Pediatric Surgery Flashcards
A 3 year old boy is referred to the clinic with a scrotal swelling. On examination, the mass does not transilluminate and it is impossible to palpate normal cord above it. What is the most likely diagnosis?
Hydrocele Direct inguinal hernia Indirect inguinal hernia Femoral hernia Lymphatic malformation
This is likely to be an indirect hernia. In children these arise from persistent processus vaginalis and require herniotomy.
A male infant, born at term appears well following delivery. Six hours later, he is noted to have bilious vomiting by the paediatricians. On examination, he seems well and his abdomen is soft and non tender. What is the best course of action?
Arrange an abdominal x-ray Undertake a test feed Perform serial abdominal examinations Arrange an upper GI contrast study Arrange a laparotomy
Arrange an upper GI contrast study
Bilious vomiting in neonates is a surgical emergency and is intestinal malrotation and volvulus until otherwise proven. It is investigated with an upper GI contrast study. Contrast should be seen to exit the stomach and the location of the DJ flexure is noted (it lies to the left of the midline). If this is not the case, or the study is inconclusive, a laparotomy is performed.
A 6 day old baby was born prematurely at 33 weeks. He has been suffering from respiratory distress syndrome and has been receiving ventilatory support on NICU. He has developed abdominal distension and is increasingly septic. Ultrasound of the abdomen shows free fluid and evidence of small bowel dilatation. His blood pressure has remained labile despite inotropic support. What is the best course of action?
Laparoscopy Laparotomy Contrast enema Upper GI contrast study MRI abdomen
Laparotomy
He has necrotising enterocolitis and whilst this is often initially managed medically a laparotomy is required if the situation deteriorates.
A female infant is born by cesarean section at 38 weeks gestation for foetal distress. The attending paediatricians notice that she has a single palmar crease and a mongoloid slant to her eyes. Soon after the birth the mother tries to feed the child who has a projectile vomit about 10 minutes after feeding. On examination she has a soft, non distended abdomen. What is the most likely cause?
Pyloric stenosis Duodenal atresia Milk allergy Meconium ileus Anal atresia
Duodenal atresia
Proximally sited atresia will produce high volume vomits which may or may not be bile stained. Abdominal distension is characteristically absent. Whilst under resuscitated children may be a little dehydrated they are seldom severely ill. The presence of Trisomy 21 (palmar and eye signs) increases the likelihood of duodenal atresia.
What is the most common abdominal emergency in children under 1 year of age?
Appendicitis Intussusception Intestinal malrotation Pyloric stenosis Mid gut volvulus
Intussusception
The commonest emergency in this age group is inguinal hernia followed by intussusception. Appendicitis is commoner in those older than 1 year of age.
The parents of a 1 year old child are concerned after he develops a lump in his neck. On examination, there is a swelling in the subcutaneous tissue of the posterior triangle which transilluminates. What is the most likely cause?
Brachial cyst Branchial sinus Cystic hygroma Lipoma Pharyngeal pouch
Cystic hygroma
This is a classical description. Collection of dilated lymphatic sacs which are fluctuant and brilliantly transilluminable. Recurrence following surgical excision is not uncommon.
A 14 month old child is admitted with colicky abdominal pain and on investigation is found to have an ileo-ileal intussusception. What is the best course of action?
Attempt hydrostatic reduction with barium enema Attempt pneumatic reduction with air insufflation Undertake a laparotomy Undertake a colonoscopy Undertake a flexible sigmoidoscopy
Undertake a laparotomy
Ileo-ileal intussusception are far less common than the ileo-colic variant. However, where they occur, they require surgery and are not amenable to pneumatic reduction.
At what age should children with otherwise uncomplicated umbilical hernias be considered for surgery?
Within the first few days of life 6 months of age 12 months of age 18 months of age After 3 years of age
After 3 years of age
Many umbilical hernias will close in the first year of life. Defer surgery until the child is 3 years or older
A 2 month old baby presents with jaundice. He has an elevated conjugated bilirubin level. Diagnosis is confirmed by cholangiography during surgery. What is the best course of action?
