Paediatric Surgery

Question 1

DDx paediatric abdominal pain?

Answer 1

Appendicitis
Mesenteric adenitis 
Pneomonia
Impaction 
Volvulus
Intusseption
Ileus 

Non-specific abdominal pain

Question 2

Important Hx questions for paeds abdo pain?

Answer 2

SOCRATES

Vomiting

Question 3

What does pain near the umbillicus indicate?

Answer 3

Less likely to be pathological

Question 4

What is murphy’s triad?

Answer 4

APPENDICITIS

1. Pain over macburneys point
2. Vomiting
3. Fever

Question 5

How do you DDx between appendicitis and non-specific abdominal pain?

Answer 5

Is it painful when moving?
Y = appendicitis
N = NSAP

Question 6

Symptoms of mesenteric adenitis?

Answer 6

Non- septic

URTI

Question 7

What causes a volvulus?

Answer 7

Developmental failure of small intestine during rotations

Question 8

What is a volvulus?

Answer 8

Small intestine is on R hand side of abdomen pushing caecum up to R hypochondriac

Fibrous band covering upper duodenum obstructs caecum => volvulus (obstruction)

Question 9

What are the symptoms of volvulus?

Answer 9

Billous vomit
Abdo pain
Inconsolable
Tachycardia then hypotension

SIRS

Question 10

Investigation volvulus?

Answer 10

Urgent GI Contrast study (AxR with contrast)

Question 11

What is treatment of volvulus?

Answer 11

Laparotomy 
Ladd procedure (removal of fibrous attachements)

Question 12

What is intussecption?

Answer 12

Telescoping of one intestinal segment into another => obstruction

Question 13

Symptoms of intussception?

Answer 13

BILLOUS vomiting
Short history of a viral illness
Bloody stool

Question 14

What is the stool of intusseception described as?

Answer 14

Red current stool

Question 15

Investigation intusseception?

Answer 15

USS

Question 16

What is shown on USS in intusseception?

Answer 16

Target sign

Question 17

Treatment intusseception?

Answer 17

Pneumostatic reduction

Question 18

What should be done if pneumostatic reduction fails?

Answer 18

Laparotomy

Question 19

What age is intusseception common?

Answer 19

6 - 12 months

Question 20

What is gastroschisis?

Answer 20

Abdominal wall defect - causing abdominal contents to be outside of the abdominal cavity

Question 21

Who is more affected by gastroschisis?

Answer 21

Males

Born to young mothers

Question 22

What are 15% of gastroschisis associated with?

Answer 22

Other congenital abnormalities

Question 23

Investigation for internal gastroschisis?

Answer 23

USS

Question 24

Tx for gastroschisis?

Answer 24

Primary repair

Delayed repair w/ TPN

Same as omphalocele

Question 25

Compare gastroschisis and omphalocele?

Answer 25

Different to an omphalocele as omphalocele is still in the peritoneal membrane

Omphalocele is UMBILLICAL defect not gut wall