Paediatric Surgery Flashcards
A distended abdomen is a sign of what?
Obstruction
A 6 week old child presents with vomiting, abdominal swelling and a distended stomach. What is the most likely diagnosis?
Pyloric stenosis
Why does vomiting occur in pyloric stenosis?
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.
What test should you use to investigate pyloric stenosis?
Ultrasound
How can you tell there is something wrong when looking at an ultrasound of pyloric stenosis?
If you could measure the pylorus because it is so inflamed (normally this wouldn’t be possible)
What is the treatment for pyloric stenosis? What are the outcomes?
Pyloromyotomy (cut the pyloric muscle)- they will then be able to feed normally
Is pyloric stenosis rare?
No, it is pretty common
How may you be able to tell that an infant is in pain?
They will draw their legs up
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?
Intussusception
Intussusception presents usually at around the same age as which other, much less serious condition?
Simple colic
What differentiates intussusception from simple colic?
These children will be limp and pale
What is intussusception?
A type of obstruction which involves folding of the bowel (which causes swelling and obstruction)
Where is the obstruction in intussusception usually found?
Where the small and large bowels meet
What happens to the obstruction in intussusception?
It travels through the bowel and occasionally out of the rectum
What is the correct investigation for intussusception?
Ultrasound
This ultrasound appearance is seen in what condition?
If it is taken from the other angle, what will it look like?
Intussusception (target sign)
Kidney bean shaped
How should you treat intussusception?
Blow air into the rectum to move the obstruction up and out
Why is surgery not really used for intussusception?
Risk of bowel perforation
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?
Some kind of peritonitis, likely appendicitis
Will children with appendicitis have a high fever?
They will have a fever, but not particularly extreme
Tummy pain in a child could actually be coming from where else? What diagnosis could this suggest?
Coming from the chest - pneumonia
If a child is admitted with tummy pains and a fever, what should you always test for?
UTI
A child is vomiting bile. What is the diagnosis until proven otherwise?
Malrotation
What is malrotation?
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
What is the most worrying presentation of an acute scrotum? Is this common?
Testicular torsion - not the most common presentation of acute scrotum
A boy presents with an acute scrotum. It is red, swollen and sore. What is the most likely diagnosis?
Epididymitis
It can be hard to distinguish epididymitis from testicular torsion, how do you check?
Have to open the scrotum to check
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?
Mullerian duct remnant
What is the treatment for a Mullerian duct remnant if it is…
a) sore?
b) not sore?
a) Removal
b) Leave it to fall off
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?
Idiopathic scrotal oedema, can give an anti-histamine
In idiopathic scrotal oedema, where may the redness spread to?
How may the tissues appear?
Groin and perineum
Waterlogged
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?
Balanitis Xerotica Obliterans (BXO) - needs a circumcision
Why do cases of BXO require a circumcision?
Can cause urethral stenosis
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?
Hernia
Operate quickly so the bowel doesn’t get obstructed by the hernia
What is hypospadias?
Where the urethra is on the underside of the penis
Why is it important to find an undescended testes?
They can become malignant
A child presents with bilous vomiting a few hours after birth. An AXR shows a double bubble sign. What is the most likely diagnosis?
Duodenal atresia
Who is duodenal atresia more common in?
Babies with Down’s syndrome
When does malrotation usually present?
3-7 days after birth
A baby presents 24 hours after birth with bilous vomiting. AXR shows air-fluid levels. What are the 2 most likely diagnoses?
Jejunal/ileal atresia
Mecoium ileus
Meconium ileus has a close relationship with what condition?
CF
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?
Necrotising enterocolitis
