Paeds Surgery Flashcards
What is the most common hernia in children?
Indirect (though process vaginalis)
60% on the right
What on examination can strongly suggest its an ingunial hernia?
Can’t get above it
Does not trans-illuminate
Reducible
What is anorchia?
Absences of both testes at birth
Find negative hcg stimulation with raised lh and fsh
What is hypospadias?
The urinary meatus is not in the usual location
What are the possible causes for undescended testis at 6months old?
Absent testis
Intra-abdominal
Non-palpable ingiunal testis
The higher th testis the lower the fertility
What are phimosis, paraphimosis and balanitis?
Phimosis- irretractile foreskin (normal <5yrs)
Paraphimosis- tight prepuce stuck behind corona of glans-> oedema
Balanitis- inflammationnof foreskin
What are the indications for male circumcision?
Balanitis xerotica obliterans (bxo)- atrophic white patches on penis - like lichen sclerosis in women.
Recurrent balanitis with scarred foreskin
At what age would it be appropriate to close an umbilical hernia?
4years old, unlikely to spontaneously close
How may a neonate present with malrotation?
Bile stained vomiting
Shock/ acidosis
What is the Ladds procedure for malformation?
De-rotation of volvulus
Widening of mesentary into non-rotated position
Appendicectomy
At what age should a boy with undecended testis be referred to a surgeon for possible orchidopexy?
Referral from 3 months, seeing urological surgeon by 6months.
Most procedures are performed about 1 year of age
What percentage of undescended testis spontaneously descend by 4-6m?
75%
What hormones regulate testicular decent?
Phase 1- trans abdominal- leydig cell hormone INS3
Phase 2- inginal scrotal - 24-35wks - androgens and genitofemoral nerve.
Which vessel is compromised in a intestinal volvulus?
Superior mesenteric artery
What most always be excluded in people with painful red scrotums?
Torsion - requires urgent scrotal exploration
Most commonly around puberty
What are the most common causes of scrotal swelling in primary care?
Epididymal cysts - found in posterior testical - dx by us
What is the incidence and presentation of pyloric stenosis?
3-4/1000
Males x4 > females
Projectile vomiting after feeds,
Dehydration and constipation
Palpable mass- visable peristalsis
Hypochlorimic, hypokalemiac alkalosis.
Rx- ramstedt pyloromyotomy
What are the features of intussusception?
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
What is meckeks diverticulum and how does it arise?
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
How many type of oesophageal atresia are there? And which is the most common?
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
What are the 2 types of diaphragmatic hernias?
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)
What are the different approaches to ano-rectal malformations?
Surgery - 3 stage approach
Psarp - posterior sagital ano-rectoplasty (pull through procedure)
Depends on where the abnormality is.
Higher malformation - less become continent
What are the absolute indications for surgery in NEC?
Pneuoperitoneum
Clinical deterioration despite max Rx
Abdominal mass with obstruction or sepsis
What is the gold standard of diagnosis for Hirschsprung’s disease?
Rectal/colonic biopsy
Showing aganglionic bowel
Failure of the parasympathetic Auerbach and Meisser plexus
Contrast enema shows funnel shaped transistion zone.
Why is the incidence gastroschisis increasing?
Teenage mums
Recreational drug use
Spina bifida
Hmm
