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Paediatric surgery Flashcards

1
Q

What are the essential surgery topics in paediatrics?

A 
Acute abdomen in children
Acute scrotum
Foreskin problems
Groin swellings
Head and neck lumps
Umbilicus
Undescended testes
Vomiting infant
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2
Q

What is it important to do with a child presenting with abdominal pain?

A

Always examine testes in males

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3
Q

How do you diagnose testicular torsion?

A

Surgical exploration

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4
Q

How do you diagnose acute scrotal pain?

A

Surgical exploration

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5
Q

How long do you have to save the testicle from onset of testicular torsion?

A

6 hours

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6
Q

What are the differential diagnoses of acute scrotal pain?

A 
TESTICULAR TORSION
Torsion of hydatid (torsion of appendix testis)
Epididymo-orchitis
Trauma - needs to be significant
Acute hydrocele
Idiopathic scrotal oedema (3,4,5)
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7
Q

What investigations should you do in a child with acute scrotal pain?

A

Surgical exploration

Urine dip - rules out epididymo-orchitis

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8
Q

How common is testicular torsion?

A

2 peaks of incidence - neonatal and puberty
1 in 4000/year
Can happen at any time

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9
Q

What are the S&S of testicular torsion?

A

Sudden onset pain
Often severe pain so vomiting
Tender testicle
Redness and swelling are LATE signs

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10
Q

What is the appendix testis?

A

Hydatid of morgagni

Remnant of paramesonephric/malarian duct

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11
Q

What are the S&S of torsion of appendix testis?

A

Mimics testicular torsion
Often in pre-pubertal boys
Pain not usually as severe or as acute onset as torsion
Can be blue dot in 1/3 cases - infarcted section on upper pole of testes

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12
Q

What is idiopathic scrotal oedema?

A

Condition that occurs in young children with no particular cause

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13
Q

What are the S&S of idiopathic scrotal oedema?

A 
Becomes red and swollen
Urticarial appearance
Oedema
Redness goes up onto groin area and down onto perianal area
Not particularly painful
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14
Q

How is idiopathic scrotal oedema treated?

A

Rest

NSAIDs

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15
Q

Is non-retractile foreskin normal?

A

Yes

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16
Q

What condition should you circumcise?

A

Balanitis xerotica obliterans

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17
Q

Why do we circumcise BXO?

A

If untreated goes on to affect the glands

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18
Q

What is hypospadias?

A

Birth defect where opening of urethra located at tip of penis
Foreskin is hooded
Penis has bend when erect

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19
Q

What should you check in a child with hypospadias and why?

A

Check testes are palpable
Check whether baby is actually XX but has been exposed to a lot of testosterone in womb due to congenital adrenal hyperplasia

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20
Q

What is the other problem with congenital adrenal hyperplasia?

A

Aldosterone not working properly so baby can get very ill

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21
Q

How do you treat hypospadia?

A

Recommend to parents not to get baby circumcised even for religious reasons
Refer to paediatric urology

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22
Q

What is the importance of the inguinal canal?

A

Testes descend through inguinal canal

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23
Q

What are the two main groin problems?

A

Hernia

Hydrocele

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24
Q

How do you differentiate between a hernia and a hydrocele?

A

Can you get above it?

