Paediatric essential surgery Flashcards
Why is there a higher risk of perforation in children <2yrs?
They can’t verbalise so symptoms go unnoticed
What are the history features of a child with appendicitis?
-Anorexia
-Vomiting
-Diarrhoea
-Imprecise localisation of pain
What are the examination findings of a child with appendicitis?
- Bad breath (foetor)
- Flushed cheeks with perioral pallor
- Low grade fever
- Localised tenderness/guarding
- Rigid abdomen suggests peritonitis (child may be very still to avoid pain)
What is Intussusception?
When the ilium fold into the large bowel causing obstruction
Blood vessels become trapped so blood flow decreases causing oedema, strangulation of bowel, and eventually gangrene, sepsis, shock, and death
What are red current jelly stools suggestive of?
Late stage intussusception
tool mixed with blood and mucus)
How is Intussusception treated?
With air enema reduction or surgery in pathological cases
(Air will push the bowel out and fix the problem. There’s a risk of perforation so patient is not anaesthetised during the procedure to look for signs of complication like pain. Safer then water because air can easily be seen on an x-ray)
When is idiopathic Intussusception most common?
3-6 months. Cause unknown but it seems to be to do with weaning baby off milk and it often proceeded after chest/bowel infections
What is the donut sign on an ultrasound diagnostic of?
Intussusception
A donut forms where the bowel intercepts
What is transient Intussusception?
When the obstruction comes and goes so doesn’t need surgery
When is pathological Intussusception most common?
Can be caused by tumours so in diseases like Burkitt’s lymphoma
What are the differentials for acute scrotal pain?
- TESTICULAR TORSION (needs to be ruled out first as most limb threatening)
- Torsion of hydatid
- Epididymo-orchitis
- Trauma (can lead to torsion)
- Acute hydrocele
- Idiopathic scrotal oedema (usually bilateral)
When is testicular torsion most common?
In neonates and puberty
But can happen at any time
What are the signs and symptoms of testicular torsion?
- Acute onset severe pain that may lead to vomiting
- Tender testicle
Late stage:
Redness and swelling
What is the appendix testes?
The remnant of the Mullerian duct, which in women develops into the oviducts, uterus, cervix and upper vagina
What is torsion of the appendix testes?
It mimics testicular torsion often in prepubertal boys, but pain is less severe and not as acute
Identified by a blue dot of the scrotum in 1/3 cases
What is idiopathic scrotal oedema?
A self-limiting disease of uncertain aetiology, more common in children
Usually bilateral and testicle itself is not tender
Where is testicular pain referred to in the body?
To the abdomen as that’s where tests descend from
How is testicular torsion diagnosed?
Through surgery to explore
How long will a testicular survive in testicular torsion?
6 hours from the onset of pain
Patient will arrive at hospital much later so usually there is less time
Is which age group are foreskin problems most common?
6-7yrs
Risk decreases with age
Which is phimosis?
Inability to retract the foreskin
Treated with a circumcision
What is Balanitis Xerotica Obliterans (BXO) of the foreskin?
Scarring of the foreskin. Treated with a circumcision
In adults it’s precancerous
What is a smegmal cyst?
When the normally released smegma gets trapped because in young boys the gland and foreskin are connected
Doesn’t need treatment, will disappear once foreskin and glans separate
What is smegma?
A combination of shed skin cells, skin oils, and moisture
Occurs in both male and female genitalia. In females, it collects around the clitoris and in the folds of the labia minora; in males, smegma collects under the foreskin
What is hypospadias?
A birth defect in boys in which the opening of the urethra is not located at the tip of the penis
Its a disorder of sex differentiation
How do you differentiate between a hernia and a hydrocele?
Hydrocele: non-reducible. Can be checked with ultrasound
Hernia: retractable
What is an indirect hernia?
Related to a defect in the lower abdominal wall that is present at birth
What are some differentials for paediatric neck lumps?
- Lymph nodes (most common)
- Thyroglossal remnants
- Malignant
- Brachial arch/cleft remnants
- Sternomastoid tumour
- Cystic hygroma
- Haemangioma
- Pilomatrixoma
What is a Pilomatrixoma?
A slow-growing, usually non-cancerous, skin tumour of the hair follicle
What is a haemangioma?
A common vascular birthmark, made of extra blood vessels in the skin
What is a cystic hygroma?
A birth defect that appears as a sac-like structure with a thin wall that most commonly occurs in the head and neck area of an infant
What is a brachial arch/cleft remnant?
A congenital condition where tissue develops incorrectly on one or both sides of the neck
What are some differentials for paediatric head lumps?
- Dermoid cyst
- Encephalocele
- Tumour secondaries
What are dermoid cysts?
Skin-lined cysts under the skin
Cysts with hair follicles
What is an encephalocele?
A sac-like protrusion or projection of the brain and the membranes that cover it through an opening in the skull
Happens when the neural tube does not close completely during pregnancy
When should a neck lump be suspected for lymphoma?
> 2cm
Inflamed >2/52
Enlarging
What is the difference between a thyroglossal fistula and cyst?
Fistula: acquired
Cyst: congenital
When are brachial fistulas treated?
Once they get infection
Done by complete surgical excision of all abnormally placed epithelium
When are umbilical hernias treated?
95% resolve spontaneously
Operate at age 4-5 if still not closed
What is divarication of recti?
There is a gap in the midline between the two rectus abdominus muscles
Usually closes by the age of 3 when the abdominal muscles strengthen
Not harmful but causes problems like lower back pain, poor posture, constipation, and instability of core muscles
What is omphalitis?
Infection of the umbilicus and/or surrounding tissue
What is a granuloma of the umbilical cord?
An overgrowth of scar tissue during the healing process of the belly button
When are undescended testes treated?
After 6 months
If premature, done after maturity is reached plus 6 months
What are true undescended testes?
When they’re stuck in the abdomen, inguinal canal, or supracrustal
What are ectopic undescended testes?
When they’re pre-penile, superficial ectopic, transverse scrotal, femoral, or perianal
Why is having bilateral impalpable testes a medical emergency?
Could be intersex
How are undescended testes treated?
Usually caused by arteries being in the way so they’re cut, and 6 months later when collateral blood supply has been established, they are descended
What are bright green secretions suggestive of?
A volvulus (when the intestine twists on itself causing an obstruction