Insertion of PTC Choledochoduodenostomy ERCP Roux-en-Y portojejunostomy Liver transplant
Roux-en-Y portojejunostomy
This child has biliary atresia. The aim is to avoid liver transplantation (however, most will come to transplant in time).
A neonate born at term has an episode of bilious vomiting and on investigation is found to have a DJ flexure displaced to the right. What procedure are they most likely to require?
Ladds procedure Gastrojejunostomy Kasai procedure Duoduodenostomy Ramstedts procedure
Intestinal malrotation with volvulus is treated with a Ladd’s procedure
A 2 week old baby is referred to the surgical team by the paediatricians. They are concerned because the child has a painful area of macerated tissue at the site of the umbilicus. On examination, a clear- yellowish fluid is seen to be draining from the umbilicus when the baby cries. What is the most likely diagnosis?
Omphalitis Umbilical granuloma Persistent vitello-intestinal duct Patent urachus Isolated cellular remnants
A patent urachus will present with umbilical urinary discharge. The skin may become macerated if not properly cared for. The discharge is most likely to be present when intra-abdominal pressure is raised. It is associated with posterior urethral valves.
A premature infant (30-week gestation) presents with distended and tense abdomen. She is passing blood and mucus per rectum, and she is also manifesting signs of sepsis. What is the most likely underlying explanation?
Viral gastroenteritis Necrotising enterocolitis Meconium ileus Intestinal volvulus Ileal atresia
Necrotising enterocolitis is more common in premature infants. Mesenteric ischemia causes bacterial invasion of the mucosa leading to sepsis. Terminal ileum, caecum and the distal colon are commonly affected. The abdomen is distended and tense, and the infant passes blood and mucus per rectum. X -Ray of the abdomen shows distended loops of intestine and gas bubbles may be seen in the bowel wall.
A 1 day old child is born by emergency cesarean section for foetal distress. On examination, he has decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen but is otherwise unremarkable. What is the most likely cause?
Pyloric stenosis Congenital diaphragmatic hernia Tracheo-oesophageal fistula Ileal atresia Meconium ileus
Congenital diaphragmatic hernia
Displaced apex beat and decreased air entry are suggestive of diaphragmatic hernia. The abdomen may well be scaphoid in some cases. The underlying lung may be hypoplastic and this correlates directly with prognosis.
A 10 year old boy is shot in the abdomen with an airgun pellet. He is concerned that he will get into trouble and the injury remains concealed for 10 days. Imaging using CT scanning shows it to be lodged in the left lobe of the liver. On examination, his abdomen is soft and non tender and he seems well. What is the best course of action?
Operate and remove the pellet on the next emergency list Operate and remove the pellet on the next elective operating list Do not operate and review the patient several weeks later Extract the pellet using interventional radiology techniques Perform an MRI scan
Do not operate and review the patient several weeks later
Given that the child is well, the risks of removing the pellet are not outweighed by the benefits and it should be left in situ at this stage.
A 4 year old boy is brought to the clinic. He gives a history of difficult, painful defecation with bright red rectal bleeding. What is the most likely diagnosis?
Crohns disease Ulcerative colitis Anal fissure Haemorrhoids Juvenile polyp
Anal fissure
Painful rectal bleeding in this age group is typically due to a fissure. Treatment should include stool softeners and lifestyle advice
A 1-day-old baby girl is noted to become profoundly cyanotic whilst feeding and crying. A diagnosis of congenital heart disease is suspected. What is the most likely cause?
Transposition of the great arteries Coarctation of the aorta Patent ductus arteriosus Hypoplastic left heart Ventricular septal defect
Transposition of the great arteries
Congenital heart disease
Cyanotic: TGA most common at birth, Fallot’s most common overall
Acyanotic: VSD most common cause
A 4 week old baby is developing well and develops profuse and projectile vomiting after feeds. He has been losing weight and the vomit is described as being non bilious. What is the most likely underlying pathology?
