Lecture Day 2 Essential Paediatric Surgery Flashcards
Name some elective paediatric surgery
Inguinal hernia Hydrocele Umbilical hernia Undescended testicle Penile problems
Inguinal are more common in which children?
Which type of inguinal hernia is more common?
Preterm delivery
Indirect.
Direct is rare.
Operate within 6 week, risk of bowel ischaemia or ovary
What is a hydrocele?
What is the cause
Cure
Scrotal swelling of variable size.
Persistant processus vaginalis
will better with time
Umbilical hernia
who’s it more common in?
Treatment
Preterm
Black 9:1 (black children more likely to need repair)
Ofter spontaneous closure.
Undescended testicle Incidence What must you differentiate? Will the descent continue after birth? Risks What makes difference to management
- 1:300
- true undescended & retractile testies
- up to 3 months
- risks: ↓ fertility, torsion, malignant change
- if testicles is palpable in abdomen
Phimosis
What is it
What is a common cause?
the inability to retract the skin
Separation of foreskin from glans occur from birth, release ‘smegma’
BSO: Balanitis xerotica obliterans -lichen sclerosus of penis
Paediatric emergency
Acute abdominal pain Painful scrotum Inguinal lumps The vomiting child Rectal bleeding Trauma
What is the most common emergency in childhood
acute appendicitis, 1/3 perforation
Intussusception
What is it caused by.
What age is it common in
how does it present
pain DD
Common in 5-18 months (payers patches in small bowel, enlarge -> blockage + hyper mobile bowel)
Invagination of bowel often at ileo-ceacal valve.
RSV vaccination
Present
leathery & floppy, colicky abdo pain, nothing settles them, bilious vomiting (late sign), red current jelly nappy
D.D appendicits
Testicular torsion
How does it present?
Acute scrotal pain
Systemic upset
scrotal swelling + erythema
Bell-clapper testies & contraction of cremaster spin the testies
Adhesion obstruction
When does it present
How does it present
Hx of previous surgery
Mostly in 3/12 after OP
Bile stained vomiting +- abdominal distension
Pyloric stenosis
First born male children 6/52 of age Strong family relationship Non-bilious projectile vomiting (milky) Constipation (2nd to dehydration) Poor/no weight gain Hypochloraemic, hypokalaemic, hyponatraemic alkalosis
Neonatal Surgery
Inguinal Hernias Necrotizing Enterocolitis Oesophageal atresia Bowel Obstruction Anterior Abdominal Wall Defects Diaphragmatic Hernias
Necrotizing Enterocolitis
Risk factors:
- prematurity (↓ immune, blood supply)
- asphyxia/hypoxia
- maternal drugs abuse
- early feeding
First 2 weeks of life, feedings difficulty, vomiting - abdodistension
GI emergency
Examination:
abdominal distension from intestinal loops,
Neonatal SIRS: liver failure, ↑ WCC
Anterior abdominal wall defects
1. Gastroschisis- what is it
No peritoneal covering of bowel protruding from R side of umbilicus.
Still poor outcome: bowel transplants or TPN
