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RC: Specialties Woo Hoo > Surgery > Flashcards

Surgery Flashcards

1
Q

T or F: Umbilical hernias tend to close on their own.

A

True.

  • 95% of < 1cm close w/in 5 y.o.
  • No sx unless does not go way by 4 y.o., strangulated,or progressively larger after 1-2 y.o.
  • Note: defect > 2cm less likely to close on their own
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2
Q

Surgical abdo. What do you do? CT or Fluids + analgesia?

A

Fluids + Analgesia

Stabilization first.

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3
Q

Most common cause of testicular pain in M > 12 y.o.

A

Testicular Torsion

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4
Q

List dx that transilluminate in scrotum:

A
  • Hydrocele

- Inguinal Hernia

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5
Q

BB with acute scrotal swelling. Transilluminate. Testes red, irritable. Mild tachycardia. Afebrile. Dx?

a. testicular torsion
b. epididymitis
c. inguinal hernia
d. acute hydrocele

A

Inguinal Hernia vs. Hydrocele

  • can transilluminate in BB since thin bowel wall
  • makes sense w/ acute, irritable, tachy
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6
Q

What is the risk of a communicating hydrocele?

A

Direct Hernia

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7
Q

When to refer a communicating hernia

A

18 mon

  • should resolve otherwise before then by itself
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8
Q

New hydrocele in teenager. R/O

A

Tumour
Trauma
Infection

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9
Q

When do you US a hydrocele?

A

confirm testis if > 6 mo.
can’t tell if hernia
R/O testicular tumour (teenager)
scrotal pain

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10
Q

What is the key to dx of hydrocele

A

Transillumination

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11
Q

When do you refer or correct a non communicating hydrocele?

A
  • large, tense, bothersome
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12
Q

T or F: most hernia are direct (bulge through abdo wall)

A

False.

99% Inguinal (through PV)

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13
Q

T or F: most hernia appear in 1st year of life.

A

True

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14
Q

Describe a clinical hallmarks for hernia:

A

Smooth
Firm mass
Lateral to pubic tubercle
Enlarge w/ abdo pressure w/ discomfort

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15
Q

What’s the diff between incarcerated vs. strangulated hernia?

A

Incarcerated= obstruction signs. Organ contained. Overlying red skin.

Strangulated: ischemic contacts.

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16
Q

How do you treat torsion of appendix testis?

A

Bed rest x 24 hr
NSAID x 3-5 d

Will resolve in 3-10d

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17
Q

13 y.o. 3d gradual pain. Tenderness of superior pole. Bluish discolouration at the tip. Next step?

A

Supportive care
+ Reassurance.

= Bed rest x 24 hr
NSAID x 3-5 d
Will resolve in 3-10d

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18
Q

3 month old. Pale. Intermittent vomiting. Tachy. Next:

  • AXR
  • Air enema floor
  • UGI
  • Contrast
A

Air enema fluoroscopy

  • Intussusception most common intestinal obstruction btwn 3 mo.-3 y.o.; rare in NICU
  • colicky sudden pain, lethargic. vomiting then bilious.
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19
Q

T or F: Intussusception most common cause of obstruction in neonates.

A

False.

MOST common in 3 mo. - 3 y.o.!

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20
Q

T21 baby with non bilious vomiting after feed. Risk of?

A

Duodenal Atresia.

Test: XR

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21
Q

What are the most common aetiologies of intussusception?

A

90%= idiopathic

Other:

  • correlation w/ adenovirus
  • Lymphoid nodular hyperplasia (Swollen Peyer patches)
  • Lead point (Meckel diverticulum, Intestinal polyp, neurofibroma)
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22
Q

What is the US finding of intussusception?

A

Doughnut/Target

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23
Q

Older infant. Resp symp. CXR show diaphragmatic hernia or diaphragmatic eventration. What is MOST dx test:

a. Sx exploration
b. diaphragm fluoroscopy
c. U/S
d. MRI

A

MRI

or US

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24
Q

What is diaphragm eventration?

A

abN elevation of diaphragm.