Can’t get above a hernia

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25
How common are inguinal hernias?
Incidence 1% 80% male Slight R>L 10% bilateral
26
Which inguinal hernia do you get in children?
Indirect (through deep inguinal ring)
27
Do you more urgently repair a hernia in younger or older children and why?
Younger - Within days in neonates - Within weeks in infants Higher risk of complications such as strangulation in younger children
28
How common are hydroceles?
Very common in children
29
By what age do hydroceles tend to have cleared by?
4/5
30
How do you treat a hydrocele?
Leave them | If symptomatic/very large/haven't cleared by 4/5 may do surgery
31
Why should you not transiluminate in children?
Bowel will also transiluminate due to thin bowel wall
32
What are possible differentials of neck lumps in children?
``` Lymph nodes Thyroglossal remnants Malignany Branchial arch/cleft remnants Sternomastoid tumour Cystic hydroma Haemangioma Pilomatrixoma ```
33
What are the possible differentials for head lumps?
Lymph nodes Dermoid cyst Encephalocoele Tumour secondaries
34
What is a thyroglossal remnant?
Moves when stick tongue out Need surgery as can become infected/inflamed Chunk of hyoid bone often removed too to prevent recurrence
35
What happens with branchial arch/cleft remants?
Sinus Fistula Cyst Often weeps on neck
36
What is a dermoid cyst?
Folds of skin in development get trapped under other folds of skin Get larger over time If laterally over face don't need to worry If in midline then high risk of tracking into CSF so refer to neurosurgeons
37
When do we worry with lymphadenopathy?
> 2cm Inflamed > 2 weeks Enlarging BUT very common in children and may not go back down in size
38
When do you operate on capillary haemangiomas?
If covering something like eye/nose
39
How are umbilical hernias treated?
Leave, conservative management 95% resolve spontaneously Risk of incarceration very low Operate age 4-5 if not closed
40
What is omphalitis?
Umbilical infection
41
Why is omphalitis very serious?
Good lymphatic drainage connections to IVC via umbilical ligament so can rapidly cause sepsis
42
How is omphalitis treated?
Admit and treat with IV antibiotics
43
How are granulomas of the umbilicus treated?
Treat with saline washes
44
How common are undescended testes?
Up to 5% at birth | 1% at 6 months - a lot will slowly descend if leave
45
When should you operate on undescended testes and why?
Optimal around 9 months If not descended after 6 months then unlikely to descend any more, if leave after 1 year then unlikely to be fertile testes
46
How commonly might you be able to palpate an undescended testes?
Palpable 80% Impalpable 20% - not there? Intrabdominal? Ectopic? Bilateral impalpable testes in newborn male - medical emergency
47
How do you investigate undescended testes?
Surgical exploration
48
How is an undescended testes treated?
Move the testes Laparoscopy and examination under anaesthetic for impalpable May need 2 stages for intrabdominal Risk of re-ascent later in life
49
What should you thing of and do with a baby with bright green vomit?
Malrotation | Refer to surgery immediately
50
What is gastroschisis?
Bowel exposed and come through umbilicus
51
How common is gastroschisis?
1 in 1000 | Not really related to congenital abnormalities (when it is it's related to bowel injury)
52
How is gastroschisis treated?
Reduced surgically or preformed silo (generally silo as abdomen often too small as bowel hasn't developed in abdomen)
53
What is exomphalos?
Bowel come through umbilicus but still in a sac
54
How common is exomphalos?
1 in 5000 Related to congenital anomalies - chromosomal, cardiac, Beckwith-Weidemann Can be giant including liver through too
55
What can cause neonatal surgical respiratory distress?
Oesophageal atresia Thoracic problems - Congenital diaphragmatic hernia - Congenital pulmonary airway malformations
56
How common is oesophageal atresia?
1 in 3000 | VACTERL associated
57
What is VACTERL association?
``` Vertebral defects Anal atresia Cardiac defects Tracheo-oesophageal fistula Renal anomalies Limb abnormalities ```
58
What are the two types of oesophageal atresia?
Proximal - no way through at all | Distal - attached to airway instead
59
How is the oesophagus formed?
Lungs formed from bud within embryonic foregut which will form oesophagus and trachea
60
How common are congenital diaphragmatic hernias?
``` 1 in 2500 50% overall survival rate Antenatal diagnosis Usually left sided Usually posterolateral ```
61
How common are congenital pulmonary airway malformations?
1 in 10,000 Leave alone if small and asymptomatic Antenatal diagnosis
62
How common is duodenal atresia and what is it associated with?
1 in 5000 Trisomy 21 VACTERL
63
How does duodenal atresia present?
Double bubble appearance on XR | 90% bilious vomiting
64
How common are small bowel atresias?
1 in 5000 Can be multiple Can be short bowel (bowel loss) Can be very discrepant - might have to anastamose bowel
65
How common are anorectal malformations and what is it related to?
1 in 5000 VACTERL Many different types
66
How are anorectal malformations treated?
Stoma then PSARP operation
67
How common is Hirschsprung's disease?
1 in 5000
68
What is Hirschsprung's disease?
Distal aganglionosis
69
How does Hirschsprung's disease present?
Failure to pass meconium (normally 95% passed by 24 hrs) | Progressive abdominal distension
70
How is Hirschsprung's disease treated?
Washouts | Pullthrough operation
71
What is meconium ileus related to?
10% CF patients
72
Why is meconium ileus related to CF?
Thick intestinal secretions form pellets | Blocks terminal ileum
73
How is meconium ileus treated?
Laparotomy
74
How common is trauma in children?
Leading cause of death in over 15s | Cancer higher until then
75
How is trauma different to adults?
Different injury patterns Different imaging protocols Different management
76
Who gets necrotising enterocolitis?
Premature babies
77
How does necrotising enterocolitis present?
``` Red distended abdomen Bowel inflamed - undergoes necrosis Pneumatosis Blood in stool Bile vomit Feed intolerance ```
78
Why does necrotising enterocolitis occur?
Premature babies have immature and fragile bowels but still need feeding and some get infection
79
How is necrotising enterocolitis treated?
Bowel rest | Might need surgery to prevent bowel dying and to repair any perforations
80
What is the prognosis of necrotising enterocolitis?
50% mortality rate in those needing surgery

Paediatrics (21 decks)

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