Surgery 2 Flashcards
What is a normal foreskin in infancy?
Normal foreskin does not retract in infancy and retraction should not be attempted.
At 1 year of age- bout half of uncircumcised boys have a non-retractile (normal) foreskin Only 1% of boys over 16 have a non-retractile foreskin
Why does the foreskin balloon on urination?
Results from lysis of preputial adhesions around the glans before those at the preputial opening. It stops once the preputial adhesions have lysed completely.
It has no functional consequence, does not represent obstruction and does not need intervention.
What is phimosis?
Physiological = when gentle traction is applied, the skin at the preputial opening is seen to evert, even if it doesn’t open up. Pathological = renders the glans ‘muzzled’ (w kagancu)
What are the medical reasons for circumcision?
BXO causing true phimosis
Recurrent balanoposthitis causing refractory symptoms
Prophylaxis of recurrent UTIs, especially in the presence of a congenital uropathy (such as posterior urethral valves- the stylish kid from 1st clinic) or if renal reserve is limited
If access to the urethra is required reliably for intermittent catheterization (e.g. spina bifida)
What are the complications of circumcision?
Post-op bleeding (that may require return to theatre)
Infection in the skin margin
Ulceration of exposed granular skin
Meatal stenosis (more common after circumcision for BXO)
Rarely: urethral fistula
How does balanitis present?
Inflammation of the glands
Balanoposthitis = inflammation of the glans and foreskin
sore, red inflamed glans. Phimosis. Dysuria
What is the management for balanitis?
Manage with abx or antifungals if candida infection is suspected
What are labial adhesions?
Fusion of the labia minora, usually in prepubertal girls. Usually there is adequate orifice for the passage of urine
Local irritation
superficial fusion of labia minora with a translucent (or
even slightly bluish) area of flimsy (cienki) tissue between labia
What is the management for labial adhesions?
None needed, unless the adhesion causes significant
symptoms.
Topical corticosteroids or oestrogens can be helpful to lyse the adhesions, but re-adhesion is common.
Formal ‘division of adhesions’ should be undertaken only exceptionally because of high reoccurrence rate.
What is cleft lip?
results from failure of fusion of the frontonasal and maxillary processes.
In bilateral cases, the premaxilla is anteverted
most are inherited polygenically, but it may be part of a syndrome. Some are associated with maternal anticonvulsant therapy.
Can be detected on antenatal scan
Management: surgical repair at 3 months of age
Which devices can be used to aid feeding in infants with cleft palate?
May make feeding difficult, but some affected infants can still be breastfed successfully. In bottle-fed babies, if milk is spotted to enter the nose and cause coughing and choking, special dummies and feeding devices may be helpful. Orthodontic advice and dental prosthetics may be helpful with feeding
What are the complications of cleft palate?
Secretory otitis media is relatively common and should be sought on follow-up. Infants are also prone to acute otitis media
What is the management for cleft palate?
MDT approach is required, involving plastic and ENT surgeons, paediatrician, orthodontist, audiologist and speech specialist.
Surgical repair usually takes place at 6-12 months of age
How does a diaphragmatic hernia present?
1 in 4000 births
Usually left-sided herniation of abdominal contents through the posterolateral foramen of the diaphragm.
Vigorous resuscitation may cause a pneumothorax in the normal lung, aggravating
situation.
Failure to respond to resuscitation or as respiratory distress
How does a diaphragmatic hernia present on examination?
the apex beat and heart sounds will then be displaced to the right side of the chest, with poor air entry in the left chest. These babies usually struggle a lot and need all sorts of respiratory support