Duodenal atresia Ileal atresia Hypertrophy of the pyloric sphincter Achalasia cardia Intestinal malrotation
Hypertrophy of the pyloric sphincter
A history of projective vomiting and weight loss is a common story suggestive of pyloric stenosis. The vomit is often not bile stained. Diagnosis is further suggested by hypochloraemic metabolic alkalosis and a palpable tumour on test feeding.
A newborn baby boy presents with gross abdominal distension. He is diagnosed with cystic fibrosis and his abdominal x ray shows distended coils of small bowel, but no fluid levels. Which of the following interventions is the usual first line treatment?
Laparotomy and removal of meconium Administration of sodium picosulphate orally Enemas with N- acetyl cysteine Laparotomy and small bowel resection Colonoscopy
Enemas with N- acetyl cysteine
The most likely diagnosis here is meconium ileus. The first line treatment for uncomplicated cases is enemas of either dilute gastrograffin or N-acetyl cysteine. It’s important to ensure the child is adequately hydrated first. They are contra indicated if there is a suspected underlying perforation.
A male infant is born prematurely at 26 weeks gestation by emergency cesarean section. Following the birth he develops respiratory distress syndrome and is ventilated. He begins to improve twelve days after birth. Then he becomes unwell and develops abdominal distension and passes bloody stools and vomits a small quantity of bile stained vomit. What is the most likely cause?
Ileal atresia Hirschprungs disease Pyloric stenosis Necrotising enterocolitis Meconium ileus
Necrotising enterocolitis often has a delayed presentation and affected infants will typically pass bloody stools. Plain films may show air in the intestinal wall (Pneumatosis).
A 1 month old baby girl presents with bile stained vomiting. She had an exomphalos and a congenital diaphragmatic hernia. What is the most likely underlying explanation?
Duodenal atresia Intestinal malrotation Duplication cysts Annular pancreas Ileal atresia
Intestinal malrotation
Exomphalos and diaphragmatic herniae are commonly associated with malrotation.
A 7 month old girl presents with vomiting and diarrhoea. She is crying and drawing her legs up. There is a a sausage shaped mass in the abdomen. What is the most likely diagnosis?
Mesenteric cyst Intussusception Colonic cancer Small bowel tumour Internal hernia
Intussusception
In a child of this age the history of colicky pain and the presence of a sausage shaped mass are strongly suggestive of an ileo-colic intussusception.
A 6 month old boy is brought to the clinic by his mother. She is concerned that his testes are not located into the scrotum. She has noticed them only when he is in the bath, but not at any other time. What is the most likely underlying diagnosis?
Retractile testis Ectopic testis Undescended testis Testicular agenesis Intersex child
Retractile testis
A testis that appears in warm conditions or which can be brought down on clinical examination and does not immediately retract is usually a retractile testis.
Which of the following statements relating to omphalocele is false?
The herniated organs lie outside the peritoneal sac Cardiac abnormalities co-exist in 25% The caecum is usually right sided The defect occurs through the umbilicus Mortality may be as high as 15%
The herniated organs lie outside the peritoneal sac
They are contained within the peritoneal sac and therefore do not have the fluid losses seen in gastroschisis. True malrotation is unusual and minor variants may not result in a requirement for surgery.
A 3 day old baby presents with recurrent episodes of choking and cyanotic episodes. There is a history of polyhydramnios. What is the most likely diagnosis?
Meconium ileus Oesophageal atresia Duodenal atresia Pyloric stenosis Diaphragmatic hernia
Oesophageal atresia
The history of polyhydramios makes diaphragmatic hernia less likely. The other conditions tend not to cause chocking. In the short term this is addressed by passage of a Replogle tube which can be used to remove the oesophageal secretions, pending surgery.
Which of the following statements relating to biliary atresia is untrue?
It most commonly presents as prolonged conjugated jaundice in the neonatal period. Evidence of portal hypertension at diagnosis is seldom present in the UK. It may be confused with Alagille syndrome. The Kasai procedure is best performed in the first 8 weeks of life. Survival following a successful Kasai procedure is approximately 45% at 5 years.
