Surg Cram

Question 1

Timing of reducible inguinal hernia repair?

Answer 1

If <6 weeks needs urgent repair
6weeks - 6 months needs repair in 2/52
>6 months needs repair in 2/12

Question 2

Rate of second hernia on contralateral side if one present?

Answer 2

1 in 20 / 5%

Question 3

Umbilical hernia mx?

Answer 3

90% self resolve by age 2-3

Surgical mx if still present when starting school OR if syndromic baby

Question 4

Pathophysiology of Hischprung’s?

Answer 4

Failure of neural crest cells to migrate completely → absent parasympathetic ganglion cells in mysenteric & submucosal plexus of rectum +/- colon

Question 5

Conditions associated with Hirschprung?

Answer 5

Sporadic (most)
MEN2A MEN2B
RET
T21
Congenital Central Hypoventilation
Waardenburg syndrome (hypopigmentation)

Question 6

Number of infants who fail to pass mec in 24hrs who will have Hirschprungs?

Answer 6

50%

Question 7

Investigation of choice for diagnosis of Hirschprungs?

Answer 7

Rectal biopsy - gold standard

Suction biopsy 2cm above dentate line (to reduce perf risk)

Question 8

Syndromes associated with omphalocele?

Answer 8

Beckwith Wiedemann
T21
Trisomy 13, 18

Question 9

Estimated fluid loss increase in gastroschesis?

Answer 9

2.5x normal neonatal fluid loss

Question 10

Oesophageal atresia associations?

Answer 10

Tracheo-oesophageal fistula (90%)
Prematurity
VACTERL/CHARGE
25% CHD / R sided aortic arch
5% renal abnormalities

Question 11

Pathophysiology of duodenal atresia?

Answer 11

Failure of recanilisation of 2nd part of duodenum at level of ampulla of Vater. Occurs in week 8-10 GA
Assoc w T21

Question 12

Pathophysiology of jejunal atresia?

Answer 12

Mesenteric vascular accident during foetal life

Assoc w CF, gastroschisis, midgut volvulus, maternal ephedrine/pseudoephedrine use

Question 13

Duodenal atresia on XR vs jejunal atresia on XR?

Answer 13

Duodenal atresia - double bubble

Jejunal atresia - small bowel

Question 14

Pathophysiology of malrotation?

Answer 14

In normal gut development bowel rotates 270deg anticlockwise. If this does not/incompletely occurs cecum ends up in mid/upper abdo and banded to peritoneum by Ladd bands, risking volvulus/obstruction.

Question 15

Malrotation associations?

Answer 15

Congenital diaphragmatic hernia
CHD - heterotaxy (atrial isomerism)
Omphalocele
Atresias
Meckel
Cornelia de Lange

Question 16

Treatment of malrotation and goal of intervention?

Answer 16

Surgical management
Bowel does not return to anatomically normal position - goal of surgery is to widen base of mesentery and create adhesions to hold the bowel in position making volvulus less likely.

Question 17

Investigation of malrotation?

Answer 17

Malposition of the superior mesenteric vessels on USS is diagnostic

Question 18

Meconium ileus association?

Answer 18

CF (90%)

Atresias