Paeds surgery Flashcards by K D

Inguinal hernia pathophysiology

failure of oblitration of processus vaginalis

- with hernation of abdominal contents into peritoneal sac

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Types of inguinal hernia

Direct (directly through the fascia)

Indirect (through deep inguinal ring)

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M:F of inguinal hernia

9:1

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Right to left ratio of inguinal hernia

3:1

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Mx of inguinal hernia

herniotomy - high ligation of processus

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When to manage inguinal hernia in prematures

before d/c from NICU

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When to manage inguinal hernia in infants

within 1 mo

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When to manage inguinal hernia in children

elective

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Hydrocele

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

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How to differentiate between a hydrocele and hernia

Hydrocele:

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

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Cryptorchidism

undescended testes

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

orchidopexy

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Mx of unilateral UDT which is impalpable

laproscopy

orchidopexy

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Mx of bilateral UDT which is impalpable

make sure it’s a boy!

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Hypertrophic pyloric stenosis Dx

test feed clinically
VBG:
metabolic hypochloraemic alkalosis
U/S

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How to test feed for Hypertrophic pyloric stenosis

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

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Phimosis

inability to retract foreskin

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Definite indications for circumcision

-
pathological phimosis

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BXO

Balanitis Xerotica Obliterans

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

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Intussusception

Most common abdo pain in 3 months - 2 yrs

Telescoping of bowel into more distal bowel

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Sx of intussusception

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

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Ix for intussusception

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

Abdo US findings for intussusception

Transverse = Doughnut / target sign

Longitudinal = tubular mass

AXR findings for intussusception

Dilated proximal bowel

Multiple fluid levels

Mx of intussusception

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

Types of intussusception

Primary | Secondary

Primary Intussusception pathophysiology

Secondary to lymphoid hyperplasia of Peyer's patches in terminal ileum following a viral infection

Secondary intussusception

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

Normal rotation of gut

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

Abnormal rotation of gut in utero

<270 degrees rotation

Consequence of Abnormal rotation of gut in utero

- shortness base of the mesentery | - predisposes to mid-gut volvulus

Malrotation presentation

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

Ix for malrotation

AXR | Upper GI contrast

AXR findings of malrotation

double bubble small amount of air distally not good for Dx

Upper GI contrast finding of malrotation

corkscrew appearance due to obstruction of flow of contrast

Mx of malrotation

Ladds procedure: - urgent laprotomy - division of adhesional bands allowing widening of small mesentery

Extra abdominal causes of abdo pain

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

Differentials for RIF pain

Appendicitis Mesenteric adenitis Psoas abscess Apparently pneumonia too but meh

Mesenteric adenitis

Central abdo pain and URTI | Inflamed abdominal lymph node

Differentials for sudden severe testicular pain

Testicular torsion Hydatid of morgagne Epididymo-orchitis Idiopathic scrotal oedema

Mx of testicular torsion

Emergency surgical scrotal exploration | Bilateral orchidopexy

Hydatid of morgagne

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

Hirschsprung's disease pathophysiology

- 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

Sx of hirchsprung's disease

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

Dx of hirchsprung

- suction biopsy at the distal end; no ganglion cells

Mx of Hirchsprung disease

- Rectal washouts initially, | - Anorectal pull through procedure

Gastroschisis

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

Omphalocele/exomphalos

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

What is meconium ileus

Delayed passage of meconium

Meconium ileus cause

Majority cystic fibrosis

Meconium ileus mx

Initially: PR contrast ( may dislodge meconium plugs) + NG N acetyl cysteine Surgery

Necrotising enterocolitis risk factor

Prematurity

Necrotising enterocolitis presentation

Abdo distension Bloody stool Septic

Necrotising enterocolitis mx

Total bowel rest | TPN