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Paediatrics > Paediatric surgery and GI > Flashcards

Paediatric surgery and GI Flashcards

1
Q

Common GI presentation in children

A

Crying
Vomiting
Abdo pain
Poor feeding
Abdo distension

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2
Q

What is intussuception

A

Section of bowel telescopes into another usually around lymph nodes following a viral illness

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3
Q

Intessuception presention

A

3-9 months age
Following viral illness

Sx
- Pain
- non bilous vomiting
- drawing of legs in pain
- RECURRENT JELLY STOOL

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4
Q

Intussuception Ix and findings

A

Tender sausage shaped mass palpable

Blood tests - FBC, CRP
Abdominal X Ray
USS - target sign

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5
Q

Intussuception treatment

A

Antibiotics
Analgesia
Fluids
Barium air enema reduction during X ray - if fails surgery due to risk of bowel perforation

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6
Q

What is appendicitis

A

Inflammation of appendix

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7
Q

Appendicitis symptoms

A

Generalised abdominal pain that moves to right iliac fossa

Diarrhea and vomiting
Fever
Reduced appetite
Lethargy

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8
Q

Appendicitis investigation and examination findings

A

Tenderness in RIF
Rebound or percussion tenderness
Psoas sign
Rosvings Sign
Oburator sign
McBurneys point
Signs of shock

Ix
- Bloods
- Urine dipstick and MC&S
- Stool MC&S
- USS

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9
Q

Appendicitis treatment

A

Surgery

IV fluids
IV abx
IV analgesia
NBM

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10
Q

Meckel’s diverticulum presentation

A

same as appendicitis

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11
Q

Complications of meckel’s diverticulum

A

ecoptic gastric cells may lead to ulceration = blood stools
may lead to intussuception or volvulus

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12
Q

Meckel’s diverticulum diagnosis

A

Meckel’s scan

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13
Q

What is meckel’s diverticulim

A

congenital outpouching or bulge in the lower part of the small intestine - leftover of umbilical cord

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14
Q

DDx of bilious vomiting

A

Volvulus
Duodenal atresia / stenosis
Necrotising entercolitis
Meconium ileus
Hirschsprung’s disease
Post op ileus
Incarcerated hernia

  • all signs of bowel obstruction
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15
Q

What is volvulus and what can it lead to (complications)

A

Twist in intestine (malrotated gut)

RED FLAG BOWEL OBSTRUCTION - CAN LEAD TO DEATH OF SMALL BOWEL - TIME CRITICAL

COMPLICATIONS
- DEATH
- adhesions
- small gut syndrome

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16
Q

Ix and Tx for volvulus

A

Abdo XR
Bloods
Barium swallow if able

Tx
- resuscitate fluids
- analgesia
- abx
- NG TUBE INSERTION to decompress abdo distention
- EMERGENCY LAPAROTOMY FOR LADDS PROCEDURE (MAY ALSO PUT IN STOMA)

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17
Q

Sx of volvulus

A

Bilious vomiting
sever abdo pain
irritability
poor feeding
diarrhoea
fever

distended abdo
v tender
dehyrdated
tachycardic
signs of shock

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18
Q

DDx of non bilious vomiting

A

Reflux/GORD
Cows milk intolerance
Normal posseting
Pyloric stenosis
Sepsis / infection
Excessive feeding
Duodenal stenosis
Appendicitis
Gastroenteritis
Raised ICP
Intussusception
Incarcerated hernia

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19
Q

What is pyloric stenosis

A

Hypertrophy of pylorus muscle - resultis in narrow channel and obstruction

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20
Q

Pyloric stenosis presentation

A

PROJECTILE NON BILIOUS VOMITING
poor feeding
signs of dehydration

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21
Q

Ix and investigation findings of pyloric stenosis

A

Palpable olive mass in midline

Bloods
BLOOD GAS - METABOLIC ALKALOSIS, RAISED PH AND HCO3, HYPOCHLORAEMIA, HYPOKALAEMIA (due to vomiting and dehydration and loss of electrolytes)
USS

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22
Q

Pyloric stenosis treatment

A

NBM
NG Tube insertion
IV fluids - electrolyte correction

Surgery - pylorectomy
Post op - build feeds slowly

23
Q

Umbilical hernia tx

A

May close spontaneously by 2 yrs old - not concerning if reducible

IF NOT RESOLVED BY 5 YRS OLD, IF NOT REDUCIBLE OR SIGNS OF BOWEL OBSTRUCTION = SURGERY

24
Q

What is Wilms tumour and how does it present and treatment

A

Unilateral renal tumour

May have haematuria
Palpable abdominal mass
Abdo distension
May have hypertension

