Surgery Flashcards
Hirschsprung’s disease:
- Definition + types
- Risk factors (3)
- Symptoms (3)
- Complications (2)
- DD (3)
- Investigations
- Management
Hirschsprung’s disease:
- Definition + types: congen disease where ganglionic cells of myenterric + submucosal plexuses fail to develop in large intestine from rectum up causing failure peristalsis presenting around 2 days after birth. 3 subtypes which are short segment (aganglionesis only in retrosigmoid), long seg (to splenic flexure), total colonic aganglionosis disease
- Risk factors: male, downs, fam hist
- Symptoms: can present in later childhood, failure to pass meconium in 48 hours, abdo distension, bilious vomiting
- Complications: failure to pass meconium leads to dilatation proximally increasing intraluminal pressure which decreases bowel blood flow and stasis leading to bact prolif (c diff/staph aures) = hirsch assoc enterocolitis which is inflamm and obstruction of intestine which can lead to toxin megacolon + perforation (fever, vomit, diarr, tender and needs fluid resus, bowel decompression, abx), faecal incont
- DD: meconium plug syndrome, intestinal atresia, intestinal malrotation
- Investigations: axr, contrast enema (short transition zone between proximal colon and distal end), gold standard rectal suction biopsy stained for acetylcholinesterase (only if delayed passed >48hrs/ constip first few weeks / fam hist/ faltering growth)
- Management: iv abx, ng tube, bowel decompression, surgery to resect aganglionic section and rejoin to dentate line
Pyloric stenosis:
- Definition
- Risk factors (3)
- Symptoms (4)
- Signs (2)
- DD (5)
- Investigations
- Management
- Complications (3)
Pyloric stenosis:
- Definition: progressive hypertrophy of pyloric muscle causing gastric outlet obstruction
- Risk factors: premature, M, fam
- Symptoms: 4-6 weeks old post prandial non bilious projectile vomiting after every feed, haematemesis (due to oesophagitis), weight loss, dehydration
- Signs: visible peristalsis, palp olive sized pyloric mass in right epigastric region
- DD: gastroenteritis, gor, overfeeding, sepsis, uti
- Investigations: test feed with ng tube and stomach aspirated and during examiner should palpate pyloric mass and observe for peristalsis, uss diagnostic (hypertrophic pyloric mass thickness >3mm), blood gas (hypokal hypochloraemic met alk due to loss hcl and vomiting and kidneys exch k for h)
- Management: correct met abnorm, 10-20ml/kg fluid boluses, stop oral feeding, ng tube and aspirate every 4 hours, check blood gases/u+es reg, surgical ramstedt’s pyloromyotomy and can resume feeding after 6 hours
- Complications: hypovol, apnoea due to hypovent + met acidosis, post op wound dehiscence/infection/bleeding
Biliary atresia:
- Definition
- Symptoms (4)
- Investigations (5)
- Management
- Complications (2)
- DD (3)
Biliary atresia:
- Definition: congen condition where section bile duct absent or narrowed due to fibrosis resulting in cholestasis so bile can’t be transported from liver to bowel for excretion causing high conj bilirubin levels
- Symptoms: signif/persistent jaundice >14 days in term/>21 in preterm, dark urine, pale stools, faltering growth
- Investigations: conju + unconj bilirubin levels (total bilir normal but conj high), bloods (lfts), hepatic scintigraphy (liver takes up technetium 99 isotope but poor excretion indicating bile ducts destroyed), abdo uss (echogenic fibrosis), percut liver biopsy with intraop cholangiography definite diag test
- Management: surgical hepatoportoenterosomy (kasai portoenterostomy) where attach small section small bowel to opening liver to bypass, full liver transplant
- Complications: liver failure, cirrhosis hence hepatocellular carcinoma
- DD: hepatitis, choledochal cyst (abdo pain, jaundice, abdo mass), algille syndrome
Cryptochordism:
- Def
- Pathos
- Risk f
- Symptoms
- Signs
- DD
- Manage
- Complic
Volvulus:
- Definition + types
- Symptoms
- Investigations
- Management
Umbilical hernia
- definition
- associated conditions
- mx
Umbilical hernia
- definition: common in newborns
- associated conditions: downs, afro caribbean, mucopolysaccharide storage diseases
- mx: no treatment as should resolve by age 3. If persists beyond 5 then elective outpatient surgical repair
GI perforation/ peritonitis:
- Causes
- Symptoms
- Signs
- Investigations
- Management
Appendicitis:
- Definition + pathophysiology
- Symptoms
- Signs
- DD
- Investigations
- Management
- Complications
Bowel obstruction / ileus:
- Definition + pathophysiology
- Causes
- Symptoms
- Signs
- Investigations
- Management
- Complications
Bowel obstruction:
- Definition + pathophysiology: mechanical obstruction. Increased peristalsis + dilatation causes secretion fluids + electrolytes into bowel causing dehydration, oedema, ischaemia and perforation
- Causes: in large tumour, volvulus, diverticular disease. small adhesions, hernias, strictures.