  • uncommon
  • congenital or acquired (injury to phrenic nerve from traumatic birth or Sx)
  • US tell this vs. CDH
  • most asymptomatic and do no need repair
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25
Q

List key traits of Gastroschisis:

A
  • usually periumbilical (R of)
  • NO membranous sac
  • 1/10= intestinal ATRESIA
  • other malformation rare
  • TX: ABC (no CPAP, if need to = intubate), OGT to LIS, cover gut, examine gut, bolus + fluids + Abx
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26
Q

Which of the following is TRUE regarding paediatric appendicitis?

a. incidence of perforated appendicitis in kids < 2 rare
b. routine imaging recommended
c. peak incidence 6-8 y.o.
d. pt w/ perforated appendicitis may be treated w/ abx alone.

A

Pt w/ perf appy may be tx w/ Abx alone.

  • 1/4 of appy= perf
  • peak: 11-12 y.o.
  • clinical dx; decision for imaging based on Sx
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27
Q

T or F: appendicitis is a clinical diagnosis.

A

True!

“febrile bowel obstruction”= perf appy until proven otherwise.

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28
Q

Peak age for appendicitis:

A

11-12 y.o.

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29
Q

How does the paradoxical acuduria occur in pyloric stenosis?

A
  • urine initially reflect primary process (low Cl with high bicarb)
    = then more dehydrated over time
    = aldosterone= Na retained and K and H excreted in urine
    = urinary paradoxical acuduria
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30
Q

What are RF for pyloric stenosis:

A
  • *first born
  • M
  • bottle fed
  • *erythro or azithro if < 2 wk old
  • *(+) FHX
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31
Q

T or F: pyloric stenosis is most common from 2 wk-2 month old?

A

True.

2-to-2

RARE after 12 weeks esp (3 mon.)

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32
Q

Pyloric stenosis presents with:

A

Non bilious

+ Projectile emesis

+ Dehydration

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33
Q

What is the lytes + gas pattern for pyloric stenosis?

A

Vomit= lose HCL

= Hypochloremic
Metabolic alkalosis
+/- Hypokalemic

= renal try to compensate for H+ loss by preserving Na and excrete K= low K

= urine initially reflect primary process (low Cl with high bicarb)
= then more dehydrated over time
= aldosterone= Na retained and K and H excreted in urine
= urinary paradoxical acuduria

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34
Q

What is the sign on U/S for pyloric stenosis?

A

“target” sign

  • length > 14mm
  • thick > 3mm
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35
Q

How do you treat pyloric stenosis:

A

Rehydrate + Stabilize

  • IV bolus NS until U/O
  • Change to dextrose + K after (0.45NS if < 4 week or 0.9NS if > 4 wk)

OR
- Pyloromyotomy

36
Q

List two complications of pyloric stenosis OR:

A
  • mucosal perforation

- incomplete pyloromyotomy

37
Q

What is the most common area for intussusception:

  • oleo-colic
  • ileo-ileocolic
  • jejunoileal
  • coli-colic
  • ileocolic w/ lead point
A

Ileo-Colic

38
Q

Ages for intussusception:

A

3 mo- 3 y.o.

peak at 9-12 months

39
Q

What is the most common pathological lead point in intussusception

A

Mickey Diverticulum

Other: polyp, intestinal duplication, Henoch-Schonlein purpura, Appendix etc.

40
Q

Are young or old more likely to have lead point in intussusception?

A

Old

  • W/U for other lead point (i.e. lymphoma, polyp etc.)
41
Q

What is the gold standard test to for intussusception?

A

U/S= doghnut/target sign

but air anema dx + tx

42
Q

Pain
+ Palpable sausage abdo mass
+ Bloody or currant jelly stool. Dx?

A

Intussusception

Classic Triad

43
Q

List one contraindication to enema (air, water, contrast) in intussusception cases:

A

Free air/ pneumoperitoneum.

Other: Peritonitis, persistent low BP

These pt= OR reduction

44
Q

Recurrence rate of intussusception?

A

10%

45
Q

2 y.o. M w/ large bloody painless stool. Dx?

A

Meckel diverticulum

46
Q

List a ddx for Meckel diverticulum:

A
  • colonic polyp
  • intussusception
  • bleeding esophageal varices
47
Q

what is the most common congenital anomaly of the GI tract?