DO NOT LEAVE UNTREATED (HIGH MORTALITY)
CHEMO AND SRUGICAL RESECTION

25
Q

Define Nueroblastoma, presentation and treatment

A

Tumour starting from adrenal or paraspinal sites

Abdominal distension / mass
Anorexia
CATECHOLAMINE IN URINE

Tx
- Chemo, surgery, radiotherapy

26
Q

What is rhabdomyosarcoma

A

Soft tissue sarcoma around muscular structures

27
Q

Rhabdomyosarcoma presentation

A

mass - esp in head / neck
associated to li fraumeni syndrome

28
Q

DDx of neonatal GI surgical conditions

A

 Gastroschisis
 Exomphalos/Omphalocele
 Tracheo-oesophageal Fistula
 Oesophageal atresia
 Necrotising enterocolitis
 Duodenal atresia
 Hirschsprung’s disease
 Anorectal malformation
 Meconium ileus
 Congenital lung malformation
 Volvulus
 Spina Bifida

29
Q

Main time critical emergencies

A

bilious vomiting
testicular torsion

emergency referral to paediatric surgery

30
Q

Define gastroschisis and its treatment

A

Defect in abdominal wall, gut exposed, urgent tx
required, bowel may be ischaemic

Wrap in plastic to prevent fluid loss

31
Q

Define omphalocele and its treatment

A

Failure of viscera to return into abdo cavity, covered
in sac

Tx: silo formation, gradual reduction into abdo cavity

32
Q

Sx and Tx of button battery or ball bearing magnet ingestion + complication

A

Drooling
Poor orla intake
Distress when feeding

EMERGENCY ADMISSION
RISKS - corrosion to trachea, oesophagus, aorta, fistula formation between bowel wall

33
Q

Types of stoma

A

Colostomy - solid contents
Ileostomy - liquid contents
End colostomy - one end is stoma and other is mucuous fistula
Loop stoma - halved stoma for temporary use

34
Q

DDx of scrotal swelling

A

Testicular torsion
Hydrocele
Epididymo orchitis
Inguinal hernia
Incarcerated hernia
Acute idiopathic scrotal oedema
Trauma

35
Q

Testicular torsion Tx

A

NBM
IV analgesia
Refer to surgery - to untwist, if necrotic = orchidectomy

36
Q

What is a incarcerated hernia

A

Irreducible hernia

37
Q

Clinical findings and Tx of incarcerated hernia

A

Lump on groin/abdomen - more prominent when crying/coughing
Feels separate to testis

Urgent referral to surgery - manual reduction - delay may cause bowel strangulation and bowel death

38
Q

What is a hydrocele - how does it present and Tx

A

Fluctuant scrotal swelling

  • not tender
  • no erythema
  • gradual onset swelling

Should go away by 2 yrs, if not refer to surgery

39
Q

Epidiymoorchitis presentation and tx

A

quick onset
testicular pain, redness and swelling
associated to STI or UTI
Penile discharge
Dysuria

antibiotics

40
Q

Acute idiopathic scrotal oedema presentation and treatment

A

Scrotal skin in red and tender
NO hydrocele
Testis normal
Erythema spreads to perineum

Tx
- antibistamine and steroids

41
Q

Penile pathologies in children

A

Balanitis
Balanitis xerotica obliterans
Para phimosis
Trauma
phimosis

42
Q

Balanitis symptoms and signs

A

Head of penis is sore and itchy and red
Exudate on penis head
Bleeding from foreskin
Odour
Dysuria
Tightening of foreskin
Inability to retract foreskin (phimosis)

43
Q

Balanitis treatment

A

Lukewarm spoks
Topical steroids, antifungals or antibiotics

44
Q

What is balanitis xerotica obliterans

A

Chronic often progressive inflammation of glans penis

45
Q

Complications and cause of balanitis xerotica obliterans

A

Leads to
- phimosis
- urethral stenosis
- scarred white foreskin with pinhole opening

Lichen sclerosis may cause it

46
Q

Tx of balanitis xerotica obliterans

A

Topical steroid +
circumcision+/- meatal dilatation

47
Q

What is paraphimosis and how does it present

A

Tight prepuce is retracted and then unable to be replaced

Erythema, swelling and pain

48
Q

Paraphimosis Tx

A

Urgent referral to surgeons

manual reduction
osmotic reduction (sugar water)
Surgery

49
Q

What is phimosis and presentation

A

Irretractable foreskin

  • normal until 2 yrs old
  • incidence of balanitis
50
Q

Tx of phimosis

A

Avoid retraction if congenital - can cause scar formation
If issue is after 2 yrs of age - surgery

51
Q

What is hypospadias and tx

A

Meatus on underside of penis

Repair
TELL PARENTS DO NOT CIRCUMCISE - FORESKIN IS USED IN THE REPAIR

52
Q

UTI treatment in children

A

Under 3 - safeguarding, urine urgent MC&S (no urine dip), refer to paediatric specialist (may be congenital malformation)

Over 3 - Urine dip - abx tx and urine mc&s

53
Q

Pyelonephritis sx and tx

A

Systemically unwell with urinary symptoms

Paeds urgent referral
Long course of abx

Paediatrics (12 decks)

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