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
