Pediatric Surgery z

Question 1

HIRSCH SPRUNG ‘S DISEASE

Answer 1

cong. megacolon / aganglionosiS
- nce of ganglionic cells in nerve plexus of colon due to failure in migration of nerve crest cells. Rectum is always involved.

M. C - Rectosigmoid

Question 2

Compare CF blw short & long segment aganglionosis

Answer 2

short - constipation
long - intestinal obstruction

Question 3

IOC for Aganglionosis
- diagnosis
- extent of disease
- severity

Answer 3

Footnote

• suctional rectal biopsy
• Barium enema
• Ano-rectal manonmetry

In Manomety
Narrow constricted part - Path.
Proximal dilated part - Norm

Question 4

Rx HIRSCH SPRUNG disease

Answer 4

footnote

Duhamel operation - general
long segment - emergency - proximal colostomy

Duhamel opn- cutting proximal end of colon & connected it with anus bypassing aganglionic rectum. This gives a ganglionic rectum without removing the aganglionic rectum.

Question 5

X-ray sign of renal pelvis duplication, hydatid cyst , Ureterocele, horse shoe kidney

Answer 5

RP dup - Drooping lily
hydatid - water lily
Ureterocele - Cobra head
house shoe kidney - joing hands

Question 6

Meyer- Weigert law

Answer 6

It predicts law of draining pattern of duplex Ureters in bipolar renal duplications.
upper pole is ectopic thus dysplastic due to obs. while lower pole is related to versicoureteral reflux

#. footnote
In Ectopic Ureter upper ureter passes distally & opens more medially.
In male opening - trigone apex, seminal vesicle, post. urethra, ejaculatory duct
In female - Distal to distal sphincter

Question 7

1 Cf of ectopic ureter in male &female
2 IOC
3 Rx

Answer 7

1 Male - Recurrent UTI
Female - Dribbling urinary in continence
2. IVU
3. Ureter reimplantation

Question 8

Why endoscopic longitudinal Incision of wrelic orifice rarely used in Ureterocele

Answer 8

Due of vesico ureteric reflux complication)
Ioc- micturating Urography

Question 9

I IOC- post. urethra valves
II Rx for incomplete & complete valves

Answer 9

. footnote

I Micturating urography
II Rx - Transurethral Resection of valve/ fulguration

complete valve case suprapubic cystostomy / Urethral catheterization is done due to urine retention before Value resection

Question 10

1. Hypospadias
2. Types
3. Relation b/ w hypospadias & pregnancy

Answer 10

1. condition of urethra opening Underside of penis instead of its tip.
2. Glanular (M. C), coronal ; sub coronal ; Distal, Mid, proximal peniIe; Penoscrotal; scrotal ; perineal (L. C)
3. taking Diethyl Stilbestrol during pregnancy is associated with it.

Question 11

1. Chordee association w/ hypospadias
2. Problems in hypospadias
3. Rx & complication

Answer 11

footnote

1. hypospadias is associated with chordee causing meatal stenosis
2. Urination, Erection, sperm deposition
3. Rx - chordee correction + Urethroplasty
   Comp. - Urethrocutaneous fistula

Ventral chordee affected in Hypospadias
Posterior chordee affected in trauma

Question 12

Why circumcision is CI in hypospadias

Answer 12

bez prepuce is used for Urethroplasty.

Question 13

J. Difference b/w cryptorchidism & Undescended testis
2. How long does it take for UDT to descend on its own
3. Ectopic testis
4. Retractile testis

Answer 13

1. cryptorchidism is B/L UDT
2. 3 months
3. Testis deviate normal path of descend
4. Testis move b/w scrotum & groin NO Rx

Question 14

1 MC site for UDT & ectopic T
2. complication of UD T
3 Diagnosis & Rx

Answer 14

1 UDT - high scrotum
Ectopic - Superficial inguinal Pouch, femoral triangle, Penis soot, perineum

2. Comp- [ ATESTIS ]- - - Atrophy, Trauma, Epididymo orchitis, Sterility, Torsion, Inguinal hernia, Seminoma
3. Diagnosis- US abd & scrotum, laparoscopy if US fails
   Rx - Orchidopexy

Question 15

Age for Orchidopexy

Answer 15

6-18 months

Question 16

I MC case of imperforate anus in male & female
II IOC
III Rx

Answer 16

I Male- Rectubulbar urethral fistula
Female - fistula opens in post. Vestibule behind Vagina / in perineum
II Ioc- x-ray (lat. prone position)
Ill low - Anoplasty
High- Post. Sagittal Anorectoplasty