Survival following a successful Kasai procedure is approximately 45% at 5 years
Biliary atresia usually presents with obstructed jaundice. A Kasai procedure is best performed in the first 8 weeks of life. If a Kasai procedure is successful most patients will not require liver transplantation. 45% of patients post Kasai procedure will require transplantation. However, overall survival following a successful Kasai procedure is 80%.
A premature neonate is born by emergency cesarean section at 29 weeks gestation. He initially seems to be progressing well. However, the team are concerned because he has become septic and on examination has a swollen and erythematous umbilicus. What is the most likely diagnosis?
Patent urachus Patent vitello--intestinal duct Omphalitis Umbilical granuloma Pyogenic granuloma
Omphalitis
Infection from omphalitis may spread rapidly and cause severe sepsis especially in immunologically compromised, premature neonates.
An 8 year old boy presents with abdominal pain,a twelve hour history of vomiting, a fever of 38.3 0C and four day history of diarrhoea. His abdominal pain has been present for the past week. What is the most likely cause?
Coeliac disease Appendix abscess Irritable bowel syndrome Mesenteric adenitis Diverticulitis
Appendix abscess
The high fever and diarrhoea together with vomiting all point to a pelvic abscess. The presence of pelvic pus is highly irritant to the rectum, and many patients in this situation will complain of diarrhoea. Mesenteric adenitis is less likely to run such a protracted course. IBS does not typically produce such marked systemic symptoms. Diverticulitis is almost unheard of in children.
A 3 day old baby develops dyspneoa. A chest x-ray is performed and shows a radio-opaque shadow with an air-fluid level in the chest. It is located immediately anterior to the 6th hemivertebra. Which of the following is the most likely underlying diagnosis?
Bronchogenic cyst Congenital diaphragmatic hernia Infection with Staphylococcus aureus Oesphageal duplication cyst Hiatus hernia
Bronchogenic cyst
A midline cystic mass of an infant in this age group is most likely to be a bronchogenic cyst. Hiatus hernia is unusual in the neonatal period. Oesophageal duplication cysts are very rare and respiratory symptoms are less common than with bronchogenic cysts. Midline congenital hernias are rare and would usually not include an air/ fluid level in the rare event that they occur at this site.
Which one of the following is least associated with Tetralogy of Fallot?
Right ventricular outflow tract obstruction Overriding aorta Pan systolic murmur Left-to-right shunt Right ventricular hypertrophy
Left-to-right shunt
Right-to-left shunting is characteristic of Fallot’s
A 2 year old accidentally inhales a peanut. They arrive in the emergency department extremely distressed and cyanotic. Imaging shows it to be lodged in the left main bronchus. What is the best course of action?
Arrange bronchoscopy on the next scheduled operating list Manage conservatively Treat in emergency department under sedation Arrange immediate transfer to theatre for bronchoscopy Attempt to remove in the emergency department
Arrange immediate transfer to theatre for bronchoscopy
As they are cyanosed it requires immediate removal and this should be undertaken in a fully staffed theatre. Ideally, a rigid bronchoscopy should be performed.
A 3 year old boy is brought to the clinic with symptoms of urinary hesitancy and poor stream. Which of the following is the most likely underlying diagnosis?
Benign prostatic hypertrophy Posterior urethral valves Neurogenic bladder Urethral calculus Hypospadias
Posterior urethral valves are one of the commonest causes of poor urinary stream and hesitancy in children. Prostatic disorders are rare.
Hypospadias is associated with urine that is difficult to control, but should not produce hesitancy.
A male infant, born at term by normal vaginal delivery is well. However, 72 hours following delivery, he has still not passed meconium. On examination, his abdomen is soft and not particularly distended. He has a normally sited anus. What is the best course of action?
