Paediatric Surgery Flashcards
Peak age for intussusception
3 months to 2 years old
What is hypospadias
Urethral opening is proximal to normal meatus on the glans due to failure of completion of urethral tubularisation
What is chordee?
Ventral curvature of the shaft of the penis, most apparent in erection. Only marked in the most severe form of hypospadias
What does hypospadias consist of
Ventral urethral meatus, hooded dorsal foreskin, chordee
How to manage hypospadias?
Surgery before 2 years of to produce a terminal urethral meatus, straight erection and a normal looking penis
What is the spiral/corkscrew sign indicative of and where is it located
Midgut volvulus, at the duodenojejunal junction
Tests for intussusception
IV resus and Analgesia first!
AXR: absence of cecal gas, crescent sign, dilated small bowel, target sign
ABD US: target sign and pseudo kidney sign
Contrast/gas enema: CI if peritonitis, perf, shock
FBC, FBG, U&E, blood group and hold
Immediate management of intussusception
2 large bore cannula NBM Analgesia O2 If in shock: bolus NS Monitor signs of shock: urine output, VS
Definitive management of intussusception
Air enema
If perf/bowel obstruction: insert NG tube
Consider IV cefazolin/metronidazole
Other options: USG guided saline solution
If above fails: surgical reduction
Features of intussusception
Paroxysmal severe colicky pain and pallor
May refuse feeding
Vomiting
Sausage-shaped mass in abdomen
Red-currant jelly stool
Abdominal distention, tenderness, guarding, shock
When does malrotation and volvulus present and when does it occur in gestation
Within 1st few days but potentially up to 2 weeks, 8-10 weeks gestation
How to test for malrotation and volvulus
Oral contrast study Of upper GI
Abdominal U/S
Hirschsprung’s disease clinical features
Failure to pass meconium within 24 hours of life
Constipation, poor feeding, +/- bilious vomiting, abdominal distention, Squirt sign on PR exam
Tests for Hirschsprung’s
Rectal suction biopsy
Abd X Ray - distended large bowel, fluid levels
FBC TRO enterocolitis
Necrotizing enterocolitis features
Rapidly progressing distention, tenderness, vomiting, fever, watery foul smelling diarrhoea, blood on DRE.
Managing pyloric stenosis
NBM
NG tube if profuse vomiting continues
IV rehydration
Delay surgery till hydration, electrolyte levels and acid base disturbance corrected
- monitor VBG and electrolytes 6 holy initially
- aim for full correction in 48 hours
Pyloromyotomy
How to investigate pyloric stenosis
U&E, VBG, abdominal U/S
When does pyloric stenosis present and what are its clinical features
2-6 weeks of chronological age
Vomiting which gets more frequent and forceful and eventually is projectile, soon after feeding and non-bilious, can have blood
Child often hungry afterwards until dehydration curbs that
Weight loss if delayed presentation
Classification of undescended testis
Retractile: can manipulate into scrotum without tension but retracts into the inguinal region after because the cremasteric muscle pulls it up. Needs follow-up but usually it resides in the scrotum permanently
Palpable: in the groin but not in scrotum, sometimes ectopic
Impalpable: may be in inguinal canal, intra-abdominal or absent
Tests for undescended testis
Ultrasound: in children with bilateral impalpable testes to verify internal pelvic organs
Hormonal: for bilateral impalpable tested, can confirm testicular tissue by recording rise in serum testosterone to IM injection of HCG, may require endocrine review
Laparoscopy: test of choice.
Management of undescended testis
Orchidopexy by 1-2 y/o because
- fertility (testis needs to be in scrotum below body temperature)
- malignancy (is greater, greatest in intra-abdominal)
- cosmetic and psychological
- must do abdominal ultrasound and serum tumor markers beforehand
How to manage inguinal hernia in infant
Try reducing by administering opioids and sustained gentle compression, delay surgery for 24-48 hours to allow odema to resolve
If reduction impossible/associated with undescended testis, emergency surgery needed
Hydrocoele management
It resorbs and tunica vaginalis closes spontaneously in first year
Consider surgical referral for repair if present after 2 years
Cause of inguinal hernia and hydrocoele
Patent processes vaginalis
Varicocoele management
Refer to surgery when symptomatic, impaired testicular growth and infertility
Testicular torsion management
Need early surgical consult because it will infarct in 8-12 hours
Clear fluids until surgical review
Torsion hydatid peak onset, classic sign, management
11 years old
Blue dot sign - necrotic appendage seen thru skin
Analgesia, rest
Pain resolves in 2-12 days, should lessen by 48 hours
Usually requires surgical exploration, can excise torted areas
Epididymoorchitis management
Urine MCS + PCR for chlamydia and gonorrhea
Antibiotics: IV benpen + gentamicin if systemically unwell/young infant
PO Co-trimoxazole if we’ll
Slow to resolve, may have weeks of gradually subsiding scrotal discomfort and swelling
Second episode: do renal tract US/MCU
Testicular or epidydymal rupture
Surgical review in ALL testicular trauma unless testis clearly felt to be normal and without significant tenderness
