Peadiatric Surgery

Question 1

What are inguinal hernias

Answer 1

When obliteration of processes vaginalis fails to close = therefor in children always indirect inguinal hernias

Question 2

Swelling of inguinal hernia can be either in inguinal region or in scrotum

Answer 2

In both- it depends on the obliteration, if complete obliteration fail then will be in both, but if mayber incomplete then in inguinal

Question 3

Clinical pictures of inguinal hernia

Answer 3

Intermittent visible scrotal swelling after crying or straining
Resolves when baby is sleeping
In examination can be reduced

Question 4

Repair of inguinal hernia should be done as soon as infant is not wearing nappies any more

Answer 4

No you should not wait

Question 5

Treatment of uncomplicated hernia

Answer 5

High risk of incarceration or strangulation

Inguinaal hernias never close spontaneously

Question 6

Best practice is to do an inguinal hernia repair laparoscopically

Answer 6

Yes, but not much difference

Question 7

What is incarcerated/strangulated inguinal hernia

Answer 7

The bowel trapped out side the abdominal cavity

Incarceration is a common cause of bowel obstruction in babies and children

Question 8

What is strangulated ingurnal hernia

Answer 8

Entrapment becomes so severe as to compromise blood supply of bowel

Question 9

Treatment of incarcerated Herman

Answer 9

An attempt of reduction should be made
Sedate the child and then put it in trendelensburg position on mothers lap
Should be referred for surgery if it is not successful, but it reduced then successful but must still examine

Question 10

Transillumination confirm diagnosis of hydrocoele

Answer 10

No = bowel filled with fluid also transilluminate

Question 11

What is hydroceles

Answer 11

Painless non reducible swelling of the scrotum or inguino-scrotal region
Sonar might be helpful in differentiating a hydrocele from hernia
Remember transilluminations does not help at all

Question 12

Routine repair of hydrocoele should be done before school going age

Answer 12

Yes but it does not complicate so it parents don’t consent can leave

Question 13

Uncomplicated umbilical hernias can cause abdominal pain

Answer 13

No

Question 14

What is umbilical hernias

Answer 14

Majority does not cause any problems, operation indicated if

• hernia has not closed by the age of 5 years
• In the rare event of incarceration of contents
• can be momentum, worms, stones in child with pica
• larger defect (>2cm): will not close

Question 15

Risk of incarceration of umbilical hernia stay the same throughout life

Answer 15

No if from childhood

Yes if starts at adulthood

Question 16

What is omphalocoele

Answer 16

• Congenital abdominal wall defect at the umbilical ring
• evisceration of internal organs in a sac
• sac usually contains: small bowel, liver, spleen, colon, gonads sometimes
• problem occurs at 6-10 week of gestation

Question 17

What ig prognosis of omphalocoele

Answer 17

Depends on associated abnormalities 
# vacterl birth defects
# genetic abnormalities
# beckwith-wiedeman syndrome

Question 18

Babies with beckwith-wiedeman syndrome need life Long follow-up

Answer 18

Yes - they are more prone to hernia malignancy (tumors of kidneys)

Question 19

What is initial treatment of omphalocele

Answer 19

If intact membrane
* drip (maintenance (fuids)
* nasogastric tube en free drainage
* treat omphalocele sac with antiseptic
* cover with gauze and crepe
 * refers to paediatic surgeon
lf membrane is ruptured = treat as gastoroschisis

Question 20

Paediatric surgeon Treatment of omphalocele

Answer 20

If giant omphalocele (bigger than baby’s head)
→ Conservative treatment (no surgery yet because no space)
→omphalocelo sac painted with antiseptic daily until it is fully epithelialized
If small less than 5 cm
→ primary closures in tertiary hospital

Question 21

Small omphalocoeles do not have long term issues

Answer 21

Depends on VACTRL association

Question 22

Babies with gastroschisis should be screened for other abnormalities

Answer 22

Yes

Question 23

Primary reduction of bowel should never be attempted

Answer 23

Yes

Question 24

Do all babies with omphalocoele or gastro chisis have malrotation

Answer 24

Yes

Question 25

What is gastroschisis

Answer 25

Defect of the abdominal wall to the right of the normal umbilical cord

Question 26

What abnormalities in gastroschisis

Answer 26

Small bowel atresia - 10%

Question 27

Treatment of gastroschisis

Answer 27

Give excessive fluid
Treat as bowel obstruction
Examine and then cover bowel with plastic does not need to be sterile patient loose fluid and heat
Refer to tertiary hospital (with ICU)

Question 28

What is the plastic bag called that is used in gastroschisis

Answer 28

Silo-bag

Question 29

What is congenital diaphragmatic hernias (CDH)

Answer 29

Abnormal diaphragmatic development
Herniation of abdominal viscera through defect into the thoracic cavity
Bochdalek = postero-lateral side of the diaphragm
Morgagni = retrosternal

Question 30

Morgagni diaphragmatic hernia is rare

Answer 30

Yes
4-6%
A symptomatic or recurrent respiratory symptoms
Colonic obstruction and gangrene possible anytime
Closure of hernia necessary when diagnosis made

Question 31

Bochdalek hernia recovers well after operation (prognosis)

Answer 31

No due to hypoplasia of the lungs
Operation does not improve hypoplasia
Better to do a delayed approach = treat pulmonary hypertension

Question 32

Long term of CDH

Answer 32

10% mental retardation
50% pulmonary function abnormal
30-50%Growth failure
50% GORD
20% intestinal obstruction