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Child Health > Surgery > Flashcards

Surgery Flashcards

1
Q

Appendicitis symptoms

A

Anorexia
Vomiting or diarrhoea
Abdominal pain - initially central and colicky but then localises to RIF

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2
Q

Appendicitis signs

A

Fever
Persistent tenderness with guarding in RIF (McBurney’s point)
Rebound tenderness
Obturator sign

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3
Q

Appendicitis age?

A

Can happen at any age
Uncommon <3yrs
Most common in 2nd decade of life

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4
Q

Complications of appendicitis

A

Appendiular mass

Appendicular abscess

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5
Q

Appendicular mass features

A

Omentum and small bowel adhere to appendix

Presents with fever and palpable mass

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6
Q

Appendicular mass treatment

A

Initially conservative with fluids, analegsia and abs
But urgent surgical intervention if mass enlarges of patient’s condition deteriorates
Conservative treatment followed by appendectomy

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7
Q

Appendicular abscess

A

Worsening CRP
Can be shown by US or CT
Initial treatment is by percutaneous or open drainage (open enables appendectomy)

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8
Q

Features of small intestinal obstruction

A

Persistent bilious vomiting
Meconium may be initially passed but subsequent stool passage is usually delayed or absent
High lesions will present straight away, low lesions a bit later
Abdo pain
Child unable to keep still
Tympanic percussion - peritonitis?

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9
Q

Causes of small bowel obstruction

A

Atresia or stenosis
Malrotation of volvulus
Meconium ileus
Meconium plug

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10
Q

Causes of large bowel obstruction

A

Hirschsprung disease

Rectal atresia

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11
Q

Intussusception definition

A

Invagination of proximal bowel into a distal segment - most commonly the ileum passing into the caecum

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12
Q

Intussusception peak age of presentation

A

3 months to 2 years

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13
Q

Intussusception complications

A

Stretching and constriction of mesentery
Results in venous obstrcution
Causing bleeding, fluid loss, perforation, peritonitis and necrosis

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14
Q

Presentation of intussuscpetion

A

Paroxysmal, severe colicky pain and pillow - during episodes of pain the child becomes blue around the mouth and draws up his legs
May refuse feeds
Bilious vomiting
Palpable sausage shaped mass?
Passage of characteristic redcurrant jelly stool (blood stained mucus) = later sign
Abdo distension and shock

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15
Q

Intussusception treatment

A

Fluid resuscitation and then rectal air insufflations to reduce the intussusception

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16
Q

Define malrotation

A

Abnormality of bowel which happens whilst baby is developing

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17
Q

Define volvulus

A

Complication of malrotation when the bowel twists so the blood supply to that part of the bowel is cut off

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18
Q

Volvulus S+S

A 
Bloody or dark red stools
Constipation
Distended abdome
Pain or tenderness of the abdomen
Nausea or bilious vomiting
Failure to thrive
Shock
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19
Q

If child has bilious vomiting….

A

Child should be presumed to have volvulus unless proven otherwise

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20
Q

Necrotising enterocolitis

A

P.aeuruginosa invades bowel wall causing ischaemia - can lead to necrosis and perforation

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21
Q

Increased risk of NEC in

A

Preterm infants in first weeks of life
PDA
Infants fed cow’s milk formula

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22
Q

Where is NEC

A

Can be anywhere but most commonly in terminal ileum and proximal ascending colon

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23
Q

Initial symptoms of NEC

A 
Feeding intolerance
Delayed gastric emptying
Abdominal distension and tenderness
Ileus
Erythema
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24
Q

Non-specific systemic signs of NEC

A 
Apnoea
Lethargy
Decreased peripheral perfusion
Shock
Cardiovascular collapse
Hypoglycaemia
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25
Q

Specific symptoms of NEC

A 
Bilious vomiting
Abdominal distension
Blood per rectum
Free abdominal air
Systemic shock
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26
Q

NEC on AXR

A

Distended loops of bowel and thickening of bowel wall with intramural gas
If perforation - air under diaphragm

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27
Q

Medical management of NEC

A 
Stop oral feeding
Broad spec abs
Parenteral nutrition
Artificial ventilation
Circulatory support
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28
Q

Define atresia

A

Congenital obstruction that is complete

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29
Q

What is duodenal atresia heavily associated with?

