Paediatric surgery and GI Flashcards
Common GI presentation in children
Crying
Vomiting
Abdo pain
Poor feeding
Abdo distension
What is intussuception
Section of bowel telescopes into another usually around lymph nodes following a viral illness
Intessuception presention
3-9 months age
Following viral illness
Sx
- Pain
- non bilous vomiting
- drawing of legs in pain
- RECURRENT JELLY STOOL
Intussuception Ix and findings
Tender sausage shaped mass palpable
Blood tests - FBC, CRP
Abdominal X Ray
USS - target sign
Intussuception treatment
Antibiotics
Analgesia
Fluids
Barium air enema reduction during X ray - if fails surgery due to risk of bowel perforation
What is appendicitis
Inflammation of appendix
Appendicitis symptoms
Generalised abdominal pain that moves to right iliac fossa
Diarrhea and vomiting
Fever
Reduced appetite
Lethargy
Appendicitis investigation and examination findings
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
Appendicitis treatment
Surgery
IV fluids
IV abx
IV analgesia
NBM
Meckel’s diverticulum presentation
same as appendicitis
Complications of meckel’s diverticulum
ecoptic gastric cells may lead to ulceration = blood stools
may lead to intussuception or volvulus
Meckel’s diverticulum diagnosis
Meckel’s scan
What is meckel’s diverticulim
congenital outpouching or bulge in the lower part of the small intestine - leftover of umbilical cord
DDx of bilious vomiting
Volvulus
Duodenal atresia / stenosis
Necrotising entercolitis
Meconium ileus
Hirschsprung’s disease
Post op ileus
Incarcerated hernia
- all signs of bowel obstruction
What is volvulus and what can it lead to (complications)
Twist in intestine (malrotated gut)
RED FLAG BOWEL OBSTRUCTION - CAN LEAD TO DEATH OF SMALL BOWEL - TIME CRITICAL
COMPLICATIONS
- DEATH
- adhesions
- small gut syndrome
Ix and Tx for volvulus
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)
Sx of volvulus
Bilious vomiting
sever abdo pain
irritability
poor feeding
diarrhoea
fever
distended abdo
v tender
dehyrdated
tachycardic
signs of shock
DDx of non bilious vomiting
Reflux/GORD
Cows milk intolerance
Normal posseting
Pyloric stenosis
Sepsis / infection
Excessive feeding
Duodenal stenosis
Appendicitis
Gastroenteritis
Raised ICP
Intussusception
Incarcerated hernia
What is pyloric stenosis
Hypertrophy of pylorus muscle - resultis in narrow channel and obstruction
Pyloric stenosis presentation
PROJECTILE NON BILIOUS VOMITING
poor feeding
signs of dehydration
Ix and investigation findings of pyloric stenosis
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
Pyloric stenosis treatment
NBM
NG Tube insertion
IV fluids - electrolyte correction
Surgery - pylorectomy
Post op - build feeds slowly
Umbilical hernia tx
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
What is Wilms tumour and how does it present and treatment
Unilateral renal tumour
May have haematuria
Palpable abdominal mass
Abdo distension
May have hypertension
DO NOT LEAVE UNTREATED (HIGH MORTALITY)
CHEMO AND SRUGICAL RESECTION
Define Nueroblastoma, presentation and treatment
Tumour starting from adrenal or paraspinal sites
Abdominal distension / mass
Anorexia
CATECHOLAMINE IN URINE
Tx
- Chemo, surgery, radiotherapy
What is rhabdomyosarcoma
Soft tissue sarcoma around muscular structures
Rhabdomyosarcoma presentation
mass - esp in head / neck
associated to li fraumeni syndrome
DDx of neonatal GI surgical conditions
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
Main time critical emergencies
bilious vomiting
testicular torsion
emergency referral to paediatric surgery
Define gastroschisis and its treatment
Defect in abdominal wall, gut exposed, urgent tx
required, bowel may be ischaemic
Wrap in plastic to prevent fluid loss
Define omphalocele and its treatment
Failure of viscera to return into abdo cavity, covered
in sac
Tx: silo formation, gradual reduction into abdo cavity
Sx and Tx of button battery or ball bearing magnet ingestion + complication
Drooling
Poor orla intake
Distress when feeding
EMERGENCY ADMISSION
RISKS - corrosion to trachea, oesophagus, aorta, fistula formation between bowel wall
Types of stoma
Colostomy - solid contents
Ileostomy - liquid contents
End colostomy - one end is stoma and other is mucuous fistula
Loop stoma - halved stoma for temporary use
DDx of scrotal swelling
Testicular torsion
Hydrocele
Epididymo orchitis
Inguinal hernia
Incarcerated hernia
Acute idiopathic scrotal oedema
Trauma
Testicular torsion Tx
NBM
IV analgesia
Refer to surgery - to untwist, if necrotic = orchidectomy
What is a incarcerated hernia
Irreducible hernia
Clinical findings and Tx of incarcerated hernia
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
What is a hydrocele - how does it present and Tx
Fluctuant scrotal swelling
- not tender
- no erythema
- gradual onset swelling
Should go away by 2 yrs, if not refer to surgery
Epidiymoorchitis presentation and tx
quick onset
testicular pain, redness and swelling
associated to STI or UTI
Penile discharge
Dysuria
antibiotics
Acute idiopathic scrotal oedema presentation and treatment
Scrotal skin in red and tender
NO hydrocele
Testis normal
Erythema spreads to perineum
Tx
- antibistamine and steroids
Penile pathologies in children
Balanitis
Balanitis xerotica obliterans
Para phimosis
Trauma
phimosis
Balanitis symptoms and signs
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)
Balanitis treatment
Lukewarm spoks
Topical steroids, antifungals or antibiotics
What is balanitis xerotica obliterans
Chronic often progressive inflammation of glans penis
Complications and cause of balanitis xerotica obliterans
Leads to
- phimosis
- urethral stenosis
- scarred white foreskin with pinhole opening
Lichen sclerosis may cause it
Tx of balanitis xerotica obliterans
Topical steroid +
circumcision+/- meatal dilatation
What is paraphimosis and how does it present
Tight prepuce is retracted and then unable to be replaced
Erythema, swelling and pain
Paraphimosis Tx
Urgent referral to surgeons
manual reduction
osmotic reduction (sugar water)
Surgery
What is phimosis and presentation
Irretractable foreskin
- normal until 2 yrs old
- incidence of balanitis
Tx of phimosis
Avoid retraction if congenital - can cause scar formation
If issue is after 2 yrs of age - surgery
What is hypospadias and tx
Meatus on underside of penis
Repair
TELL PARENTS DO NOT CIRCUMCISE - FORESKIN IS USED IN THE REPAIR
UTI treatment in children
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
Pyelonephritis sx and tx
Systemically unwell with urinary symptoms
Paeds urgent referral
Long course of abx
