Paediatric Surgery Flashcards

1
Q

Biliary atresia - Jaundice in infants:

Colour of stools and urine…

Associated with…

A

> 14 days in term infants (>21 days in pre term infants)

Pale stool, yellow urine (colourless in babies)

Associated with cardiac malformations, polysplenia, situs inversus

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2
Q

Biliary atresia - Surgical Treatment with.

A

Jaundice > 14 days
Increased conjugated bilirubin

Roux-en-Y portojejunostomy (Kasai procedure).

If Kasai procedure fails or late recognition, a liver transplant becomes the only option.

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3
Q

Bilious vomiting in neonates ALL…

A

Few hours after birth - Duodenal atresia - Duoduodenostomy. Double bubble AXR

Around 24 hours of birth - Jejunal/ ileal atresia - Laparatomy + primrary resection/ Air -fluid level AXR.

Around 24-48 hours - Meconium ileus - surgical decompression, PR contrast or NG NAC. Fluid level AXR. Sweat test for CF.

Usually 3-7 days after birth - Malrotation with volvulus - Ladd’s procedure

The second week of life - Necrotising enterocolitis - Conservative and supportive for non perforated cases, laparotomy and resection in cases of perforation of ongoing clinical deterioration

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4
Q

Bronchogenic cysts

A

anomalous development of the ventral foregut

lie near the midline and most frequently occur in the region of the carina

maybe asymptomatic or present with respiratory symptoms early in the neonatal period.

maybe detected on conventional chest radiography as a midline spherical mass or cystic structure

Once the diagnosis is suspected a CT scan should be performed

Thoracoscopic resection is the ideal treatment. Very young babies can be operated on once they reach six weeks of age.

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5
Q

Cyanotic Congenital heart disease

Most Common…

A

TTTP

Tetralogy of Fallot
Transposition of the great arteries (TGA)
Tricuspid atresia
Pulmonary valve stenosis

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6
Q

Ayanotic Congenital heart disease

Most Common…

A
Ventricular septal defects (VSD) - most common, accounts for 30%
Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
Coarctation of the aorta
Aortic valve stenosis
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7
Q

Inguinal hernia in children

hernia sac is often a remnant of

A

ernia sac is often a remnant of the processus vaginalis and association with undescended testis is recognised

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8
Q

Inguinal hernia in children
Type and timing of presentation

Treatment..

A

Most common in the first few weeks of life. Nearly all will be indirect hernias. The treatment of which is inguinal herniotomy. Formal repair using meshes is not required because the posterior wall of the canal is usually intact.

BL tendency- offer BL exploration in females but not in males (risk of cord and testicular injury)

Fix on next available list!

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9
Q

Embryogenesis the intestine

A

4th week - into abdomen via umbilcus
270 degree clockwise twist
ligament of Treitz lies to the left of the spine and the caecum in the right lower quadrant.

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10
Q

Malrotation with volvulus - Ladd’s procedure

A

Usually 3-7 days after birth
Billous vomiting

an abdominal ultrasound scan to determine the relationship between the superior mesenteric artery and vein (normally SMA lies to the left of the SMV

Ladds procedure - division of adhesional bands - appendicectomy as caecum is replaced in upper left

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11
Q

Intraoperative fluid management
Neonates should receive
Other children should receive

A

Neonates should receive glucose 10% during surgery - at a rate of 60ml/Kg/day.

Other children should receive isotonic crystalloid.

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12
Q

Pyloric stenosis

A

2-6 weeks of life

30mins after feeding - Projectile non-bile stained vomitin, mass in RUQ

Treatment: Ramstedt pyloromyotomy (open or laparoscopic)

M>F
5-10% Family history in parents

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13
Q

Intussusception

A

6-9 months age - Telescoping bowel

Proximal to or at the level of, ileocaecal valve

Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool.