A

Down’s syndrome

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30
Q

Presentation of atresia

A 
Bilious vomiting
Prematurity
Polyhydramnios
Low birth wt
Jaundice
Abdo distension
Failure to pass meconium
Signs of fluid loss
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31
Q

Meckel’s diverticulum

A

V small remnant of the vitellointestinal duct due to its incomplete obliteration
Located in distal ileum

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32
Q

Complications of Meckel’s diverticulum

A

Bowel obstruction
Haemorrhage
Diverticulitis
Umbilical abnormalities

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33
Q

Which side does an inguinal hernia most commonly develop?

A

Right

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34
Q

Pathology of inguinal hernia

A

Normally inguinoscrotal descent of the testis is preceded by some peritoneum (processes vaginalis) which normally obliterates after birth. Failure of this process may lead to the development of an inguinal hernia or hydrocele

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35
Q

Inguinal hernia presentation

A

Intermittent swelling in groin or scrotum on crying or straining

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36
Q

Inguinal hernia - boys or girls?

A

Almost exclusively seen in boys

Can present in girls with the ovaries being incarcerated in the hernia sac

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37
Q

Hydrocele

A

Has same principle as inguinal hernia but tract is smaller and only allows peritoneal fluid to accumulate

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38
Q

Risks in inguinal hernia

A

Of bowel and testicular compromise

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39
Q

Aetiology of testicular torsion

A

Most common in adolescents but can happen at any age

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40
Q

Presentation of testicular torsion in newborn

A

Asymptomatic except for firm, hard scroll mass which does not transilluminated

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41
Q

Why is testicular torsion a surgical emergency?

A

Torsion of the spermatic cord can cause strangulation of the gonadal blood supply causing testicular necrosis and atrophy

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42
Q

Extravaginal torsion

A

Manifest in neonatal period

Develops prenatally in spermatic cord proximal to attachment of tunica vaginalis

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43
Q

Intravaginal torsion

A

Happens within tunica vaginalis
Older children
Usually left is affected

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44
Q

Presentation of testicular torsion in older boys

A

Sudden onset severe testicular pain followed by inguinal or scrotal swelling
Pain lessens as necrosis becomes more complete

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45
Q

Examination of testicular torsion

A

Swollen and tender high riding testes
Hard firm scrotal mass
Does not transilluminate
Absent cremasteric reflex

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46
Q

Epididymo-orchitis

A

Inflammation of epididymis and testes

47
Q

Causes of epididymo-orchitis

A 
UTI
STI
Mumps
Operation
Meds esp amiodarone
48
Q

Symptoms of epididymo-orchitis

A

Affected testes rapidly swells
Scrotum becomes enlarged, red and tender
Symptoms due to complications = dysuria, fever and discharge

49
Q

Treatment of testicular torsion

A

Manual detorsion needed within 6-8 hrs (testes dead in 24 hours)
If successful then perform definitive surgical fixing

50
Q

Management of epididymis-orchitis

A

Rest and analgesia
NSAIDs
Abstain from sex
Have STI check

51
Q

Balanitis

A

Inflammation of the end of the penis (glans). Usually foreskin is inflamed at the same time

52
Q

Balanitis epidemiology

A

Most common in boys <4yrs or uncircumcised men (v uncommon in circumcised men)

53
Q

Balanitis symptoms

A

Redness, irritation and soreness of the end of penis
May have a thick discharge
May have dysuria

54
Q

Causes of balanitis

A

Poor hygiene (combined with tight foreskin can lead to irritation by smegma)
Infection - candida or STI
Allergy or irritants
Skin condition

55
Q

Pathological phismosis

A

Is seen as white scarring of the skin
Rare before 5 yrs
Due to balanitis xerotica obliterans
Can cause urethral meatal stenosis

56
Q

Symptoms of BXO

A 
Burning
Pruiritis
Hypoesthesia
Dysuria
Painful erection
57
Q

Treatment of balanitis

A

Dependent on cause but may include anti-yeast cream, abs or mild steroid cream

58
Q

Until what age is non-retractile foreskin physiologically normal?

