Neonatal surgical problems Flashcards
Aetiology of cleft lip +/- palate (3)
Maternal smoking and alcohol
Genetic factors
Certain drugs e.g. phenytoin, sodium valproate, benzos, steroids
Failure of the diaphragm to fuse properly allowing abdominal organs to migrate into the chest, displacing the mediastinum
Diaphragmatic hernia
Diaphragmatic hernias more commonly occur on what side, and are associated with what other conditions (2)?
Usually the left, and associated with pulmonary hypoplasia and heart defects
X-ray appearance of diaphragmatic hernia
Loops of bowel in the chest cavity
Management of diaphragmatic hernia (2)
Gut decompression, surgical repair
Persistentbilious vomiting within hours of birth, and “double bubble” appearance of duodenum and stomach on X-ray
Duodenal atresia
Noisy respiration, with inspiratory stridor worse lying down, and normal cry
Laryngomalacia
Difference between gastroschisis and exomphalos
Both are congenital defects with extrusion of bowel contents; in exomphalos there is a covering of peritoneum and amnion, whereas in gastroschisis there is no peritoneum
Hirchsprung’s disease is also known as
congenital megacolon
Underlying pathology of Hirchsprungs disease
Absence of parasympathetic ganglia in the colon, often extending to the rectum, causing functional colonic obstruction
Diseases associated with Hirchsprungs (2)
Multiple endocrine neoplasia
Downs syndrome
Presentation of Hirchsprungs (2)
Failure to pass meconium first 24 hours
Megacolon on X-ray/barium enema
Surgical treatment of Hirchsprungs (2)
Resection of the aganglionic segment and end-to-end anastamosis. Colostomy (either temporary or permanent) may be required
Excess of fluid between the two layers of the tunica vaginalis due to failure of closure of processus vaginalis, or impaired reabsorption of fluid after closure
Hydrocele (communicating hydrocele if processus vaginalis still open)
Inguinal hernias in young boys are usually…
Indirect
Most common sites for the testicle in testicular maldescent
Within inguinal canal, at the external ring, or “high rectractile”
“Telescoping” of proximal bowel into distal
Intussusception
Aetiology of Intussusception
viral hypertrophy of Peyer’s patches
Presentation of Intussusception (4)
Children aged 3 months to 2 years
crampy abd pain
vomiting
“redcurrant jelly” stools
What is Meckel’s diverticulum?
Congenital diverticulum in the small intestine
How does Meckels diverticulum present? (2)
Painless rectal bleeding (from ulcer). Usually around 2 years old
4 week year old with non-bilious projectile vomiting and “olive-shaped” mass just above the umbilicus
Pyloric stenosis
Treatment of pyloric stenosis
Rmastedt pylorotomy
Where does intussusception most commonly occur?
Proximal to/ at the level of the ileocaecal valve