Treatment: reduction with air insufflation

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14
Q

Hirschsprung’s disease

A

Absence of ganglion cells from myenteric and submucosal plexuses
Occurs in 1/5000 births
Full-thickness rectal biopsy for diagnosis
Delayed passage of meconium and abdominal distension
Treatment is with rectal washouts initially, thereafter an anorectal pull through procedure

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15
Q

Oesophageal atresia

A

Associated with tracheo-oesophageal fistula and polyhydramnios
May present with choking and cyanotic spells following aspiration
VACTERL associations

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16
Q

Cherry red rectile polyps

A

Juvenile polyps may occur as part of the familial polyposis coli syndromes. The lesions, which are hamartomas, are often cherry red if they protrude externally.

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17
Q

Umbilical vessels

A

The arteries are continuous with the internal iliac arteries (medial umbilical ligaments) and the vein is continuous with the falciform ligament (ductus venosus)

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18
Q

Omphalitis

A

infection of the umbilicus - Staphylococcus aureus is the commonest cause

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19
Q

cherry red lesions surrounding the umbilicus, they may bleed on contact and be a site of seropurulent discharge.

A

Umbilical granuloma - often respond favorably to chemical cautery with topically applied silver nitrate.

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20
Q

urinary discharge from the umbilicus

A

persistence of the urachus which attaches to the bladder. They are associated with other urogenital abnormalities.

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21
Q

umbilical discharge that discharges small bowel content

A

Persistent vitello-intestinal duct

Complete persistence of the duct is a rare condition. Much more common is the persistence of part of the duct (Meckels diverticulum). Persistent vitello-intestinal ducts are best imaged using a contrast study to delineate the anatomy and are managed by laparotomy and surgical closure.

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22
Q

dermatological condition in which scarring of the foreskin occurs leading to phimosis

A

Balanitis xerotica obliterans

This is a dermatological condition in which scarring of the foreskin occurs leading to phimosis. It is rare below the age of 5 years. Treatment is usually with circumcision.

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23
Q

Tetralogy of Fallot typically presents at around…

A

Most common CHD, typically presents at around 1-2 months, although may not be picked up until the baby is 6 months old.

ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

Other features
causes a right-to-left shunt
ejection systolic murmur due to pulmonary stenosis (the VSD doesn’t usually cause a murmur)
a right-sided aortic arch is seen in 25% of patients
chest x-ray shows a ‘boot-shaped’ heart, ECG shows right ventricular hypertrophy

Management
surgical repair is often undertaken in two parts
cyanotic episodes may be helped by beta-blockers to reduce infundibular spasm

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24
Q

AT BIRTH, most common cyanotic heart disease presentation is…

A

at birth transposition of the great arteries is the more common lesion as patients with TOF generally present at around 1-2 months

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25
Q

Commonest cause of infravesical outflow obstruction in males…

A

Posterior urethral valves

high emptying pressures in utero, the child may develop renal parenchymal damage. This translates to renal impairment noted in 70% of boys at presentation.

Treatment is with bladder catheterisation. Endoscopic valvotomy is the definitive treatment of choice with cystoscopic and renal follow up.

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26
Q

Most common cause of UTI and management

A

E-Coli accounts for 80% cases.

important to establish whether there is underlying urinary stasis or vesico-ureteric reflux

Pyrexia lasting for more than 3 days mandates urine testing.

> 2 UTI’s (or 1 in males) in a 6 month period should prompt further testing.

Voiding cystourethrograms show the greatest anatomical detail and is the ideal first line test in males; isotope cystography has a lower radiation dose and is the first line test in girls.

USS should also be performed. Renal cortical scintigraphy should be performed when renal scarring is suspected.

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27
Q

Long obstructed breech delivery

A

Developmental dysplasia of the hip

28
Q

Perthes
Age
Imaging
Sclerosis Catarall Staging

A

Perthes – 5-12 – MRI hip – Fem head sclerosis Catarall Stage 2

29
Q

Achondroplasia inheritance

A

Achondroplasia – sporadic autosomal dominant (dwarfism, fibroblast growth factor)

30
Q

Small round yellow nodule within the inguinal canal

A

Small round yellow nodule within the inguinal canal – Adrenal Rest

31
Q

Scrotal swelling – indirect inguinal hernia - treatment is

A

inguinal herniotomy w/o mesh

32
Q

Scrotal skin -

A

5/0 vicryl rapide

33
Q

Bilious vomiting in neonates - surgical emergency -

A

intestinal malrotation and volvulus until proven otherwise - upper GI contrast study - Ladds

