weeks old (irrespective of gestation)
- strong family relationship
Symptoms of pyloric stenosis
- 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
Signs of pyloric stenosis
- Dehydration
- Hypochloraemic, hypokalaemic, hyponatraemic alkalosis
Investigations for suspected pyloric stenosis?
- 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)
Management for pyloric stenosis
- Resuscitate fluids and electrolyte correction
(0. 45% saline with 5% dextrose and potassium supplementation) - Surgery (pyloromyotomy)
