Paediatric Surgery

Question 1

Meckel’s Diverticulum

Answer 1

Vestigial remnant of the Vitelline duct
Most common malformation of the GI tract
2% of population have this
2% symptomatic (actually 4-6%)
2 inches long
2 feet from the ileocaecal valve (distal ileum)
2:1 M:F
2 types of ectopic tissue - gastric and pancreatic
Symptoms usually <2yo
Symptoms: painless rectal bleeding, bowel obstruction, intussusception, epigastric pain and bloating
Complications: GI bleeding, bowel obstruction, diverticulitis, umbilical anomalies, neoplasm

Question 2

Hirschsprung’s disease

Answer 2

1:5000
Section of large bowel is not innervated, which causes stricture of the bowel
If apparent at birth it manifests as not passing meconium <48 hours or megacolon
50% diagnosed in first year of life
Constipation #1 symptom, then vomiting, abdominal pain, diarrhoea, slow growth
Complications: enterocolitis, megacolon, bowel obstruction, perforation, abdominal swelling
Can occur in isolation or with genetic differences eg trisomy 21

Question 3

Appendicitis incidence by age

Answer 3

1:10 000 preschool
7:10 000 5-9yo
20:10 000 10-14yo

Question 4

Intussusception high risk groups

Answer 4

Previous intussusception
Sibling with intussusception
Intestinal malrotation
CF
Intestinal polyps
M>F

Question 5

Intussusception facts and hx/exam

Answer 5

Most common cause of intestinal obstruction <3yo
Intermittent crying spells ~q20 mins
Pulling legs up
Fever/vomiting/diarrhoea
Red currant jelly stool
Mass in RUQ - sausage-shaped
Peritonism/collapsed

Question 6

Inguinal hernia facts and risks

Answer 6

3-5% full term infants, 13% of <33weeks
Patent processes vaginalis allowing herniation of omentum, bowel, testes and ovaries. If small defect will cause hydrocoele
RF:
Prematurity
Undescended testes
9:1 M:F
CF
FHx hernias
DDH
Urethral abnormalities

Question 7

Inguinal hernia - when to refer

Answer 7

Neonate = 1week
Infant = 2-4 weeks
Child = 1-3 months

Question 8

Constipation - functional

Answer 8

Use Rome III criteria for diagnosis of functional constipation
-incontinence 1 or more episode per week in prev. toilet trained
-excessive soil retention or posturing in older children
-firm/painful stools
-large diameter stool stools
-2 or less BM per week
-large faecal mass in rectum

Question 10

Constipation - red flags for organic cause

Answer 10

-Failure to pass meconium <48 hours
-Onset <1mo
-Failure to thrive
-Empty rectum
-Abdominal distension
-Tight anal sphincter
-Intermittent diarrhoea and explosive stools
-Pilonidal dimple/tuft
-Midline abnormal pigmentation changes lower spine
-Neuro changes - absent anal wink, absent cremasteric reflex, lower limb reflexes or tone decreased
-Occult blood in stool
-General sx - vomiting, appears ill, fever
-Gushing of stool with rectal exam
-No hx withholding or soiling
-No response to conventional treatment