Peadiatric Surgery Flashcards
What are inguinal hernias
When obliteration of processes vaginalis fails to close = therefor in children always indirect inguinal hernias
Swelling of inguinal hernia can be either in inguinal region or in scrotum
In both- it depends on the obliteration, if complete obliteration fail then will be in both, but if mayber incomplete then in inguinal
Clinical pictures of inguinal hernia
Intermittent visible scrotal swelling after crying or straining
Resolves when baby is sleeping
In examination can be reduced
Repair of inguinal hernia should be done as soon as infant is not wearing nappies any more
No you should not wait
Treatment of uncomplicated hernia
High risk of incarceration or strangulation
Inguinaal hernias never close spontaneously
Best practice is to do an inguinal hernia repair laparoscopically
Yes, but not much difference
What is incarcerated/strangulated inguinal hernia
The bowel trapped out side the abdominal cavity
Incarceration is a common cause of bowel obstruction in babies and children
What is strangulated ingurnal hernia
Entrapment becomes so severe as to compromise blood supply of bowel
Treatment of incarcerated Herman
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
Transillumination confirm diagnosis of hydrocoele
No = bowel filled with fluid also transilluminate
What is hydroceles
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
Routine repair of hydrocoele should be done before school going age
Yes but it does not complicate so it parents don’t consent can leave
Uncomplicated umbilical hernias can cause abdominal pain
No
What is umbilical hernias
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
Risk of incarceration of umbilical hernia stay the same throughout life
No if from childhood
Yes if starts at adulthood
What is omphalocoele
- 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
What ig prognosis of omphalocoele
Depends on associated abnormalities # vacterl birth defects # genetic abnormalities # beckwith-wiedeman syndrome
Babies with beckwith-wiedeman syndrome need life Long follow-up
Yes - they are more prone to hernia malignancy (tumors of kidneys)
What is initial treatment of omphalocele
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
Paediatric surgeon Treatment of omphalocele
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
Small omphalocoeles do not have long term issues
Depends on VACTRL association
Babies with gastroschisis should be screened for other abnormalities
Yes
Primary reduction of bowel should never be attempted
Yes
Do all babies with omphalocoele or gastro chisis have malrotation
Yes
What is gastroschisis
Defect of the abdominal wall to the right of the normal umbilical cord
What abnormalities in gastroschisis
Small bowel atresia - 10%
Treatment of gastroschisis
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)
What is the plastic bag called that is used in gastroschisis
Silo-bag
What is congenital diaphragmatic hernias (CDH)
Abnormal diaphragmatic development
Herniation of abdominal viscera through defect into the thoracic cavity
Bochdalek = postero-lateral side of the diaphragm
Morgagni = retrosternal
Morgagni diaphragmatic hernia is rare
Yes
4-6%
A symptomatic or recurrent respiratory symptoms
Colonic obstruction and gangrene possible anytime
Closure of hernia necessary when diagnosis made
Bochdalek hernia recovers well after operation (prognosis)
No due to hypoplasia of the lungs
Operation does not improve hypoplasia
Better to do a delayed approach = treat pulmonary hypertension
Long term of CDH
10% mental retardation 50% pulmonary function abnormal 30-50%Growth failure 50% GORD 20% intestinal obstruction
