Paeds surgery

Question 1

Inguinal hernia pathophysiology

Answer 1

failure of oblitration of processus vaginalis

- with hernation of abdominal contents into peritoneal sac

Question 2

Types of inguinal hernia

Answer 2

Direct (directly through the fascia)

Indirect (through deep inguinal ring)

Question 3

M:F of inguinal hernia

Answer 3

9:1

Question 4

Right to left ratio of inguinal hernia

Answer 4

3:1

Question 5

Mx of inguinal hernia

Answer 5

herniotomy - high ligation of processus

Question 6

When to manage inguinal hernia in prematures

Answer 6

before d/c from NICU

Question 7

When to manage inguinal hernia in infants

Answer 7

within 1 mo

Question 8

When to manage inguinal hernia in children

Answer 8

elective

Question 9

Hydrocele

Answer 9

fluids enter peritoneal sac, but too narrow for abdo content to do so

Question 10

How to differentiate between a hydrocele and hernia

Answer 10

Hydrocele:

• slow to fill, slow to empty
• can get above the swelling
• it transilluminates

Question 11

Cryptorchidism

Answer 11

undescended testes

Question 12

Mx of unilateral /bilateral undescended testes (UDT) that is palpable

Answer 12

orchidopexy

Question 13

Mx of unilateral UDT which is impalpable

Answer 13

laproscopy

orchidopexy

Question 14

Mx of bilateral UDT which is impalpable

Answer 14

make sure it’s a boy!

Question 15

Hypertrophic pyloric stenosis Dx

Answer 15

• test feed clinically
• VBG:
  metabolic hypochloraemic alkalosis
• U/S

Question 16

How to test feed for Hypertrophic pyloric stenosis

Answer 16

• Pass a nasogastric tube
• Examine from the LEFT
• Feed/put air down NG tube
• Watch for visible peristalsis
• Feel for the tumour

Question 17

Phimosis

Answer 17

inability to retract foreskin

Question 18

Definite indications for circumcision

Answer 18

-
pathological phimosis

• BXO

Question 19

BXO

Answer 19

Balanitis Xerotica Obliterans

lichen sclerosis of male genitalia; stenosis of foreskin making harder to pee

Question 20

Intussusception

Answer 20

Most common abdo pain in 3 months - 2 yrs

Telescoping of bowel into more distal bowel

Question 21

Sx of intussusception

Answer 21

Partially formed stool
Redcurrent jelly stool
Vomiting (clear then becomes more bilious)
Colic abdo pain
Mass
Infarction
Peritonitis

Question 22

Ix for intussusception

Answer 22

• Abdo US (diagnostic)
• AXR
• if in doubt, contrast enema

Question 23

Abdo US findings for intussusception

Answer 23

Transverse = Doughnut / target sign

Longitudinal = tubular mass

Question 24

AXR findings for intussusception

Answer 24

Dilated proximal bowel

Multiple fluid levels

Question 25

Mx of intussusception

Answer 25

Drip and suck resus Air enema < 120 mmHg Laparotomy reduction/resection

Question 26

Types of intussusception

Answer 26

Primary | Secondary

Question 27

Primary Intussusception pathophysiology

Answer 27

Secondary to lymphoid hyperplasia pf Peyer's patches in ternminal ileum following a viral infection

Question 28

Secondary intussusception

Answer 28

secondary to pathological lead point eg Meckel's diverticulum - suspect in older children and recurrent episodes

Question 29

Normal rotation of gut

Answer 29

In utero, gut returns to abdo cavity at 10 wks and rotates 270 degrees counterclockwise

Question 30

Abnormal rotation of gut in utero

Answer 30

<270 degrees rotation

Question 31

Consequence of Abnormal rotation of gut in utero

Answer 31

- shortens base of the mesentery - predisposes to mid-gut volvulus

Question 32

Malrotation presentation

Answer 32

- presents within 1st yr - sudden onset bile stained vomiting - abdo pain

Question 33

Ix for malrotation

Answer 33

AXR | Upper GI contrast

Question 34

AXR findings of malrotation

Answer 34

double bubble small amount of air distally not good for Dx

Question 35

Upper GI contrast finding of malrotation

Answer 35

corkscrew appearance due to obstruction of flow of contrast

Question 36

Mx of malrotation

Answer 36

Ladds procedure - urgent laprotomy

Question 37

Extra abdominal causes of abdo pain

Answer 37

``` Hernia Testes Hip Vertebrae URT LRT ```

Question 38

Chronic abdo pain

Answer 38

Less likely to be surgical

Question 39

Colic pain vs Inflammatory pain

Answer 39

Inflammatory constant - eg. peritonitis

Question 40

Differentials for RIF pain

Answer 40

Appendicitis Mesenteric adenitis Psoas abscess Apparently pneumonia too but meh

Question 41

Mesenteric adenitis

Answer 41

Inflammed abdominal lymph node

Question 42

Abdo pain + tachypnoea

Answer 42

Think respiratory problem

Question 43

Differentials for sudden severe testicular pain

Answer 43

Testicular torsion Hydatid of morgagne Epididymo-orchitis Idiopathic scrotal oedema

Question 44

Mx of testicular torsion

Answer 44

Emergency surgical scrotal exploration | Bilateral orchidopexy

Question 45

Hydatid of morgagne

Answer 45

Torsion of small outpouching of testes | May see small dark blue spot

Question 46

Hirschsprung's disease pathophysiology

Answer 46

- Neural crest cells dont migrate fully to form the myenteric plexus, which supplies the intestine. - also absence of ganglion cells-> persistent overstimulation of nerves in the affected region, resulting in contraction

Question 47

Sx of hirchsprung's disease

Answer 47

- vomiting - constipation (failure of passing meconium) - explosive stool

Question 48

Dx of hirchsprung

Answer 48

- suction biopsy at the distal end; no ganglion cells

Question 49

Mx of Hirchsprung disease

Answer 49

- remove the affected segment and reanastomise it

Question 50

Gastroschisis

Answer 50

defect lateral to umbilicus | abdo content outside abdo, and not covered by peritoneum

Question 51

Omphalocele/exomphalos

Answer 51

defect within umbilicus abdo content outside abdo but COVERED by peritoneum ass with trisomies