Paeds Flashcards
What is the operation of choice for Malrotation of the Gut?
Ladd’s procedure.
- Division of Ladds bands
- Place colon on left side, remove appendix
What is the most common type of Diaphragmatic hernia?
Bochdalek hernia (usually left sided)
How does Hirshprungs disease typically present?
With failure to pass meconium in 48 hours
Diagnose with suction rectal biopsy
Treat with serial washouts and pull through at 6 months
High incidence of NEC
How does Pyloric stenosis tend to present?
Non bile stained vomiting at 4-6 weeks
Ramstedt pyloromyotomy
5-10% FH
Where is the most frequent location of a thyroglossal cyst?
Just inferior to hyoid (65%)
Treat with Sistrunk procedure - excision of hyoid bone
Thin walled and anechoic
Where are branchial cysts most frequently located?
Usually located anterior to SCM near angle of mandible
75% from second branchial cleft
Usually anechoic and water like unless infected
Where is a cystic hygroma most commonly found?
Posterior to SCM
Usually present <2
Typically hypo echoic on USS
How do infantile haemangiomas present?
Rapidly growing neck mass that often spontaneously regresses
Contains calcified phleboliths on XR
What is the most common cause of PR bleeding in young children?
Probably Meckel’s or a polyp
IBD in older children
What is the best imaging test for a Meckel’s diverticulum?
Technetium 99
How do Meckel’s most frequently present if symptomatic?
Obstruction
Only 5% symptomatic
2% of population, 2 inches long , 2feet from IC valve
What is the incidence of Cryptorchidism?
Defined by failure to reach bottom of scrotum by 3 months, then 1-2%.
5% at birth
What congenital defects are associated with cryptorchidism?
PPV Abnormal epididymis Cerebral palsy Learning difficulties Wilms Tumour Abdominal wall defects
What is the increased risk of testicular cancer with undescended testis?
40 times normal risk (seminoma)
50% of intra-abdominal will become malignant
When should an orchidopexy be performed for cryptorchidism?
6-18months of age.
If impalpable in the groin then laparoscopic exploration and 1/2 stage procedure
Above 2 the Sertoli cells degrade, and if presenting in teenage years, probably should just have orchidectomy
When does intestinal rotation occur in embryological development?
About the 4th week 270deg anticlockwise twist
What is the characteristic X-ray finding of duodenal atresia?
Double bubble sign on plain X-ray
40% have Down’s
8% of Downs have duodenal atresia
Treated with duodenoduodenostomy through transverse incision. Has good outcomes
How frequent is umbilical hernia in infants?
Up to 20%. Majority close spontaneously
What is the most common infective organism causing Omphalitis?
Staph Aureus
How does a persistent urachus present?
Urinary discharge from umbilicus
How does a persistent Vitello-intestinal duct present?
Umbilical discharge of small bowel content - often a Meckel’s diverticulum
How are paediatric inguinal hernias repaired?
High risk of strangulation <1 and should be repaired urgently. If >1, ?electively
Herniotomy is the treatment of choice
Females should have bilateral exploration ?lap
What are indications for circumcision?
Lichen sclerosus> BXO
Paraphimosis
Recurrent balanitis
Persistent phimosis - but only if pathological. 10% of 11 year olds non-retractile (does not matter)
When should a paediatric hydrocele be considered for treatment in children?
> 12 months and not decreasing in size –> referral
Ligation of PPV
How should microscopic haematuria be investigated in children?
If asymptomatic, may be benign and resolve. Consider repeating in 6 months
Red flag features include abnormal renal function, proteinuria, signs of fluid overload, hypertension or frank haematuria
Consider diagnosis of Alport syndrome or structural abnormalities NB wilms (mass)
What is the peak incidence of Intussusception?
5-7 months, 70%<1 year