Intramural - foreign body, ileus gallstone, faecal impaction
Luminal - strictures, intussusception, meckels
Extraluminal: tumour, adhesions, volvulus
- Symptoms: DISTENSION, colicky cramp pain, bilious N+V, not passing faeces/wind
- Signs: dehydration, distended, guarding, tinkling bowel sounds
- Investigations: obs, urine dip, bloods (lactate, U+es (urea), fbc, crp, creatinine), ct abdo pelvis contrast, axr
- Management: nbm, ng tube, iv fluids, catheter, analgesia, antiemetics, iv abx, Surgery or adhesiolysis
- Complications: infarction, dehyd, perforation, renal impairment
Intussusception:
- Definition
- Pathophysiology
- Risk factors (5)
- Symptoms (5)
- Signs (5)
- DD (5)
- Investigations (3)
- Management
- Complications (5)
Intussusception:
- Definition: telescoping of one part of bowel into another mostly at 5-7 months mostly idiopathic or due to lead point in their intestinal wall
- Pathophysiology: can stretch/constrict bv in bowel mesentery leading to venous congestion + oedema in bowel wall. Also leads to intest obstruction mostly ileocolic meaning distal ileum passes into caecum through ileo caecal valve
- Risk factors: meckels diverticulum, polps, henoch schonlein purpura, lymphoma, post op
- Symptoms: sudden onset inconsolable crying episodes, draw up knees to chest, lethargic, if late bloody jelly stools, if older vomit/abdo pain
- Signs: distension, palp sausage shaped abdo mass in right upper quad, guarding, bowel sounds present, hypotension
- DD: colic, testic torsion, appendicitis, gastroenteritis, volvulus
- Investigations: abdo uss (doughnut sign on transverse plane, pseudokidney sign on longit plane)
- Management: fluid resus, ng to decompress, air/contrast enema for decompression via radiologist or paed surgeon unless peritonitis/shock, surgery manual reduction + removal necrotic bowel
- Complications: obstruction, perforation, bowel necrosis, dehyd, hypovol shock
Epididymo-orchitis:
- Definition
- Risk factors
- Symptoms
- Investigations
- Management
- Complications
Testicular torsion:
- Definition
- Risk factors
- DD
- Symptoms
- Signs
- Investigations
- Management
- Complications
Intestinal malrotation:
- definition
- symptoms
- ix
- mx
Intestinal malrotation:
- definition: when the caecum is high at the midline. occurs in exopmphalos, congen diaphragmatic hernia, duodenal atresia. Can develop into volvulus:
- symptoms: bilious vomiting + obstruction signs
- ix: upper gi contrast study, uss
- mx: laprotomy, if volvulus then ladds procedure
Meckels diverticulum:
- definition
- rule of 2s
- symptoms
- ix
- mx
Meckels diverticulum:
- definition: congen diverticulum of small intestine (remnant of omphalomesenteric/vitellointestinal duct
- rule of 2s: 2% pop, 2 feet from ileocaecal valve, 2 inches long
- symptoms: assymp, rectal bleeding painless, intest obstruction
- ix: if stable technetium scan, if severe mesenteric ateriography
- mx: removal via wedge excision or formal small bowel resection
