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surgery Flashcards

1
Q

what can cause acute abdominal pain

A

appendicitis most common. lower lobe pneum may cause pain referred to abdomen, primary peritonitis in nephrotic syndrome, DKA, UTI

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2
Q

symptoms appendicitis

A

anorexia, vomiting, abdominal pain- initially central then localises to RIF

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3
Q

signs appendicitis

A

tenderness with guarding RIF, flushed face, oral fetor, fever, abdominal pain aggravated by movement, Rovings sign

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4
Q

what is rovsings sign

A

if palpate left lower quadrant and it produces pain in the right lower quadrant

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5
Q

complications of appendicitis

A

abscess, perforation

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6
Q

what is complicated appendicitis

A

presence of appendix mass, abscess, perforation

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7
Q

if there is generalised guarding consistent with perforation what is the management

A

fluid resus, IV antibiotics, laparotomy

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8
Q

if there is a palpable RIF mass but no signs peritonitis what is the management

A

conservative- IV antibiotics

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9
Q

when is an appendicetomy done

A

after several weeks. if symptoms progress- laparotomy

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10
Q

what is intussusception

A

invagination of proximal bowel into distal segment. ileum passes through ileocaecal valve to the caecum

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11
Q

what is the commonest cause of intestinal obstruction in neonates

A

intussusception

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12
Q

age intussusception

A

3m-2y

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13
Q

complications intussusception

A

stretching and constriction of the mesentery, venous obstruction- engorgement and bleeding from bowel mucosa, fluid loss- perforation, peritonitis, gut necrosis

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14
Q

presentation intussusception

A

paroxysmal colicky pain which can recover in between but becoming more lethargic, vomiting, refusing feeds, sausage shaped mass, redcurrant jelly like stools, abdominal distension and shock

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15
Q

what may AXR show in intussusception

A

distended small bowel, absence of gas in distal colon

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16
Q

investigations in intussusception

A

AXR, abdominal US

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17
Q

management intussusception

A

reduction by rectal air enema- by radiologist. if fails- laparoscopy or laparotomy

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18
Q

how recurrent is intussusception

A

5%

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19
Q

what is meckel diverticulum

A

in 2% there is an ileal remnant of vitello intestinal duct containing ectopic gastric mucosa or pancreatic tissue

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20
Q

presentation meckel diverticulum

A

most asymptomatic. can present with severe rectal bleeding. neither bright red or true malaena.

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21
Q

investigation in meckel diverticulum

A

technetium scan

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22
Q

management meckel

A

surgical resection.

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23
Q

what happens in malrotation

A

during rotation of small bowel in fetal life if the mesentery is not fixed at the duodenojejunal flexure or in ileocaecal region base is shorter than normal and predisposed to volvulus

24
Q

presentation malrotation

A

obstruction (due to Ladd bands) or with compromised blood supply (ischaemic bowel)

25
Q

presentation malrotation

A

obstruction with bilious vomiting in first few days of life, or later on - volvulus. dark green vomiting

26
Q

management malrotation

A

upper GI contrast, laparotomy if vascular compromise. operate- volvulus untwisted, mobilise duodenum, bowel placed in non rotated position.

27
Q

what type of inguinal hernia is it almost always

A

indirect- due to patent processus vaginalis. more freq in boys

28
Q

what type of infant is inguinal hernia common in

A

premature

29
Q

presentation inguinal hernia

A

swelling in groin, scrotum, crying, straining. may be an irreducible lump in groin or scrotum. firm and tender lump.

30
Q

when would the groin swelling become more visible

A

increase intra abdominal pressure- press on abdomen or ask them to cough

31
Q

if the lump cant be reduced what happens (inguinal hernia)

A

emergency surgery as can lead to bowel strangulation and damage to testes

32
Q

why would surgery be delayed by 24-48 hours

A

allow resolution of oedema

33
Q

what is a hydrocele

A

patent processus vaginalis allows peritoneal fluid to track down and around the testis

34
Q

features hydrocele

A

scrotal swelling, bilateral sometimes bluish discoloration, non tender, transilluminates

35
Q

when is surgery necessary hydrocele

A

most resolve spontaneously. but if it is persistent past 18-24 months then need surgery

36
Q

what is varicocele

A

varicosities of testicular veins - abnormal enlargement of pampiniform plexus

37
Q

what is varicocele associated with

A

subfertility

38
Q

symptoms varicocele

A

visible or enlarged palpable vein, aching sensation within scrotum, feeling of heaviness

39
Q

management varicocele

A

obliteration testicular vein, surgery, laparoscopic

40
Q

what happens in testicular torsion

A

spermatic cord twists cutting off blood supply

41
Q

presentation testicular torsion

A

pain may be in scrotum, groin or lower abdomen. examine all young males with inguinal or lower abdominal pain

42
Q

management testicular torsion

A

must be relieved within 6-12h for testicular viability. Doppler US to look at flow, surgery

43
Q

why is fixation of contralat testicle in torsion surgery necessary

A

as may be predisposition to torsion eg bell clapper deformity

44
Q

what is a risk factor for torsion

A

undescended testes

45
Q

what is an undescended testis

A

has been arrested along its normal pathway of descent. present in 4% term births.

46
Q

what is the term for bilateral undescended testes

A

cryptorchidism

47
Q

in who is undescended testes more common

A

prem- as testicular descent occurs in 3rd trimester

48
Q

in examination of undescended testis what is done

A

gently massage the contents of the inguinal canal to bring the testes down to a palpable position

49
Q

classification undescended testis

A

retractile, palpable, impalpable

50
Q

what is a retractile undescended testis

A

can be massaged down into bottom of scrotum but retracts back into inguinal region due to the cremasteric muscle

51
Q

what is a palpable and impalpable testis

A

palpable- testis can be felt in the inguinal region but cant be manipulated into scrotum. impalpable- cant be felt- in the inguinal canal, intra abdominal or absent

52
Q

investigations in undescended testis

A

ultrasound, hormonal- watch for rise in testosterone when inject HCG if bilateral impalpable, laparoscopy

53
Q

what is the surgery for undescended testis

A

orchidopexy- move testis into scrotum and permanently fix it there

54
Q

indications orchidopexy

A

fertility, malignancy, cosmetic, psychological

55
Q

what is fertility reduced to in bilateral orchidopexy

A

50%

56
Q

when is the risk of malignancy higher in undescended

A

if bilateral and intra abdominal

Paeds (16 decks)

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