Undertake a colonoscopy and pan colonic biopsies Undertake a flexible sigmoidoscopy and left sided colonic biopsies Undertake full thickness rectal biopsies Undertake a loop colostomy Undertake a loop ileostomy
Undertake full thickness rectal biopsies
Delayed passage of meconium is suggestive of Hirschsprung’s disease and the investigation of choice is full thickness suction rectal biopsy. If Hirschprungs is confirmed, then the correct treatment is laparotomy and stoma formation. At between 9 and 12 months of age, definitive surgery (usually resection and primary anastomosis) is performed.
A male infant is born by spontaneous vaginal delivery at 39 weeks gestation. He is well after the birth, established on bottle feeding and discharged home. His parents are concerned because he subsequently becomes unwell and vomits a large quantity of bile stained vomit approximately 2 days after discharge home. On examination, he looks ill and his abdomen is soft and non distended. What is the most likely cause?
Intestinal malrotation with volvulus Duodenal atresia Anal atresia Pyloric stenosis Diaphragmatic hernia
Intestinal malrotation with volvulus
Intestinal malrotation with volvulus will typically compromise the vascularisation and lumenal patency of the gut. This will cause bilious vomiting and the vascular insufficiency will produce a clinical picture of illness at odds with the lack of overt abdominal signs. Delay in diagnosis and surgery will result in established necrosis, perforation and peritonitis.
A 1 year old child has been unwell with a sore throat and fever for several days. He progresses to develop periumbilical abdominal discomfort and passes diarrhoea. The paediatricians call you because the ultrasound has shown a ‘target sign’ on the right side of the abdomen. What is the best initial course of action?
Obtain intravenous access, administer fluids and antibiotics Undertake urgent fluoroscopic reduction Undertake urgent hydrostatic reduction Undertake a colonoscopy Undertake a laparotomy
Obtain intravenous access, administer fluids and antibiotics
Always ensure that children with intussusception are resuscitated first. Administration of antibiotics is also important. This should precede any intervention.
A 2 year old has a history of rectal bleeding. The parents notice that post defecation, a cherry red lesion is present at the anal verge. What is the most likely diagnosis?
Haemorrhoids Villous adenoma Juvenile polyp Peri anal abscess Anal fissure
Juvenile polyp
These lesions are usually hamartomas and this accounts for the colour of the lesions. Although the lesions are not themselves malignant they serve as a marker of an underlying polyposis disorder.
Which of the following is not a feature of oesphageal atresia in neonates?
High incidence of polyhydramnios Risk of recurrence in subsequent pregnancies of 80% Distal tracheoesphageal fistula is the commonest variant High incidence of associated imperforate anus Absence of gastric fluid on antenatal ultrasound
Risk of recurrence in subsequent pregnancies of 80%
Most are sporadic and risk in subsequent pregnancies is not increased.
A 12 day old infant is brought to the emergency department by his anxious mother who notices that he has developed a right sided groin swelling. On examination the testes are correctly located but it is evident that the child has a right sided inguinal hernia. It is soft and easily reduced. What is the most appropriate management?
Surgery over the next few days Reassure and discharge Surgery at 1 year of age Surgery once the child is 6 months old Application of a hernia truss
Surgery over the next few days
The high incidence of strangulation necessitates an urgent herniotomy be performed. In infants with a reducible hernia this can be performed on a daycase list during the same week. Deferring surgery on the basis of age is not justified.
A 6 year old child develops ballooning of the foreskin on micturition and is brought to the clinic by his anxious mother. On examination, the foreskin is non retractile but otherwise normal. By which age are 95% of all foreskins retractile
2 years 16 years 8 years 5 years 10 years
By 16 years of age almost all foreskins should be retractile and if they are not circumcision should be considered at around this time.
A neonate is noted to have bowel obstruction, what is the most likely cause?
Imperforate anus Meconium plugs Colonic atresia Anal atresia Sigmoid volvulus
Meconium plugs
Cystic fibrosis is the most common cause of meconium plugs and such cases can be treated with intestinal lavage, this should be followed by formal testing for CF.
