Surgery Flashcards
At which month is it very unlikely for an undescended testicle to descend?
4 months
What are the complications or risks of an undescended testicle?
- Poor testicular growth
- Testicular malignancy (peak age 15-45 years, most common = seminoma)
- 4x higher in the undescended testis, less common if orchiopexy <10yo but risk still exists
- Adolescents should be instructed in testicular self-examinations
- Associated hernia
- Torsion of the cryptorchid testis
- Infertility
What are indications for surgical repair of an umbilical hernia?
- Hernia persists to 4 to 5 years of age
- Causes symptoms
- Becomes strangulated
- Becomes progressively larger after 1-2 years
What is the best investigation for breast mass in teens?
What is the most common etiology?
What is the management for this issue?
Ultrasound → mammogram NOT indicated
Fibroadenoma
Management: observe 2 menstrual cycles or until adulthood, 10% will regress. Serial US to monitor.
FNA indication: >5cm (risk of giant fibroadenoma, cystosarcoma phylloides)
At what age is intussusception mostly seen?
- Most common cause of intestinal obstruction between 5 months and 3 years
- Approximately 80% of cases occur <2 years of age; rare in neonates
- M>F (3:1)
- Ileo-colic (90%) > ceco-colic > ileo-ileal
What are the classic clinical presenting symptoms?
- Sudden onset of severe paroxysmal colicky pain accompanied by straining and flexed knees
- Progressively weaker and lethargic, as well shock-like state with fever and peritonitis
- Vomiting, may be bilious
- Red currant jelly stool in 60% of infants; may more commonly be bloody
- “Sausage-shaped” RUQ mass in 30% of patients
- Classic triad of paroxysmal pain, palpable sausage-shaped RUQ abdominal mass and currant jelly stool present in <30% of affected patients
What are the contraindications to air enema for intussusception?
- Prolonged intussusception
- Signs of shock
- Peritoneal irritation / peritonitis
- Intestinal perforation
- Pneumatosis intestinalis
What is the most common associated anomaly with gastroschisis?
Intestinal atresia
What are the differences between non-communicating and communicating hydroceles?
- Non communicating - fixed amount of fluid and the tract has closed off; common in newborns and rare > 1 year → conservative, typically self-resolves (surgery if persistent at 18mo)
- Communicating - persistence or delayed closure of the processus vaginalis but smaller so doesn’t cause hernia. Fluid amounts change with gravity and throughout the day → can be corrected in 1st if truly changing volumen
What are indications for emergent or urgent removal of foreign bodies in the esophagus?
- Signs of airway compromise
- Symptoms consistent with esophageal obstruction
- Button battery in the esophagus
- Sharp or long (>5cm) objects in the esophagus or stomach
- High-powdered magnets
- Intestinal obstruction
- FB impacted in the esophagus for >24h or an unknown period
What is the peak age of appendicitis?
- Most common non-traumatic surgical emergency in children
- 1 in 1000 kids per year
- 20-25% perforated on presentation
- Peak incidence: 11-12yo (⅓ present < 18y)
- Lifetime risk: 7% female, 9% male
What is the sensitivity and specificity for ultrasound vs. CT scan in appendicitis?
- US - non compressible appendix, abscess
- Sensitivity 85%, specificity > 90%
- CT scan - ALARA principle
- Sensitivity 95%, specificity 94%