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Surgery M4 part 2 > Pediatrics 1 > Flashcards

Pediatrics 1 Flashcards

1
Q

What is VACTERL?

A 
syndrome combining 
Vertebral anomalies 
Anal anomalies 
Cardiac anomalies 
Trachea anomalies 
Esophagus anomalies 
Renal anomalies 
Limb anomalies
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2
Q

What should be done incase of trauma in children?

A
  • avoid overextension of the neck (obstructs airway)
  • fluid replacement = 20ml/kg -> could be repeated twice then blood
  • use long saphenous vein at ankle for IV access, or scalp veins in babies
  • intraosseous infusion is useful in children
  • elastic ribs that deform can cause lung contusions
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3
Q

What are the causes of hernia?

A

CONGENITAL

  • preformed sac
  • congenital defect (UNOBLITERATED PROCESSUS VAGINALIS)

ACQUIRED

  • predisposing factors (weak abdominal wall)
  • precipitating factors (increase intra-abdominal pressure)
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4
Q

How is a congenital inguinal hernia diagnosed?

A
  • complete from the start
  • testis is felt as a part of hernial content

diagnosed clinically

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5
Q

How should a congenital inguinal hernia be treated?

A
  • perform herniotomy once diagnosed

hernioplasty is contra-indicated

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6
Q

What are the types of hydrocele?

A
  • congenital: inguinoscrotal
  • infantile: inguinoscrotal
  • encysted: scrotal or inguinoscrotal, separated from testis
  • vaginal: purely scrotal & not separated from testis
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7
Q

What investigations & treatment should be done for hydrocele?

A

SCROTAL US

  • congenital -> only surgical: excision of processus vaginalis with closure of peritoneal connection
  • infantile -> conservatuve
  • encysted -> excision
  • vaginal -> excision, eversion, or plication
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8
Q

What is the pathway of the descent of the testis?

A
  • START -> renal angle opposite L2
  • 5th week -> starts descent
  • 7th month -> internal ring
  • 9th month -> in scrotum
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9
Q

What are the factors that affect the testicular descend?

A

MECHANICAL

  • gabernaculum
  • high intra-abdominal pressure

HORMONAL

  • testosterone
  • maternal HCG
  • fetal Mullerian inhibiting factor
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10
Q

what are the types of imperfectly descended testis?

A
  • Undescended testis: arrested at any point of the normal descend pathway
  • ectopic testis: present at any site away from normal pathway
  • retractile testis: descend normally then retract into inguinal region
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11
Q

What are the causes for undescended testis?

A

UNILATERAL (mechanical)

  • dysgenetic testicle
  • large testicle
  • short spermatic cord
  • short testicular artery
  • band of adhesion
  • associated congenital inguinal hernia

BILATERAL (hormonal)

  • bilateral mechanical cause
  • defect in maternal HCG
  • defect in pituitary gonadotropin or testicular sensitivity to it
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12
Q

What side is more likely to be affected by undescended testis?

A

right side & in pre matures

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13
Q

What are the sites where the descend of the testes will stop?

A
  • intra abdominal
  • inguinal canal
  • at the neck of the scrotum
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14
Q

What is the clinical picture of an undescended testis?

A
  • empty scrotum
  • poorly developed scrotum
  • deviated median raphe towards affected side
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15
Q

Why are undescended testis difficult to palpate?

A
  • could be dysgenetic
  • external oblique aponeurosis infront of it
  • lax fascia transversalis behind it
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16
Q

What are the complications of undescended testis?

A
  • reduced fertility
  • torsion
  • testicular tumor
  • epididymo-orchitis
17
Q

What investigations should be done for undescended testis?

A

INITIALLY -> US (difficult to see gonads)
BEST -> MRI
MOST VALUABLE -> exploratory laparoscopy (diagnostic & therapeutic)

18
Q

How should undescended testis be treated?

A

NO interference before 6 months
androgens contraindicated

BILATERAL -> bHCG for 4 weeks (2months max)
-> bilateral orcheopexy in 2 sets with 6 months in between

UNILATERAL -> orcheopexy at 6-24months (divide any adhesions & excise any hernial sac & fix testis in dartos pouch)

19
Q

How should undescended testis be treated if discovered late?

A

adults -> ORCHEOPEXY (works as endocrine)

intra-abdominal -> if orcheopexy is difficult -> subcutaneous

20
Q

What are the sites an ectopic testis is found in?

A
  • superficial inguinal pouch
  • femoral triangle
  • root of the penis
  • perineum

LOOKWOOD THEORY

21
Q

How does an ectopic testis differ from an undescended one?

A
  • well developed
  • easily palpable
  • more palpable with contraction of anterior abdominal wall muscles
  • long cord & well developed scrotum
  • orcheopexy is less challenging
22
Q

What is a retractile testis?

A

exaggerated cremasteric reflex leading to retraction into the inguinal region in exposure to cold & scratching of medial aspect of the thigh

23
Q

How is retractile testis diagnosed & treated?

A
  • examine patient in warm room in squatting position
  • try to milk the testis down

reassurance or divide cremasteric muscle if severe

24
Q

What are the types of congenital umbilical hernia?

A

EXOMPHALOS MAJOR

  • large >5cm
  • covered by amniotic membrane
  • contains any a of abdominal viscera up to liver
  • treated by complex & staged repair

EXOMPHALOS MINOR

  • small <5cm
  • covered by amniotic membrane & Warton’s jelly
  • contains small loop of intestine
  • simple, reduction, herniotomy & herniorraphy
25
Q

What is an infantile umbilical hernia?

A

Imperfect closure of umbilical scar

  • present few days or weeks after birth
  • covered by skin
  • contents are not apparent
  • closes spontaneously
  • if it doesn’t close for > 2 years or if admits 2 finger surgery is indicated
26
Q

What is gastroschisis?

A

Defect of anterior abdominal wall with intact peritoneum

- contents are covered with peritoneum or totally exposed

27
Q

A lack of abdominal musculature & wrinkled skin associated with undescended testis & mega-ureter with vesico-ureteric reflux?

A

Prune Belly Syndrome

28
Q

Absent lower anterior abdominal wall, & anterior bladder wall, & wide separation of symphysis pubis is know as? What are its complications & treatment?

A

Ectopic Vesica

Complications -> severe UTI, metaplasia

Treatment -> initially: temporary closure of defect
-> definitive reconstruction of bladder & pelvic wall

Surgery M4 part 2 (36 decks)

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