A

5yrs

59
Q

Hydrocele

A

Caused by a patent processes vaginalis which is sufficiently narrow to prevent the formation of an inguinal hernia but still wide enough to allow peritoneal fluid to track down the testis

60
Q

Presentation of hydrocele

A 
Asymptomatic scrotal swellings
Bilateral
Sometimes with bluish discolouration
May be tense or lax
Non-tender
Transilluminate
61
Q

Management of hydrocele

A

Most resolve spontaneously as the processes continues to obliterate but surgery is consider if it persists beyond 18-24 mths of age

62
Q

Risks of undescended testicle

A

Fertility issues

63
Q

Indications for medical circumcision

A

Phismosis

Recurrent balanoposthitis

64
Q

Possible complications of circumcision

A

Surgery under GA
Bleeding
Infection
Damage to glans

65
Q

What are labial adhesions?

A

Thin, pale, semi-translucent membranes covering the vaginal os between the labia minora.
In severe cases, these adhesions entirely close the vaginal os

66
Q

Causes of labial adhesions

A

Low oestrogen levels (protective effect of maternal oestrogen makes labial adhesions uncommon in neonatal period)
Vaginal inflammation
Trauma

67
Q

Symptoms of labial adhesions

A

Asymptomatic
May notice urine pooling in vagina
Rarely = dysuria or increased UTIs

68
Q

Mx of labial adhesions

A

No ix needed

If treatment necessary based on sx or parental request - oestrogen cream

69
Q

Varicocele

A

Abnormal dilatation of the testicular vv in the pampiniform plexus caused by venous reflux

70
Q

Consequences of varicocele

A

Reduction of testicular function and are associated with male infertility

71
Q

Which side is varicocele more common on?

A

Left

Can be R or bilateral

72
Q

Why is varicocele more common on L?

A

Anatomical reasons:
Angle at which the L testicular enters the L renal vv
Lack of effective valves between the testicular and renal vv
Increased reflux form compression of the renal vv

73
Q

Epidemiology of varicocele

A

Rare in <10yrs, increases in incidence after puberty

74
Q

Sx of varicocele

A

Usually asymptomatic and only rarely causes pain.
Scrotum may be described as feeling like a bag of worms or as heaviness
Commonly found on ix for fertility

75
Q

O/E of varicocele

A

Scrotum of varicocele sits lower
Dilation and tortuosity of v increase with standing
Valsalva manoeuvre increases it even more

76
Q

Grading of varicocele

A
  1. Small, only identified on varicocele
  2. Moderate and identified on palpation
  3. Large and easily identified
77
Q

Pyloric stenosis

A

Hypertrophy of the pyloric muscle causing gastric outlet obstruction

78
Q

Wha age does pyloric stenosis present?

A

2-7 weeks of age

79
Q

M:F of pyloric stenosis

A

4:1

80
Q

Clinica features of pyloric stenosis

A

Vomiting - that progresses o projectile
Hunger after vomiting (until dehydration leads to loss of interest)
Wt loss if presentation is delayed

81
Q

O/E of pyloric stenosis

A

Olive shaped mass in RUQ

82
Q

Electrolyte imbalances due ot pylori stenosis

A

Hypocholoraemic
Metabolic alkalosis
Low sodium and potassium

83
Q

Initial priority with pyloric stenosis

A

Correct fluid and electrolyte imbalances

84
Q

Surgical management of pyloric stenosis

A

Once hydration and acid-base electrolytes normal

Pyloromyotomy - division of the hypertrophies muscle down to but not including the mucosa

85
Q

Most common malignancies in children

A

A quarter are head and neck

86
Q

Most common malignancies in <6yrs associated with cervical lymphadenopathy

A

Neuroblastoma and leukaemia

87
Q

Most common malignancies in >6yrs associated with cervical lymphadenopathy

A

Hodgkin’s lymphoma

88
Q

Prevalence of cleft lip or palate

A

1 in 700

89
Q

Cleft lip is due to..

A

The failure of fusion of the frontonasal and maxillary processes

90
Q

Cleft palate is due to..

A

The failure of fusion of the palatine processes and nasal septum

91
Q

What is more common - cleft lip or palate?

