Some paediatric surgery

Question 1

When does pyloric stenosis tend to present in kids?

Answer 1

6-8 weeks

Question 2

Who is pyloric stenosis most common in?

Answer 2

First born males

Question 3

What may be found on examination of the abdomen in pyloric stenosis?

Answer 3

Olive like shaped mass in the epigastrium

Question 4

What investigation are used in pyloric stenosis?

Answer 4

US

Question 5

Which blood tests would you ask for if you suspected pyloric stenosis?

Answer 5

FBC (anaemia and white cell count), U&E’s for evidence of dehydration etc, blood gas to check for metabolic acidosis/alkalosis

Question 6

What is the surgery to correct pyloric stenosis?

Answer 6

Pylomyomectomy- this can be done laproscopically and this is NOT a surgical emergency.

Question 7

Does PS run in families?

Answer 7

Yes

Question 8

How can appendicitis present in children?

Answer 8

diarrhoea and vomiting/ abdominal pain

Question 9

What are the common ages that appendicitis presents in a kid?

Answer 9

School age- notoriously difficult to diagnose in first 2 years of life.

Question 10

What stool symptoms may you have in appendicitis?

Answer 10

Diarrhoea, bloody stools, constipation

Question 11

What investigations would you carry out if you suspected appendicitis?

Answer 11

CRP/FBC (white cells especially neutrophils), U&E’s, blood gas for lactate.

Question 12

When would a surgeon go ahead with operating on appendicitis without imaging tools?

Answer 12

high CRP, febrile and RIF pain

Question 13

What would a 2 day year old with a 24 hour history of bilious vomiting make you think about?

Answer 13

Duodenal atresia (not oesophageal because it is bile stained)

Question 14

What tests would you if you suspected duodenal atresia?

Answer 14

FBC, Group & Save, U&E’s, blood gas

Question 15

What imagining technique is used in duodenal atresia?

Answer 15

Abdominal film/X-ray

Question 16

What is seen on an abdominal film with duodenal atresia?

Answer 16

Double bubble appearance

Question 17

What is a differential for duodenal atresia, which might present the same but is a surgical emergency?

Answer 17

Volvulus- can become necrotic. THATS WHY BILIOUS VOMITING SHOULD ALWAYS BE ASSUMED TO BE PATHOLOGICAL UNTIL PROVEN OTHERWISE.

Question 18

What does a 10 month old with listless episodic screaming with knees drawn up to abdomen suggest?

Answer 18

Intessception

Question 19

When does intussception usually present?

Answer 19

6 months- 18 months

Question 20

What in the history may give you a clue that it is intussception?

Answer 20

Past history of a viral illness, as it is often preceded by a viral gastroenteritis.

Question 21

What is the imaging technique for intussception?

Answer 21

US

Question 22

What might you feel on palpation of the abdomen in intussception?

Answer 22

Sausage like mass on the RHS with a feeling of emptiness in the RIL.

Question 23

What is the treatment for intussception?

Answer 23

Air enema

Question 24

If there is perforation in intussception, what surgery would be needed to treat it?

Answer 24

Open laparotomy with manual reduction

Question 25

What may you see in terms of blood pressure with intussception?

Answer 25

There may be hypovolaemia, as the telescope can trap alot of fluid.

Question 26

What is the classical appearance of a stool in intussception?

Answer 26

Res current jelly stool. Although this is UNCOMMON so do not base your clinical diagnosis on its presence.