Some paediatric surgery Flashcards
When does pyloric stenosis tend to present in kids?
6-8 weeks
Who is pyloric stenosis most common in?
First born males
What may be found on examination of the abdomen in pyloric stenosis?
Olive like shaped mass in the epigastrium
What investigation are used in pyloric stenosis?
US
Which blood tests would you ask for if you suspected pyloric stenosis?
FBC (anaemia and white cell count), U&E’s for evidence of dehydration etc, blood gas to check for metabolic acidosis/alkalosis
What is the surgery to correct pyloric stenosis?
Pylomyomectomy- this can be done laproscopically and this is NOT a surgical emergency.
Does PS run in families?
Yes
How can appendicitis present in children?
diarrhoea and vomiting/ abdominal pain
What are the common ages that appendicitis presents in a kid?
School age- notoriously difficult to diagnose in first 2 years of life.
What stool symptoms may you have in appendicitis?
Diarrhoea, bloody stools, constipation
What investigations would you carry out if you suspected appendicitis?
CRP/FBC (white cells especially neutrophils), U&E’s, blood gas for lactate.
When would a surgeon go ahead with operating on appendicitis without imaging tools?
high CRP, febrile and RIF pain
What would a 2 day year old with a 24 hour history of bilious vomiting make you think about?
Duodenal atresia (not oesophageal because it is bile stained)
What tests would you if you suspected duodenal atresia?
FBC, Group & Save, U&E’s, blood gas
What imagining technique is used in duodenal atresia?
Abdominal film/X-ray
What is seen on an abdominal film with duodenal atresia?
Double bubble appearance
What is a differential for duodenal atresia, which might present the same but is a surgical emergency?
Volvulus- can become necrotic. THATS WHY BILIOUS VOMITING SHOULD ALWAYS BE ASSUMED TO BE PATHOLOGICAL UNTIL PROVEN OTHERWISE.
What does a 10 month old with listless episodic screaming with knees drawn up to abdomen suggest?
Intessception
When does intussception usually present?
6 months- 18 months
What in the history may give you a clue that it is intussception?
Past history of a viral illness, as it is often preceded by a viral gastroenteritis.
What is the imaging technique for intussception?
US
What might you feel on palpation of the abdomen in intussception?
Sausage like mass on the RHS with a feeling of emptiness in the RIL.
What is the treatment for intussception?
Air enema
If there is perforation in intussception, what surgery would be needed to treat it?
Open laparotomy with manual reduction
