Surgery Flashcards
Causes of Recurrent abdominal Pain
Constipation Urinary infections Mesenteric adenitis Dyspepsia/increased gastric secretion Chronic/sub acute appendicitis/faecolith Increased sympathetic tone Muscle spasm
Warning signs for organic causes of acute abdo pain
Pain wakes up the child at night
Child rolls around with pain
Continuous pain - well localised by patient
Absence of psychosomatic factors
Basic special investigations for acute abdo
Urine dipstick and MC&S
AXR
Ultrasound
classifications of appendicitis
Acute uncomplicated appendicitis Acute appendicitis with gangrene Complicated appendicitis -generalised peritonitis with perforation -appendix abscess -appendix mass -mucocoele
Post op complications of appendicitis
Residual sepsis, pelvic abscess or subphrenic abscess Wound infection Paralytic ileus Intestinal obstruction Mortality 1 %
Primary peritonitis
Infection of the peritoneal cavity without involvement of intra- abdominal organs
Aetiology: difficult to find often
Age 5 - 9 years old
Young girls with recent resp infection hx
Risk with nephrotic syndrome or VP shunt
Pneumococcus Streptococcus Gonococcus Meningococcus Gram negagive org. (E.coli) TB
GIT problems of worms
Worm bolus intestinal obstruction Worms in the biliary tree acute appendicitis Acute pancreatitis Peritonitis
RAPS(Recurrent Abdominal Pain Syndrome)
Incapacitating abdominal pain at least once per month for 3 months or more or 3 or more episodes over a three month period not associated with any organ dysfunction
Mainly seen in girls 10 - 12 years old age group
No specific signs or symptoms
Stress related
Different Layers of abdominal wall in the groin area (outside - inside)
Skin Subcutaneous fat External oblique Internal oblique Transvers abdominis/rectus abdominis Transbersalis fascia Supraperitoneal fat Peritoneum Abdominal cavity
Palpation findings of hernia
Swelling in the inguinal Swelling in the scrotum Thickening of the spermatic cord Silk sign Palpation of bowel in the hernia Presence of bowel sounds
Differential diagnosis of hernia
LN Abscess Undescended testes Hydrocoele Hydrocoele of the cord Femoral hernia
Clinical features of incarcerated or obstructed hernia
Sudden onset
Severe pain
Hard, tender mass in inguinal area
Intestinal obstruction with vomiting
Complications of choledochal cyst
Ductal strictures Stone formation Cholangitis Rupture Secondary biliary cirrhosis Malignancy (cholangiocarcinoma)
Presentation of choledochal cyst
Pain, jaundice, palpable mass Nausea, vomiting Fever Pruritus Weight loss
ERCP
Endoscopic retrograde cholangiopancreatography