34
Q

Types intussusception types

A

Ileo-ileal intussusception – laparotomy

Ileocolic – susage shaped mass, legs up crying, sufflation for ilio-colic

35
Q

3 month hemiscrotum swelling – spermatic cord

A

Rhabdomyosarcoma

36
Q

6 month old, firm testicular mass, weight loss

A

Rhabdomyosarcoma – malignant tumour (teratoma’s are benign)

37
Q

Scream attacks

A

Think intussusception

38
Q

2 months – elevated conjugated bilirubin + jaundice

A

2 months – elevated conjugated bilirubin + jaundice = biliary atresia – roux-en-y portojejunostomy

39
Q

For paediatric laparotomy -

A

For laparotomy - Transverse supra umbilical abdominal incision

40
Q

Umbilical hernia, age to fix..

A

Umbilical hernia – fix after 3 years of age

41
Q

Neonate spinal cord termination

A

Neonate spinal cord termination – L3 (Adults L1)

42
Q

cyanotic episodes worse on feeding. Improvement when the baby cries

A

Choanal atresia cyanotic episodes worse on feeding. Improvement when the baby cries or use of oropharyngeal airway.

43
Q

D1 cyanotic when feeding or crying

A

TPA (TOF most common overall)

44
Q

Management of Patent Processus Vaginalis hydrocele

A

Lords or Jabouley Procedure

45
Q

Viral illness + abnormal gait

X > WCC 12 + ESR 40 > Y

A

Septic Arthritis > WCC 12 + ESR 40 > Transient tenosynovitis

(Septic: T >38.5 + Inability to weigh bear)

46
Q

Rickets – Low Vit D

Features…

A
  1. Osteomalacia – femur/tib bowing,
  2. Costochondral thickening,
  3. Harrisons transverse chest sulcus, large head
47
Q

Ligamentum teres femoris –

A

Ligamentum teres femoris – femur blood supply (acetabula notch to fovea)

48
Q

Smooth RIF swelling, systemically well

A

Smooth RIF swelling, systemically well – mesenteric cyst

49
Q

Most common brain tumour in kids

A

Most common brain tumour in kids

- Astrocytoma

50
Q

Congenital undescended testis – no descent by..

A

Congenital undescended testis – no descent by 3 months!

51
Q

2yo with high output ileostomy – IVF using..

A

0.9% NaCl with K+

52
Q

Polyhydramnious + Cyanotic episodes =

A

oesophageal atresia

53
Q

Kasai procedure for biliary atresia – survoval at 5 years

A

45% survival after 5 years

54
Q

Transverse colon herniation through anterior midline defect

A

Morgagni hernia

55
Q

Cherry red lesion , post defecation bleeding

A

Cherry red lesion , post defecation bleeding – juvenile polyp

56
Q

Neuroblastoma – lesions are…

A

Neuroblastoma – lytics lesions

57
Q

Unilateral cleft lip - incomplete…

A

nasolabial muscle ring fusion

58
Q

Massive painless bleeding – otherwise well,

A

Meckels’s!

59
Q

4yo sorethroat + thick grey membrane

A

diptheria

60
Q

Direct hernia strangulation risk

A

Direct hernia strangulation risk <5% over a year

61
Q

Bilious vomiting in neonates…

Few hours after birth

A
  • Duodenal atresia - Duoduodenostomy. Double bubble AXR
62
Q

Bilious vomiting in neonates…

Around 24 hours of birth

A

Jejunal/ ileal atresia - Laparatomy + primrary resection/ Air -fluid level AXR.

63
Q

Bilious vomiting in neonates…

Around 24-48 hours

A

Meconium ileus - surgical decompression, PR contrast or NG NAC. Fluid level AXR. Sweat test for CF.

64
Q

Bilious vomiting in neonates…

Usually 3-7 days after birth

A

Malrotation with volvulus - Ladd’s procedure

65
Q

Bilious vomiting in neonates…

The second week of life

A

Necrotising enterocolitis - Conservative and supportive for non perforated cases, laparotomy and resection in cases of perforation of ongoing clinical deterioration