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Child Health > Paediatric Surgery > Flashcards

Paediatric Surgery Flashcards

1
Q

A distended abdomen is a sign of what?

A

Obstruction

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2
Q

A 6 week old child presents with vomiting, abdominal swelling and a distended stomach. What is the most likely diagnosis?

A

Pyloric stenosis

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3
Q

Why does vomiting occur in pyloric stenosis?

A

The stomach tries to push food through the pylorus but it can’t. You may be able to see the muscles of the stomach peristalsing.

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4
Q

What test should you use to investigate pyloric stenosis?

A

Ultrasound

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5
Q

How can you tell there is something wrong when looking at an ultrasound of pyloric stenosis?

A

If you could measure the pylorus because it is so inflamed (normally this wouldn’t be possible)

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6
Q

What is the treatment for pyloric stenosis? What are the outcomes?

A

Pyloromyotomy (cut the pyloric muscle)- they will then be able to feed normally

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7
Q

Is pyloric stenosis rare?

A

No, it is pretty common

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8
Q

How may you be able to tell that an infant is in pain?

A

They will draw their legs up

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9
Q

A 6 month old child presents with vomiting for a few days and episodes where the legs are drawn up which is then followed by limpness. Some areas of the abdomen are firm and there is a sausage shaped mass. The child has been passing a little stool and there has been some blood in the nappy. What is the diagnosis?

A

Intussusception

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10
Q

Intussusception presents usually at around the same age as which other, much less serious condition?

A

Simple colic

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11
Q

What differentiates intussusception from simple colic?

A

These children will be limp and pale

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12
Q

What is intussusception?

A

A type of obstruction which involves folding of the bowel (which causes swelling and obstruction)

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13
Q

Where is the obstruction in intussusception usually found?

A

Where the small and large bowels meet

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14
Q

What happens to the obstruction in intussusception?

A

It travels through the bowel and occasionally out of the rectum

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15
Q

What is the correct investigation for intussusception?

A

Ultrasound

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16
Q

This ultrasound appearance is seen in what condition?

If it is taken from the other angle, what will it look like?

A

Intussusception (target sign)

Kidney bean shaped

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17
Q
A
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18
Q

How should you treat intussusception?

A

Blow air into the rectum to move the obstruction up and out

19
Q

Why is surgery not really used for intussusception?

A

Risk of bowel perforation

20
Q

A 6 year old child presents with tummy pains, and tells you that going over the speedbumps in the car was very painful. What is the diagnosis?

A

Some kind of peritonitis, likely appendicitis

21
Q

Will children with appendicitis have a high fever?

A

They will have a fever, but not particularly extreme

22
Q

Tummy pain in a child could actually be coming from where else? What diagnosis could this suggest?

A

Coming from the chest - pneumonia

23
Q

If a child is admitted with tummy pains and a fever, what should you always test for?

A

UTI

24
Q

A child is vomiting bile. What is the diagnosis until proven otherwise?

A

Malrotation

25
Q

What is malrotation?

A

A congenital problem of the gut- the bowel is not sitting in the right place so the gut twists and loses blood supply to the midgut from the superior mesenteric artery

26
Q

What is the most worrying presentation of an acute scrotum? Is this common?

A

Testicular torsion - not the most common presentation of acute scrotum

27
Q

A boy presents with an acute scrotum. It is red, swollen and sore. What is the most likely diagnosis?

A

Epididymitis

28
Q

It can be hard to distinguish epididymitis from testicular torsion, how do you check?

A

Have to open the scrotum to check

29
Q

A boy presents with an acute scrotum. There is a black, blobby extra part which does not look nice. What is the most likely diagnosis?

A

Mullerian duct remnant

30
Q

What is the treatment for a Mullerian duct remnant if it is…

a) sore?
b) not sore?

A

a) Removal
b) Leave it to fall off

31
Q

A boy presents with a red, itchy, swollen scrotum which is not particularly sore and can come on acutely though it comes and goes. What is the most likely diagnosis and what can you give to help?

A

Idiopathic scrotal oedema, can give an anti-histamine

32
Q

In idiopathic scrotal oedema, where may the redness spread to?

How may the tissues appear?

A

Groin and perineum

Waterlogged

33
Q

A boy presents with a whitish appearance of the scrotum. There is no movement on retraction of the foreskin. What is the most likely diagnosis and what is the treatment?

A

Balanitis Xerotica Obliterans (BXO) - needs a circumcision

34
Q

Why do cases of BXO require a circumcision?

A

Can cause urethral stenosis

35
Q

A boy presents with a swelling in the groin which is so bad the penis has almost disappeared. What is the diagnosis? What is the treatment and why?

A

Hernia

Operate quickly so the bowel doesn’t get obstructed by the hernia

36
Q

What is hypospadias?

A

Where the urethra is on the underside of the penis

37
Q

Why is it important to find an undescended testes?

A

They can become malignant

38
Q

A child presents with bilous vomiting a few hours after birth. An AXR shows a double bubble sign. What is the most likely diagnosis?

A

Duodenal atresia

39
Q

Who is duodenal atresia more common in?

A

Babies with Down’s syndrome

40
Q

When does malrotation usually present?

A

3-7 days after birth

41
Q

A baby presents 24 hours after birth with bilous vomiting. AXR shows air-fluid levels. What are the 2 most likely diagnoses?

A

Jejunal/ileal atresia

Mecoium ileus

42
Q

Meconium ileus has a close relationship with what condition?

A

CF

43
Q

A baby presents in the 2nd week of life with bilous vomiting. There are dilated bowel loops. She was premature. What is the most likely diagnosis?

A

Necrotising enterocolitis

Child Health (14 decks)

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