paeds surgery Flashcards
midline of neck cyst children
thyroglossal
dermoid
lipoma
foramen cicum out
thrid pharyngeal arch
thyroglossal duct cant get infeted so need to be removed
thyroid galnd
hyoid bone
phimosis
foreskin is too tight to pull back
lichen sclerous
come in with urinary retention
narrowing of meatus
after 4/5 months of circumcision this occurs
Mx
topical steroids
smegma cyst
cheesy chalky material stuck under the fore skin
indicartions for circumcision
paraphimosis recurrent UTI preotease on foreskin spina bifida urine reflux
contraindication for circumcision
hypospadias
small/ webbing penis not enough ventral skin
varicocele
11-14
hydrocele can go above the swelling
hernia can go below the swelling - marble can push back gurgling sound
encysted hydrocelel
Mx of undescended testes
milking manoeuvre
non palpable testes
Ix
intra abdominal
hypoplastic inguinal
vanishing testes - might have undergone torsion antenatal period testicle in the gor
checked agin 6 weeks
then 6 months
then its known as
left comes down before right
NO INVESTIGATION UNLESS IT BILATERAL OR HAVE SERIOUS HYDROSAPEDIUS
INTRASEX
fsh lh testosterone if testicles are not felt bilaterally
rationale for orchidopexy
fertility torsion trauma hernia malignancy cosmetic
both not felt
retractile testis - if u pull it down adn it styas
ascended testis - born w descended testis but has moved up
trapped testis -
gliding testis - when u pull it down it goes back
testicular torsion
clamp the cord deliver testis
testicular torsion
clamp the cord deliver testis
idiopathic scrotal oedema
peak age 4-5 years
presentation
swollen, red hemiscrotum or bilateral
pain minimum
Mx - conservative, self liming within 1-2 days
varicocele
commonest on left side 11-14
pamipform plexus -
insertion is vertical on the left side
throbbing pain testicle not growing left is laggin behind 10/20%
umbilical hernia
closes at the age of 3/4
hypothyroidism
non billious vomiting projectile
gastric outlet obstruction
hx of pyloric stenosis
oesophageal atresia
1A is the commonest
absent gastric buble antenatal means no fistula
no atresia no fistule
end fistula and oesopahgus and trachea communication
- Associated with tracheo-oesophageal fistula and polyhydramnios
May present with choking and cyanotic spells following aspiration
VACTERL associations
what is hirschsrpung disease
diagnosis
Mx
The absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel results in a narrow, contracted segment. The abnormal bowel extends from the rectum for a variable distance proximally, ending in a normally innervated, dilated colon.
diagnosis
suction rectal biopsy
Mx
initally - rectal washouts/bowel irrigation
surgical and usually involves an initial colostomy followed by anastomozing normally innervated bowel to the anus.
Hirschsprung ass w
- 3x common in males
- Downs syndrome
- Neurofibromatosis
- Waardenburg syndrome (a genetic condition causing pale blue eyes, hearing loss and patches of white skin and hair)
- Multiple endocrine neoplasia type II
features of hirschsprung
failure to pass meconium within the first 48 hours of life. Abdominal distension - billious vomiting - lethargy - dehydration
In later childhood – profound chronic constipation, abdominal distension, and growth failure.
what is hirschsprung associated enterocolitis
inflammation and obstruction of the intestine
within 2-4 weeks of birth with fever, abdominal distention, diarrhoea (often with blood) and features of sepsis. It is life threatening and can lead to toxic megacolon and perforation of the bowel. It requires urgent antibiotics, fluid resuscitation and decompression of the obstructed bowel.
features of lymph nodes that requires further Ix in children
features children present
> 2 LN palpable for >2 weeks
2cm in size
2 or more regions affected
supraclavicular LNs
nodes that are firm, variable in size (TB), non-tender, matted together
fever
weight loss
night sweats
Ix we do for lymphadenopathy and why
CRP - if increased raises level of concern
FBC
• Cytopaenia in more than one cell line – Leukaemia, lymphoma, SLE.
• Isolated leucopoenia or neutropenia – viral infection or leukaemia.
• Leucocytosis with left shift – bacterial infection.
• Atypical lymphocytosis – Ebstein-Barr virus infection.
• Anaemia – TB, SLE.
• Thrombocytosis – Kawasaki disease.
what is gastrochisis and Mx
bowel outside w no covering
Mx
vaginal delivery may be attempted
newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
what is omphalocele Mx
abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.
ass
Beckwith-Wiedemann syndrome
Down’s syndrome
cardiac and kidney malformations
Mx
caesarean section is indicated to reduce the risk of sac rupture
a staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure
complications of undescended testis
Mx
unilateral
Bilateral
infertility
torsion
testicular cancer
psychological
unilateral
- At birth — re-examine the infant at 6–8 weeks of age.
- At 6–8 weeks of age — re-examine the infant at 4–5 months of age.
- At 4–5 months (corrected for gestational age), if the testis remains undescended, arrange referral to paediatric surgery or urology for specialist management depending on local referral pathways, to be seen by 6 months of age.
Bilateral
- identified at birth
- Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
- if disorder of sexual probs is excluded tests still not present in scrotum by4-5 months of age child referred by 6 ms
if at birth present but 6-8 weeks not there - urgent referral within 2 weeks
Surgical Mx
- palapble -> orchidopexy using inguinal approach
- non-palpable -> under anaesthesia with inguinal exploration and diagnostic laparoscopy may be needed to locate an intra-abdominal testis and perform subsequent orchidopexy or orchidectomy (removal of the testis).
congenital diaphragmatic hernia (CDH)
outcome of prognosis
- liver position
- lung to head ratio
risk of recurrence of CDH is possible
more common on the left hand side
pulmonary HTN and hypoplasia -> RD
what is hypospadias
characteristics
- a ventral urethral meatus
- a hooded prepuce
- chordee (ventral curvature of the penis) in more severe forms
- the urethral meatus may open more proximally in the more severe variants
Mx
- specialist services
- corrective surgery around 12 m
what is phimosis
foreskin is too tight ot be pulled back over the head of the penis
<2 yrs non-retractile foreskin/ballooining during micturtionp it is normal -> resolves with time