A female neonate who is born at term has an episode of bilious vomiting. An upper GI contrast study is performed and it shows the duodeno-jejunal flexure lies to the right of the midline. What is the most appropriate course of action?
Undertake a Ramstedts pyloromyotomy Perform a gastrojejunostomy Undertake a Ladd's procedure Undertake a duodeno-duodenoduodenostomy Undertake a Kasai procedure
Intestinal malrotation with volvulus is treated with a Ladd’s procedure.
An 18 month old boy is brought to the emergency room by his parents. He was found in bed with a nappy filled with dark red blood. He is haemodynamically unstable and requires a blood transfusion. Prior to this episode he was well with no prior medical history. What is the most likely cause?
Necrotising enterocolitis Anal fissure Oesophageal varices Meckels diverticulum Crohns disease
Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
What is the investigation of choice to look for renal scarring in a child with vesicoureteric reflux?
Abdominal x-ray Ultrasound DMSA CT KUB Micturating cystourethrogram
DMSA
Which of the following statements relating to necrotising enterocolitis is false?
It has a mortality of 30% Most frequently presents in premature neonates less than 32 weeks gestation. Should be managed by early laparotomy and segmental resections in most cases. Pneumostosis intestinalis may be visible on plain abdominal x-ray. May be minimised by use of breast milk over formula feeds.
Should be managed by early laparotomy and segmental resections in most cases.
Most cases will settle with conservative management with NG decompression and appropriate support. Laparotomy should be undertaken in patients who progress despite conservative management or in whom compelling indications for surgery exist (eg free air).
A 4 year old boy is brought to the clinic by his mother. He has a swelling in his right hemiscrotum. On examination, it transilluminates brilliantly. What is the best course of action?
Undertake a Lords procedure via a scrotal approach Ligation of the patent processus vaginalis via an inguinal approach Undertake a Jabourlays procedure via a scrotal appraoch Undertake a Lords procedure via an inguinal approach Division of the patent processus vaginalis via a scrotal approach
Ligation of the patent processus vaginalis via an inguinal approach
Ligation of the patent processus vaginalis is performed via an inguinal approach. There is no indication for scrotal surgery for hydrocele in young children.
A 1 day old neonate is developing increasing problems with feeding. On examination, she has a pan systolic murmur and her forearms have not developed properly. What is the most likely underlying problem?
Oesophageal atresia Duodenal atresia Pyloric stenosis Ileal atresia Anal atresia
Oesophageal atresia
This child has VACTERL, which is a combination of Vertebral, Ano-rectal, Cardiac, Tracheo-oesophageal, Renal and Radial limb anomalies. Half of babies with oesophageal atresia will have VACTERL. Problems that occur during feeding are more suggestive of proximal pathology.
A 6 week old baby boy is brought to the clinic by his mother. She is concerned because although the left testis is present in the scrotum the right testis is absent. She reports that it is sometimes palpable when she bathes the child. on examination the right testis is palpable at the level of the superficial inguinal ring. What is the most appropriate management?
Discharge Re-assess in 5 years Laparoscopy Re-assess in 6 months Orchidopexy
Re-assess in 6 months
Undescended testes are not uncommon in young children. They may be present in 4% of term infants, but only in 1.3% children at 3 months of age. In this scenario the testis is retractile and can be managed expectantly.
An 8 week old infant is brought to clinic with a history of 18 days of jaundice. The mother is breast feeding. He was a full term baby. There is no family history of liver disease. What is the most appropriate next step?
Liver USS Unconjugated bilirubin measurement Conjugated bilirubin measurement Reassure and discharge ERCP
Conjugated bilirubin measurement
This baby is a full term and has > 14 days of jaundice, therefore needs an urgent conjugated bilirubin check to rule out biliary atresia. If physiological jaundice the unconjugated bilirubin levels will be increased. Isotope scanning may be used in diagnosis, but a definitive diagnosis is normally made during a laparotomy.
