Paeds Surgery

Question 1

Inguinal hernia?

Answer 1

M>F 8:1

Indirect = MORE COMMON - sac passes through internal inguinal ring + along inguinal canal

Direct = rare, usually prem baby or connective tissue disorder

Question 2

Hydrocele?

Answer 2

Scrotal swelling of variable size - o/e can get above swelling, transilluminable

Due to persistance of processus vaginalis - more of a problem in boys

Resolve with time - 2 years

Question 3

Umbilical hernia?

Answer 3

More common in afro caribbean

Rarely symptomatic

Repair for cosmetic reason pre-school

Question 4

Phimosis?

Answer 4

Separation of foreskin from glands - releases smegma

Only small amount need circumcisions - only if symptomatic (painful erections, persistent infections)

Question 5

How does intussception happen?

Answer 5

Enlarged peyer’s patches –> bowel thinks its poo so tries to push it along and goes in on itself (proximal into distal)

Question 6

Oesophageal atresia +/- TOF?

Answer 6

Neonates with esophageal atresia usually develop copious, fine white frothy bubbles of mucus in the mouth and nose. Secretions recur despite suctioning.
Infants may develop rattling respiration and episodes of coughing and choking in association with cyanosis.

Closure of TOF and oesophageal anastamosis

50% have VACTRL anomalies

Question 7

VACTRL?

Answer 7

vertebral defects
anal atresia
cardiac defects
tracheo-esophageal fistula
renal anomalies
limb abnormalities

Question 8

Anorectal abnormalities?

Answer 8

Usually diagnosed before presents with obstruction

Anus may be ectopic, or absent with rectal fistula connection to UG system

Boys = perineal fistula
Girls = vesicular fistula

Mangement = initial stoma, anoplasty

Question 9

Exomphlolos/Omphalocele and Gastrochisis?

Answer 9

Gastrochisis more common

Gastrochisis = abdo contents through defect of right of umbilical cicatrix.

Exompholos = presence of abdominal contents in sac at umbilicus - major or minor defect dependent on size. Minor associate with chromosomal abnormalities.