Paediatric General Surgery

Question 1

Define pyloric stenosis

Answer 1

Hypertrophy of the circular pyloric muscles that causes gastric outlet obstruction

Question 2

How does pyloric stenosis present

Answer 2

• Non-bilious vomiting between 3 and 6 weeks of age

- Becomes projectile

Question 3

What is the biochemical consequences of pyloric stenosis

Answer 3

Hypochloraemic, hypokalaemic metabolic alkalosis

Question 4

How is the diagnosis of pyloric stenosis confirmed

Answer 4

• USS - thickened elongated pylorus

- Barium meal

Question 5

How is pyloric stenosis treated

Answer 5

1. NBM
2. IV infusion 5% dex/0.45% saline/10mmol K+
   (Anaesthesia not safe until alkalosis corrected)
3. Surgical pyloromyotomy

Question 6

Important precaution in pyloromyotomy

Answer 6

Do NOT breach the mucosa

Question 7

When should inguinal hernias be repaired in infants

Answer 7

Within 2 weeks due to the risk of incarceration

Question 8

How are inguinal hernias repaired in children

Answer 8

Herniotomy - sac is dissected free from the vas and vessels then transfixion-ligated and the deep ring

Question 9

Describe omphalitis

Answer 9

• Infection of the umbilical site

- Characterised by erythema and discharge of pus

Question 10

When should you delay operating on umbilical hernias to

Answer 10

3 years

Question 11

Describe biliary atresia

Answer 11

• Extrahepatic bile ducts are destroyed by inflammation

- Presents as jaundice, hepatosplenomegaly, pale stools, dark urine

Question 12

How is biliary atresia treated

Answer 12

• Biliary-enteric anastomosis
• Portoenterostomy
• Liver transplant (if above fail)

Question 13

Presentation of mesenteric adenitis

Answer 13

• Flu-like prodrome/URTI
• Vague abdominal pain
• Cervical lymphadenopathy
• Fever

Question 14

How is ileal-ileal intissusception managed

Answer 14

Laparotomy