Paediatric Surgery Flashcards
What are the top 5 main causes of a vomiting baby?
overfeeding Possetting Gastro-oesophageal refulx Pyloric Stenosis Obstruction (green is obstruction until proven otherwise)
What is the age of onset of pyloric stenosis?
2-6 weeks?
Which babies are more likely to get pyloric stenosis?
boys are 5x more likely to get it than girls
fHx also contributes
What are the signs and symptoms of pyloric stenosis?
projectile vomiting with no bile, soon after feeds. Acute weight loss dehydration hypochloraemic hypokalaemic
What is the management of pyloric stenosis?
Electrolyte balance before surgery
What are the 6 most common causes of bilious vomiting in a baby?
Volvulus until proven otherwise Necrotising enterocolitis Sepsis Atresia Hirschsprungs disease Meconium Disease
In paeds what is malrotation?
Failure of the orientation of the gut to orientate itself properly in utero. 3 landmarks are DJ flexure to left of midline, caecum in RIF and transverse colon ant. to S.I. mesentery
How is malrotation diagnosed in a baby?
barium contrast study
What is Necrotising Enterocolitis?
A disease affecting premature infants where inflammation leads to death of the bowel
Give 5 features of necrotising enterocolitis
abdominal distention blood in stools feeding intolerence vomiting pyrexia
What is Atresia of the intestine?
Congenital malformation - narrowing or absence of a section of the intestine.
What is the most common site for atresia of the intestine to occur?
along the ileum or the jejunum
Where is intestinal atresia most likely to occur in an infant with Downs Syndrome?
The duodenum
What is Hirschsprungs disease and what is it otherwise known as?
Cigenitial aganglionic megacolon, a section of bowel does not contain ganglia
What is the natural history of Hirschsprungs Disease?
Starts at the anus and progresses up the bowel
How does Hirschsprungs Disease most commonly present?
90% present with delayed passage of the meconium
What are the 5 most common causes of abdominal pain in children?
Acute Appendicitis Mesenteric Adenitis Constipation Gastroenteritis UTI
What 5 x-ray findings may be present in a child with acute appendicitis
Scoliosis due to pain Fecolith Absent Right posts shadowing intraperitoneal gas in perf small bowel dilatation
What is a fecolith?
a mass of hardened of stool that may be visible on imaging in acute appendicitis
What is the definition of Intussusception?
`Full thickness invagination of the proximal bowel into the distal intestine
What is the most common site for intussusception to occur?
Ileo-colic margin
What is meckel’s diverticulum?
The most common congenital abnormality of the GI tract. Incomplete obliteration of the omphalomesenteric duct and leads to out-pouching
What are the two types of complication which can arise from meckel’s diverticulum?
Ectopic mucosa which leads to GI bleeding and inflammation/ obstruction/ intussusception/ perforation
What are the three most common predisposing conditions which can lead to intussusception?
Meckels, Henoch-schonlein Purpura and Cystic Fibrosis
What is the classic triad of symptoms on intussusception?>
Intermittent abdo pain, redcurrent jelly stools and vomiting. Pulling knees up to chest in babies is also common
What is the method of diagnosis in intussusception?
x-ray is used as first line but is insensitive, USS is sensitive but Barium or air enemas are both diagnostic and theraputic in up to 90% of cases
What is the definition of a hydrocele?
fluid in the scrotum
What is the causes of a hydrocele in children?
patent processus vaginalis
On clinical examination how would you differentiate between a hydrocele and a inguinal hernia?
You can ‘get above’ a hydrocele
What are the 5 differential diagnoses for a boy with testicular pain?
Testicular torsion Torsion of the appendage Epidydimo-orchitis Hydrocele (rarely painful) Ideopathic scrotal odema (usually bilateral rarely painful)
In testicular torsion what is the ‘appendage?
Hydatid of Morgagni
At what age are boys most likely to get testicular torsion?
around 1 year old and then between 10 and 15 years old
A 5 year old boy presents to ED with scrotal pain, what is the most likely diagnosis?
epididymo-orchitis because it peaks at this age
A 10 year old boy presents to ED with scrotal pain, what is the most likely diagnosis?
Torsion of hydatid of morgagni, because its peak incidence is 10 years old. May also be torsion of testicle
