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CP2 Paediatrics > Paediatric surgery > Flashcards

Paediatric surgery Flashcards

1
Q

What are the symptoms of acute appendicitis?

A
  • anorexia
  • vomiting
  • abdominal pain (central and colicky then RIF localised)
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2
Q

What are the signs of acute appendicitis?

A
  • fever
  • abdominal pain (aggravated by movement)
  • persistent tenderness with guarding in RIF (McBurney’s point)

nb may be absent localised guarding in retrocaecal appendix and few abdo signs in pelvic appendix

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3
Q

Why is perforation of the appendix more rapid in preschool children?

A

The omentum is less well developed and fails to surround the appendix

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4
Q

What investigations would you do in acute appendicitis?

A
  • FBC for neutrophilia
  • Urine dip for presence of WBC/ organisms
  • USS - thickened non-compressible appendix with increased blood flow

NB none are consistently helpful in making the diagnosis

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5
Q

What are the differential diagnoses for acute appendicitis?

A
  • gastroenteritis
  • constipation
  • pyelonephritis
  • UTI
  • HSP
  • Intersusception
  • Meckel’s diverticulum

Pregnancy/testicular torsion/ ectopic …

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6
Q

What is the management for acute appendicitis?

A
  • Appendectomy
  • Treat shock if present
  • If guarding consistent with perforation, give IV antibiotics prior to surgery
  • Can manage conservatively if no palpable mass in RIF or signs of generalised peritonitis with IV antibiotics and an appendectomy after several weeks
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7
Q

What are the surgical causes of acute abdominal pain?

A
  • acute appendicitis
  • intestinal obstruction inc intussusception
  • inguinal hernia
  • peritonitis
  • inflamed Meckel’s diverticulum
  • pancreatitis
  • trauma
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8
Q

What is intussusception?

A

the invagination of proximal bowel into a distal segment

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9
Q

What part of the bowel is commonly involved in intussusception?

A

Ileum passing into caecum through ileocaecal valve

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10
Q

What is the peak age of presentation of intussusception?

A

3 months to 2 years but can occur at any age

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11
Q

What are the clinical presentations of intussusception?

A
  • paroxysmal, severe colicky pain with pallor
  • anorexia
  • vomiting
  • sausage-shaped mass in abdomen
  • redcurrant jelly stool
  • abdominal distension
  • shock
  • lethargy
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12
Q

Causes of intusussception

A
  • idiopathic
  • viral infection
  • Meckel’s diverticulum
  • polyps
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13
Q

Management of intussusception

A
  • IV fluid and resuscitation (shock v high risk)
  • IV antibiotics if suspected peritonitis (penicillin, gentamicin and metronidazole
  • NG tube and gastric emptying
  • rectal air enema (75% success rate)
  • surgery if that fails/peritonitis/perforation
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14
Q

What is the most serious complication of intussusception?

A

stretching and constriction of the mesentery resulting in venous obstruction, causing engorgement and bleeding from the bowel mucosa, fluid loss and subsequently bowel perforation, peritonitis and gut necrosis.

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15
Q

What is malrotation?

A

an abnormality that occurs during rotation of the small bowel in a foetus

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16
Q

What is volvulus?

A

a complication of malrotation, occuring when the bowel twists, so the superior mesenteric artery blood supply to the small intestine and proximal large intestine is compromised

17
Q

What are the two presentations of malrotation

A
  • obstruction

- obstruction with a compromised blood supply

18
Q

When does malrotation usually present and how?

A

in first 1-3 days of life with intestinal obstruction from Ladd bands obstructing the duodenum or volvulus

19
Q

Clinical presentation of volvulus?

A
  • dark green, bilious vomiting
  • abdominal pain, colicky, paroxysmal
  • tenderness (peritonitis)
  • constipation
20
Q

Investigations for intestinal rotation?

A
  • upper gastrointestinal contrast study to assess intestinal rotation
  • abdo xray/uss
21
Q

Management of volvulus?

A
  • urgent laparotomy if signs of vascular compromise

- appendix generally removed to avoid diagnostic confusion in future

22
Q

What are Ladd bands?

A

peritoneal bands that may cross the duodenum, often anteriorly

23
Q

What is a Meckel diverticulum?

A

An ileal remnant of the vitello-intestinal duct which contains ectopic gastric mucosa or pancreatic tissue.

Around 2% of individuals have it.

24
Q

Clinical presentation of Meckel diverticulum

A
  • Most are asymptomatic
  • May present with severe rectal bleeding, neither bright red nor true melaena
  • Acute reduction in haemoglobin
  • Abdominal pain mimicking appendicitis
  • May present as intussusception, volvulus or diverticulitis
25
Q

Investigations of Meckel diverticulum

A
  • FBC - anaemia

- a technetium scan will demonstrate increased uptake by ectopic gastric mucosa in 70% of cases

26
Q

Treatment of Meckel diverticulum

A

Surgical resection

27
Q

Complications of a Meckel’s diverticulum

A

May present as intusussception, volvulus or diverticulitis

28
Q

What is necrotising enterocolitis?

A

An infection of the gut seen in premature infants, as a result of bacterial invasion and ischaemic injury

29
Q

Risk factors of NEC

A
  • prematurity
  • preterm infants fed cow’s milk formula instead of breast milk
  • ischaemic injury and bacterial invasion
30
Q

Clinical presentation of NEC

A
  • feed intolerance
  • vomiting, may be bile stained
  • distended abdomen
  • fresh blood in stool
  • shock
31
Q

Investigations for NEC

A
  • abdo XRAY: distended loops of bowel and thickening of the bowel wall with intramural gas. May be gas in portal venous tract
32
Q

Management of NEC

A
  • early recognition
  • stop oral feeding, parental feeding
  • treat shock
  • triple antibiotic therapy
  • may require mechanical ventilation
  • surgery for bowel perforation
33
Q

Complications of NEC

A
  • bowel perforation
  • 20% morbidity and mortality
  • development of strictures
  • malabsorption
  • greater risk of a poor neurodevelopmental outcome
34
Q

What is pyloric stenosis?

A

hypertrophy of the pyloric muscle causing gastric outlet obstruction

35
Q

Epidemiology of pyloric stenosis

A
  • presents at 2-8 weeks
  • irrespective of gestational age
  • M:F = 4:1
  • more common in firstborn
  • may be a FH, especially on the mother’s side
36
Q

Clinical presentation of pyloric stenosis

A
  • vomiting, increased forcefulness and frequency ending up in projectile vomiting
  • dehydration
  • decreased interest in feeding
  • weight loss
  • hypochloraemic metabolic alkalosis
  • olive shaped mass in RUQ
37
Q

Investigations for pyloric stenosis

A
  • bloods esp u&e for hypokalaemia, hyponaturaemia and high urea
  • test feed: gastric peristalsis L to R waves
  • USS
  • stomach might need to be emptied by an NG tube
38
Q

Management for pyloric stenosis

A
  • correct fluid and electrolyte disturbance with IV fluids
  • pyloromyotomy
  • child can be usually fed within 6 hours and discharged within 2 days of surgery

CP2 Paediatrics (1 decks)

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