A baby boy is born by elective cesarean section at 39 weeks gestation. He initially seems to progress well and is discharged from hospital the following day. The parents bring the child to the clinic at 10 days of age and are concerned at the presence of a profuse and foul smelling discharge at the site of the umbilicus. On examination, the umbilicus has some prominent granulation tissue. When the baby cries a small trickle of brownish fluid is seen to pass from the umbilicus. What is the most likely cause?
Omphalitis Patent vitello-intestinal duct Patent urachus Pyogenic granuloma Umbilical hernia
A persistent vitello-intestinal duct may allow the persistent and ongoing discharge of small bowel content from the umbilicus. This fluid may be very irritant to the surrounding skin.
A 12 year old boy is brought to the clinic with history of weight loss and bloody diarrhea. Abdominal examination is unremarkable. What is the most likely diagnosis?
Colorectal cancer Inflammatory bowel disease Irritable bowel syndrome Munchausen syndrome Viral gastroenteritis
Inflammatory bowel disease
The systemic features in the history are strongly suggestive of inflammatory bowel disease rather than the other causes. Colorectal cancer is almost unheard of at this age.
A 3 year old child inserts a crayon into their external auditory meatus. Attempts to remove it have not been successful. What is the best course of action?
Manage conservatively Remove in the emergency department under sedation Enlist the help of additional staff members to restrain the child before attempting to remove it again in the emergency department Operate on the next emergency operating list Transfer immediately for emergency surgery
Operate on the next emergency operating list
They would not tolerate removal in the emergency department. The tympanic membrane should be carefully inspected and again this will be easier under general anaesthesia. Be wary of sedating children in ED unless you have experienced anaesthetic support as heavy sedation would be needed and this course of action is not recommended.
Which of the following statements relating to Hirschsprungs disease is false?
It is more common in males. Is typically associated with a dilated aganglionic segment of bowel. May present with delayed passage of meconium. Mucosal biopsies are inadequate for diagnosis. Disease extending beyond 30cm of colon and rectum is unusual.
Is typically associated with a dilated aganglionic segment of bowel.
There is a transition zone from the contracted aganglionic segment (the abnormal area) to dilated normal bowel on barium enema. Males are more frequently affected than females. Surgery may involve a pull through procedure. A number of patients will have ongoing evacuatory disturbance.
A 7 year old boy presents with a three day history of right iliac fossa pain and fever. On examination, he has a temperature of 39.9 0C. His abdomen is soft and mildly tender in the right iliac fossa. What is the likely underlying diagnosis?
Appendicitis Crohns disease Mesenteric adenitis Irritable bowel syndrome Threadworm infection
Mesenteric adenitis
High fever and mild abdominal signs in a younger child should raise suspicion for mesenteric adenitis. The condition may mimic appendicitis and many may require surgery. Appendicitis is likely to produce more localizing signs in a child aged 7 and seldom presents with such a high fever. The history is too short to be consistent with Crohns disease. Whilst threadworm infection is a recognized cause of right iliac fossa pain, its unusual for it to be associated with a fever such as the one described.
A 4 year old is admitted with right iliac fossa pain and is due to undergo an appendicectomy. The nursing staff would like to give the child an infusion of intravenous fluid whilst waiting for theatre. Assuming electrolytes are normal, which of the following is an appropriate fluid for infusion in this situation?
10% Dextrose solution 0.9% Saline solution 0.45% saline/ 5% glucose solution Gelofusin None of the above
- 9% Saline solution
0. 45% saline/ 5% glucose solutions carry a risk of hyponatraemia and is contra indicated
A 4 year old boy presents with symptoms of dysuria and urinary frequency. A urine dipstick is positive for blood and nitrites. A UTI is suspected. Which of the following follow up strategies is most appropriate?
Watchful waiting Cystoscopy DMSA scan CT scan of pelvis Renal MRI
Watchful waiting
A first presentation of an uncomplicated UTI (even in male children) may be managed expectantly. More than 1 UTI in a six month period should prompt further investigation. NICE guidelines from 2007 suggest that recurrent UTI and those with a non e-coli UTI should be imaged with USS and DMSA several months later
