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Paediatric Surgery Flashcards

1
Q

What is Phimosis? How common? How is it treated?

A
  • Phimosis = Non-retractable foreskin
  • 50% at age 5; decrease by 10%/yr
  • Treatment = Circumcision (rarely required <4yo)
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2
Q

What are the indications for Circumcision (2)

A
  1. Recurrent Balanitis (inflammation of glans)
  2. Balanitis xerostica obliterans (i.e genital involvement in lichen sclerosus - disease of chronic inflammatory sclerosing dernatitis)
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3
Q

What are the Complications of Circumcision (4)

A
  1. Meatal stenosis [stricture @ external meatus of urethra -> obstruction]
  2. Excessive removal
  3. Bleeding
  4. Infection (rare)
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4
Q

Pathophysiology of Inguinal Hernia & Hydrocele

A

Patent Processus Vaginalis (PPV)

  1. Processus vaginalis carries extensions of layers of the parietal peritoneum
  2. Normally closes after descent of testes and become tunica vaginalis
  3. Failure to close = PPV
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5
Q

Natural History and Treatment of Inguinal Hernia & Hydrocele

A
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6
Q

Incidence and Complications of Inguinal Hernia

A
  • Common in premature babies (30%)
  • Bilateral hernias more common in younger babies
  • Complication = Bowel strangulation
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7
Q

Incidence & Presentation of Undescended Testes

A
  • Incidence - 3%; higher in premature
  • Presentation - Empty/Hypoplastic Scrotum
  • Common Locations
    • Undescended - Intra-abdominal, Inguinal [within canal]
    • Ectopic - Perineal, Femoral
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8
Q

Management of Undescended Testes

A

Orchidopexy - move undescended testicle -> scrotum + fixing it there

  • Carried out if palpable
  • If not palpable -> further investigations before procedure
    • Imaging - US, MRI
    • Laparoscopy [intra-abdominal]
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9
Q

Benefits of Orchidopexy (4)

A
  1. Improve sub-fertility [greatest benefit if performed before 1yo]
  2. Improve tumour detection
  3. Reduce risk of physical injury
  4. Reduce risk of torsion
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10
Q

Common Benign Tumours in Paediatrics (3)

A
  1. Cystic Hygroma - maldevelopment of lymphatics
  2. Haemangioma - blood vessel
  3. Dermoid/Epidermoid Cyst - soft tissue
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11
Q

Cystic Hygroma

(Presentation, Complications, Treatment)

A
  • Cervical 70%; Axillary 20%
  • Cx = Infection, Haemorrhage, Pressure
  • Tx = Excision or Sclerotherapy (OK432, Tetracycline)
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12
Q

Infantile Haemangioma

(Incidence, Presentation, Complications)

A
  • Most common benign tumour in infants (10%)
  • Presentations
    • Salmon Patch (small rash)
    • Port-wine Stain (purple-red; single)
    • Spider Angioma (blanchable, multiple)
    • Strawberry Naevus (most in H&N; compressible, mobile, not pulsatile)
  • Cx - Haemorrhage on trauma
    • (Extremely large hepatic angioma may rarely -> HF +/- hydrops)
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13
Q

Treatment for Haemangioma

A
  • Conservative
    • Most resolve after puberty [except venous malformation]
    • Steroids/Vincristine
    • Propranolol (decrease VEGF release)
  • Surgical
    • _​_Excision, Sclerotherapy, Laser
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14
Q

Common Malignant Tumours in Children

[exlcuding haematological & O&T malignancies]

A
  1. Neuroblastoma
  2. Teratoma
  3. Hepatoblastoma
  4. Wilm’s Tumour
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15
Q

Sacro-coccygeal Teratoma

[Course, Ix, Tx]

A
  • Seen in antenatal US; benign at first -> malignant; can cause hydrops if large
  • Ix - High AFP, Post-natal CT
  • Tx - Curable by excision + coccyx
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16
Q

Neuroblastoma

[Pathophysi, Presentation, Ix, Tx, Prognosis]

A
  • Commonest solid childhood tumour
  • Patho - a/w n-myc oncogene; arises from adrenal gland or sympathetic chain
  • Presentation
    • Constitutional [WL, anorexia]
    • Abdominal mass
  • Ix - 24h urine for HVA & VMA
  • Tx - neo-adjuvant chemo + surgery
  • Prognosis - 60% @ 5yr; Depends on age & stage
17
Q

Wilm’s Tumour

[Presentation, Associations, Tx, Prognosis]

A

Aka Nephroblastoma

  • Presentation [5% bilateral]
    • ​Abdominal Mass
    • Haematuria & Anaemia
    • WL
  • Associated Genes - WT1 & WT2
  • Tx - Neo-adjuvant chemo + Surgery
    • Good response to chemo
  • Prognosis - >90% 5yr survival
18
Q

Hepatoblastoma

[Presentation, Ix, Tx, Prognosis]

A
  • Commonest malignant liver tumour in children
  • Presentation - Hepatomegaly
  • Ix - Raised serum AFP
  • Tx - Neoadjuvant chemo + Hepatectomy +/- Liver Transplant
    • Good response to chemo
  • Prognosis - 80% 5yr survival
19
Q

Testicular Torsion

[Pathophysi & Causes]

A
  • Patho
    1. _​​_Testicle twists upon spermatic cord
    2. Venous occlusion -> engorgement
    3. Arterial ischaemia & infarction
  • Causes
    • Bell-clapper deformity - tunica vaginalis joins high on SC -> testis free to rotate
    • _​_Undescended testes
    • Trauma

Surgery (8 decks)

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