Surgery Flashcards
What is congenital diaphragmatic hernia
Bowels with bowel gas above the diaphragm, pushing heart to side
What is oesophagael atreasia
Stricture of oesophagus or joining of oesophagus to trachea
XR sign of duodenal atresia
Double bubble
What is duodenal atresia associated with
Downs
What causes SB atresia
Hypoxia in utero
what is meconium ileus
xs mucous causing sticky meconium
assoication with meconium ileus
CF
2 types of anorectal anomalies
High - ectopic faecal-urinary pathway
Low
What is gastroschisis
Defect under umbilicus where bowel is extruded out of body
Picked up on 20 week scan
What is exomphalos
Similar to gastroschisis but assoicated with trisomys/other syndromes
what is bladder extrophy
bladder is open on abdominal wall
Small, splayed open penis
anterior ectopic anus
What is NEC
Intramural gas
Patchy necrosis of bowel
2 types of interesting vomitting to surgeons
Projectile (2 to 6 weeks)
Green - bile
Is projectile vomitting common?
YES - all children will have it, but they dont mean proper projectile, which would not go down the childs front, but hit the wall
Dx of pyloric stenosis
USS
PC of pyloric stenosis
Projectile vomitting
Hungry
Dehydrated
Electrolyte imbalance in pyloric stenosis
Hypocholoraemic alkalosis
What age group gets pyloric stenosis
2-6 weeks
What is malrotation
duodenum is fixed to abdominal wall, causing short mesentery which causes DJ flexure to be very high. Causes small bowel to twist on itself
what does a dark green vomit indicate
malrotation
when does malrotation surgery need to be done
within 4-6 hours
3 months to 2 year old baby with sudden colicky pain. Dx?
Intususception
pathognomonic late sign of intussusception
red currant jelly stool
XR sign of intussusception
dilated small bowel loops
Dx of intussusception
USS
Mx of intussusception
IV ABx
80% Air enema - CO2 per rectum under measured pressures to push bowel back
20% need
what is intussusception
invaginated ileum (telescopes into itself)
what chronic abdo pain would you worry about
Persistent / recurrent pain that interferes with school
Non central abdo pain - H/Pylori etc
What inguinal lumps need urgent surgery
under 2 years old and painful ones
what inguinal lumps are non urgent
reducible hernia (the majority)
old than 2 years old
empty scrotum
when do you operate on undescended testes
by 2 years of age
what is the risk of undescended testes
poor fertility
increased risk of malignancy (3-11x increase risk, up to 25% if intrabdominal)
cosmetic appearance
Ix of undescended testes
Laparoscopy
better than USS (can’t see) or MRI (needs GA)
how long do you have to operate on testicular torsion
4-6 hours
age peaks of torsion
neonates
pubertal
PC of testicular torsion
RIF pain
hemiscrotum red
whole scrotum hard and tender
Dx of epididimorchitis
surgery - can’t clinically tell from torsion
non urgent scrotal conditions
infantile hydrocele
painless lumps - epidymal cysts
varicocele
describe natural history of foreskin
starts as narrow opening of prepuce, inner layer of prepuce adhered to the glans of penis
then either of 2 problems can occur…
adhesion separates but smegma accumulates causing balanitis
OR
early retractile of foreskin, where prepuce stays adhered
Tx of balanitis
Regular washing
what is hypospadias
incomplete foreskin ventrally but excess dorsally
ureter not at the tip of the glans as it should be
what are the most urgent things to deal with if swallowed?
button batteries
causing dysphagia
sharp
if something passes into the stomach, what is the Mx?
LEAVE IT - it will pass if its got that far
why are button batteries so dangerous?
In oesophagus they can cause burns and erosions
what lumps need urgent surgery?
Large
Painful
Erythema / oedema - not always fluctuant
Anxiogenic (worried)
non acute lumps
acute midline cervical
branchial
lymph nodes under 2cm
haemangiomas in infants
when do you operate on umbilical hernias & why
4 years old - many are gone by then
if you see a midline neck lump, what do you ask child to do?
which lump are you trying to identify here?
stick tongue out - branchial cyst will move
why do you leave haemangiomas alone in infants?
they often stabalise and self resolve
what group is associated with rectal prolapse
toddlers with CF
