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Paediatrics > Paeds Surgery > Flashcards

Paeds Surgery Flashcards

1
Q

What is the most common hernia in children?

A

Indirect (though process vaginalis)

60% on the right

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2
Q

What on examination can strongly suggest its an ingunial hernia?

A

Can’t get above it
Does not trans-illuminate
Reducible

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3
Q

What is anorchia?

A

Absences of both testes at birth

Find negative hcg stimulation with raised lh and fsh

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4
Q

What is hypospadias?

A

The urinary meatus is not in the usual location

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5
Q

What are the possible causes for undescended testis at 6months old?

A

Absent testis
Intra-abdominal
Non-palpable ingiunal testis

The higher th testis the lower the fertility

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6
Q

What are phimosis, paraphimosis and balanitis?

A

Phimosis- irretractile foreskin (normal <5yrs)
Paraphimosis- tight prepuce stuck behind corona of glans-> oedema
Balanitis- inflammationnof foreskin

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7
Q

What are the indications for male circumcision?

A

Balanitis xerotica obliterans (bxo)- atrophic white patches on penis - like lichen sclerosis in women.
Recurrent balanitis with scarred foreskin

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8
Q

At what age would it be appropriate to close an umbilical hernia?

A

4years old, unlikely to spontaneously close

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9
Q

How may a neonate present with malrotation?

A

Bile stained vomiting

Shock/ acidosis

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10
Q

What is the Ladds procedure for malformation?

A

De-rotation of volvulus
Widening of mesentary into non-rotated position
Appendicectomy

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11
Q

At what age should a boy with undecended testis be referred to a surgeon for possible orchidopexy?

A

Referral from 3 months, seeing urological surgeon by 6months.
Most procedures are performed about 1 year of age

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12
Q

What percentage of undescended testis spontaneously descend by 4-6m?

A

75%

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13
Q

What hormones regulate testicular decent?

A

Phase 1- trans abdominal- leydig cell hormone INS3

Phase 2- inginal scrotal - 24-35wks - androgens and genitofemoral nerve.

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14
Q

Which vessel is compromised in a intestinal volvulus?

A

Superior mesenteric artery

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15
Q

What most always be excluded in people with painful red scrotums?

A

Torsion - requires urgent scrotal exploration

Most commonly around puberty

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16
Q

What are the most common causes of scrotal swelling in primary care?

A

Epididymal cysts - found in posterior testical - dx by us

17
Q

What is the incidence and presentation of pyloric stenosis?

A

3-4/1000
Males x4 > females

Projectile vomiting after feeds,
Dehydration and constipation
Palpable mass- visable peristalsis
Hypochlorimic, hypokalemiac alkalosis.

Rx- ramstedt pyloromyotomy

18
Q

What are the features of intussusception?

A

Telescope bowel, proximal or at the level of ilelo-ceacal valve.
3-12months normally
Crying, vomiting, drawing up legs,
Red current jelly stools

Rx- reduction with air insufflation (85% success)
If unsuccessful operation

19
Q

What is meckeks diverticulum and how does it arise?

A

Congenital dierticulum of the small intestine. The reminant of the vitelloinstestinal/ omphalomesenteric duct. (Connection from the yolk sac to the intestine)

Rule of 2s - 2% population, 2 feet from ileocaecal vavle, 2 inches long

20
Q

How many type of oesophageal atresia are there? And which is the most common?

A

5 types
Type c - 87%, full upper oesophageal pouch, connection/ fistula between lower oesophagus and trachea.

Presentation- polyhydramnious. Choking and coughing, pneumonia, cyanosis. Picked up early in life.
Associated with VACTERL

21
Q

What are the 2 types of diaphragmatic hernias?

A

Morgagni - anterior. Minamal damage, later presentation, good prognosis

Bochdalek hernia - posterior, larger defect, often diagnosed antenatally, pulmonary hypolasia, poor prognosis.

Heart lung bypass machine ECMO (extra corporeal membrane oxygenation)

22
Q

What are the different approaches to ano-rectal malformations?

A

Surgery - 3 stage approach

Psarp - posterior sagital ano-rectoplasty (pull through procedure)

Depends on where the abnormality is.
Higher malformation - less become continent

23
Q

What are the absolute indications for surgery in NEC?

A

Pneuoperitoneum
Clinical deterioration despite max Rx
Abdominal mass with obstruction or sepsis

24
Q

What is the gold standard of diagnosis for Hirschsprung’s disease?

A

Rectal/colonic biopsy
Showing aganglionic bowel

Failure of the parasympathetic Auerbach and Meisser plexus

Contrast enema shows funnel shaped transistion zone.

25
Q

Why is the incidence gastroschisis increasing?

A

Teenage mums

Recreational drug use

26
Q

Spina bifida

A

Hmm

Paediatrics (21 decks)

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