A

1/2 have cleft palate
1/4 have cleft lip
1/4 have both

In boys - combo is most common
In girls - cleft palate is most common

92
Q

Problems with cleft lip/palate

A 
Feeding problems - inadequate suck
Ear infections and hearing impairment
Speech and lang problems (try to repair before speech starts to develop)
Dental health
Psychological issues
93
Q

Cause of congenital diaphragmatic hernia

A

Failure of one of both of the pleuroperitoneal membranes to close the pericardioperitoneal canals
Therefore the peritoneal and pleural cavities are continuous with each other along the POSTERIOR body wall

94
Q

Why is there a high mortality with a large diaphragmatic hernia

A

Abdominal viscera are pushed into thoracic cavity which pushes the heart anteriorly and compress the lungs which are commonly hypoplastic

95
Q

When can congenital diaphragmatic hernia be diagnoses?

A

Most are diagnosed prenatally on US following discovery of polyhydramnios

96
Q

Signs of congenital diaphragmatic hernia?

A 
Cyanosis shortly after birth
Tachypnoea and tachycardia
Asymmetry of chest wall
Absent breath sounds (usually L side)
Bowel sounds audible over chest wall
Signs of pneumothorax
97
Q

Mx of congenital diaphragmatic hernia?

A

Severely affected infants have chronic lung disease - may need oxygen/diuretics/ventilation
Fluid restriction
NG or IV feeding
Surgical repair

98
Q

What should first be considered as a cause of material polyhydramnios

A

Oesophageal atresia

99
Q

Polyhydraminos

A

Excess fluid in the amniotic sac

100
Q

Presentation of oesophageal atresia

A

Neonates will develop copies, fine white worthy bubbles of mucus in the mouth and nose. Secretions will recur despite suctioning
Infants may develop ratting respiration and eps of coughing and choking associated with cyanosis

101
Q

What happens if oesophageal atresia + trachea-oesophageal fistula?

A

Sx worsen
Cough, aspiration and fever
Abdo distension may occur secondary to collection of air in stomach
(Fistula can happen with or without atresia)

102
Q

What may a prenatal US of TEF show?

A 
Polyhydramnios
Absence of fluid in stomach
Small abdomen
Lowe than expected fatal wt
Distended oesophageal pouch
103
Q

Surgical repair of TEF

A

Via R thoracotomy

104
Q

Exomphalos

A

Congenital abnormality in which the contents of the abdomen herniate into the umbilical cord through the umbilical ring.
The viscera is covered by a thin membrane consisting of peritoneum and amnion

105
Q

Gastroschisis

A

Congenital defect of abdominal wall, usually to the right of the umbilical cord insertion
Abdominal contents herniate into the amniotic sac (usually just small intestines but can be stomach, colon, ovaries)
No covering membrane

106
Q

Urachus

A

Fibrous remnant of the allantois is persistent. This is normally a canal that joins the urinary ladder of the foetus with the umbilical cord. Leads to leakage of urine from the umbilicus and needs surgical removal
May be a cyst, fistula, diverticulum or sinus

107
Q

Patent vitello intestinal duct

A

Leads to discharge of enteric contents from the umbilicus in the first few days of life

108
Q

Umbilical granuloma

A

Inflammatory process at the umbilicus becomes fluid with excess granulation tissue preventing the raw area from developing new epithelial cells
Normally due to infection
Will respond to silver nitrate cauterisation

109
Q

Bladder exstrophy

A

Congenital abnormality in which part of the urinary bladder is present outside the body
Due to failure of the abdominal wall to close during development and leads to the anterior bladder protruding
Needs surgical correction

110
Q

What anorectal abnormalities could happen?

A

A membrane may be present over anal opening
Imperforate annus - rectum not connected to anus
Rectum may be connect to GU system via fistula
Anal stenosis
Rectum may be connected to another part of skin

111
Q

How may anorectal abnormalities be classified?

A 
Low defects (close to skin)
High defects (further away)
112
Q

Associations with anorectal abnormalities

A

CVS - most commonly TOF and VSD
GI malformations
Sacral/spinal probs
Vaginal and uterine probs

113
Q

Surgical management

A

NG tube to empty stomach
Abx
Low = anoplasty (anus is exposed under skin)
High = temporary colostomy and then depends on location

Child Health (1 decks)

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