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MRCS med school > Paeds surgery > Flashcards

Paeds surgery Flashcards

1
Q

Inguinal hernia pathophysiology

A

failure of oblitration of processus vaginalis

- with hernation of abdominal contents into peritoneal sac

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2
Q

Types of inguinal hernia

A

Direct (directly through the fascia)

Indirect (through deep inguinal ring)

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3
Q

M:F of inguinal hernia

A

9:1

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4
Q

Right to left ratio of inguinal hernia

A

3:1

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5
Q

Mx of inguinal hernia

A

herniotomy - high ligation of processus

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6
Q

When to manage inguinal hernia in prematures

A

before d/c from NICU

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7
Q

When to manage inguinal hernia in infants

A

within 1 mo

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8
Q

When to manage inguinal hernia in children

A

elective

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9
Q

Hydrocele

A

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

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10
Q

How to differentiate between a hydrocele and hernia

A

Hydrocele:

  • slow to fill, slow to empty
  • can get above the swelling
  • it transilluminates
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11
Q

Cryptorchidism

A

undescended testes

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12
Q

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

A

orchidopexy

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13
Q

Mx of unilateral UDT which is impalpable

A

laproscopy

orchidopexy

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14
Q

Mx of bilateral UDT which is impalpable

A

make sure it’s a boy!

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15
Q

Hypertrophic pyloric stenosis Dx

A
  • test feed clinically
  • VBG:
    metabolic hypochloraemic alkalosis
  • U/S
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16
Q

How to test feed for Hypertrophic pyloric stenosis

A
  • 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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17
Q

Phimosis

A

inability to retract foreskin

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18
Q

Definite indications for circumcision

A

-
pathological phimosis

  • BXO
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19
Q

BXO

A

Balanitis Xerotica Obliterans

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

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20
Q

Intussusception

A

Most common abdo pain in 3 months - 2 yrs

Telescoping of bowel into more distal bowel

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21
Q

Sx of intussusception

A 
Partially formed stool
Redcurrent jelly stool
Vomiting (clear then becomes more bilious)
Colic abdo pain
Mass
Infarction
Peritonitis
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22
Q

Ix for intussusception

A
  • Abdo US (diagnostic)
  • AXR
  • if in doubt, contrast enema
23
Q

Abdo US findings for intussusception

A

Transverse = Doughnut / target sign

Longitudinal = tubular mass

24
Q

AXR findings for intussusception

A

Dilated proximal bowel

Multiple fluid levels

25
Q

Mx of intussusception

A

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

26
Q

Types of intussusception

A

Primary

Secondary

27
Q

Primary Intussusception pathophysiology

A

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

28
Q

Secondary intussusception

A

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

29
Q

Normal rotation of gut

A

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

30
Q

Abnormal rotation of gut in utero

A

<270 degrees rotation

31
Q

Consequence of Abnormal rotation of gut in utero

A
  • shortness base of the mesentery

- predisposes to mid-gut volvulus

32
Q

Malrotation presentation

A
  • presents within 1st yr
  • sudden onset bile stained vomiting
  • abdo pain
33
Q

Ix for malrotation

A

AXR

Upper GI contrast

34
Q

AXR findings of malrotation

A

double bubble
small amount of air distally

not good for Dx

35
Q

Upper GI contrast finding of malrotation

A

corkscrew appearance due to obstruction of flow of contrast

36
Q

Mx of malrotation

A

Ladds procedure:

  • urgent laprotomy
  • division of adhesional bands allowing widening of small mesentery
37
Q

Extra abdominal causes of abdo pain

A 
Hernia
Testes
Hip
Vertebrae
URT
LRT
38
Q

Differentials for RIF pain

A

Appendicitis
Mesenteric adenitis
Psoas abscess
Apparently pneumonia too but meh

39
Q

Mesenteric adenitis

A

Central abdo pain and URTI

Inflamed abdominal lymph node

40
Q

Differentials for sudden severe testicular pain

A

Testicular torsion
Hydatid of morgagne
Epididymo-orchitis
Idiopathic scrotal oedema

41
Q

Mx of testicular torsion

A

Emergency surgical scrotal exploration

Bilateral orchidopexy

42
Q

Hydatid of morgagne

A

Torsion of small outpouching of testes

May see small dark blue spot

43
Q

Hirschsprung’s disease pathophysiology

A
  • 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
44
Q

Sx of hirchsprung’s disease

A
  • vomiting
  • constipation (failure of passing meconium)
  • explosive stool
45
Q

Dx of hirchsprung

A
  • suction biopsy at the distal end; no ganglion cells
46
Q

Mx of Hirchsprung disease

A
  • Rectal washouts initially,

- Anorectal pull through procedure

47
Q

Gastroschisis

A

defect lateral to umbilicus

abdo content outside abdo, and not covered by peritoneum

48
Q

Omphalocele/exomphalos

A

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

49
Q

What is meconium ileus

A

Delayed passage of meconium

50
Q

Meconium ileus cause

A

Majority cystic fibrosis

51
Q

Meconium ileus mx

A

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

52
Q

Necrotising enterocolitis risk factor

A

Prematurity

53
Q

Necrotising enterocolitis presentation

A

Abdo distension
Bloody stool
Septic

54
Q

Necrotising enterocolitis mx

A

Total bowel rest

TPN

MRCS med school (44 decks)

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