Paeds Surg

Question 1

DDx Bowel obstruction Neonates

Answer 1

Hirschsprung dx
Malrotation w or w/o Volvulus
Intestinal Atresia
Pyloric stenosis
Intussusception

Question 2

DDx BO < 5 y.o

Answer 2

Intussusception
Incarcerated Inguinal hernia
Malrotation w midgut volvulus
Post Op adhesions

Question 3

DDx GI bleed

Answer 3

Intussusception
Anal fissures
Volvulus
Polyps

Question 4

DDx Bilious Vomitting

Answer 4

Atresia
Midgut volvulus
Hirschsprung Dx
Intussusception
Irreducible Inguinal hernia

Question 5

Midgut Volvulus (c/f & Ix)

Answer 5

C/F - 75% within first few months
- twisting of midgut
- p/w small bowel obstruction & bilious vomitting

Ix
Abdo XR - double bubble sign - stomach, proximal duodenum
US - duodenal distension

Question 6

Intussusception (C/F, Aetiology)

Answer 6

Aetiology - Adenovirus/rotavirus vaccine, Idiopathic (90%), Meckel’s, HUS/HSP
6-18 m.o
C/F - intermittent pain, appears well btw episodes, bilious vomitting, increasing frequency of pain, Red currant jelly stool (late)

Question 7

Intussusception (stages)

Answer 7

Bowel obstruction, venous congestion, bowel wall ischaemia

Question 8

Pyloric Stenosis (c/f, Ix)

Answer 8

2 wks - 2 m.o
C/F - projectile vomit (non bilious), abdo distension, palpable mass, vomit post feed, dilated stomach
Ix - VBG - hypochloraemic met alkalosis, HypoK, BGL
USS

Question 9

Pyloric Stenosis (Mx, aetiology)

Answer 9

IVC
IV hydration - N/s + 5% dextrose
Correct electrolyte
Pyloroplasty

Hypertrophy + Hyperplasia of 2 muscle layers of pylorus causing narrowing of gastric antrum.