A

Meckel’s diverticulum

48
Q

List the Rule of 2’s of Meckel’s Diverticulum

A 
2% of pop
2X M > F
ppt by 2 y.o.
2 inches long
2 feet proximal to ileoceccal valve
2 types of mucosa (gastric, pancreatic)
49
Q

what is the test to order in Meckel’s diverticulum:

A

Radionuclide Scan (Technetium-99 scan)

50
Q

What is a Meckel’s diverticulum

A

abnormal embryonic out pouching of bowel on small intestine

51
Q

What is the MOST appropriate next step in newborn baby w/ resp distress where you are thinking CDH?

a. immediate NG or OG
b. fluid resus
c. echo
d. prep OR for Sx
e. start inhaled NO

A

Immediate NG or OG

  • want to avoid stomach expanding with cry/gasp causing mediastinal shift
52
Q

Which CDH complication after birth challenges mngmt?

A

PPHN

  • pul hypoplasia + surfactant deficient and poor LV
    = hypoxemia + hypercarbia + acidosis
    = pul arterial vasoconstriction = pul HTN= fetal circulation and R - L shunt
53
Q

If you have an antenatal dx of CDH what should you do w/ airway?

A

INTUBATE on 1st brith + NG to decompress stomach.

- mechanical vent
\+/- HFO
\+/- inotropes
\+/- iNO
\+/- ECMO
54
Q

When do you repair CDH?

A

if stable over initial 24-48hr= Sx (primary repair if small defect vs. patch)

Otherwise depend on ABC settings.

55
Q

How can you tell an EA vs. EA with TEF on XR?

A

NG/OG stuck.

BUT air getting into abdo = air getting in through fistula!

56
Q

Most IMPORTANT maneuver to confirm dx of EA-TEF:

  • contrast esophagogram
  • urgent bronch
  • CT chest
  • attempt NG
  • U/S neck/chest
A

Attempt NG 8-10Fr.

  • NG usually block at 10cm
57
Q

Major anomaly occurs MOST frequently w/ EA-TEF?

  • skeletal
  • genitourinary
  • CVS
  • neurologic
  • GI
A

CVS

In VACERL W/U- CVS anomalies most common + life threatening

58
Q

Prem w/ polyhydraminos. Infant choking/cyanotic w/ feeding + oral secretion

A

Esophageal atresia.

59
Q

Most common TEF:

A

Type C.

Proximal EA w/ distal fistula formation btw teach-distal esophagus.

PPT: fetal polyhydraminos b/c can’t swallow AF.

60
Q

T or F: 90% of TEF have EA.

A

True.

61
Q

List three associated conditions:

A
  1. VACTERL= X linked, vertebral, anal, cardiac, TEF, renal, limb, hydrocephalus
  2. T13, T18, T21
  3. CHARGE (coloboma, heart, atresia of nasal chonanae, retardation (Growth/IQ), GU hypoplasia, ear
62
Q

List two complications of TEF repair:

A

anastomotic leak

recurrent fistula

63
Q

1 wk old infant w/ 24h hx vomiting, less stool, low U/O. lethargic. Vomit yellow-green and some streak of blood. Dehydrated. BW done. Next appropriate TEST:

a. AXR
b. CT abdo
c. US abdo
d. Upper GI series
e. Contrast enema

A

Not wrong to do XR to R/O obstruction

MOST appropriate= Upper GI to R/O mid-gut volvulus as LIFE threatening and TIME sensitive.

64
Q

Bilious emesis in neonate ddx:

A
  1. malrotation +/- midgut volvulus
  2. intestinal atresia
  3. Ileus
  4. Hirschsprung dx
65
Q

The gold standard for Malrotation w/ midgut volvulus is U/S.

A

False.
ANSWER= Upper GI series

US= may show inversion of SMA/SMV relationship (so that SMA on R and SMV on L)

66
Q

New baby with vomiting. Only small mec. Distended. Large gas + stool after DRE. Likely dx?

A

Hirschsprung’s

67
Q

What is Hirschsprung’s Disease?

A

failure of neural crest to migrate during intestinal development

68
Q

List one association w/ Hirschsprung Dx

A

T21

69
Q

List cardinal signs of Hirschsprung Disease:

A
  1. Failure to pass mec <24h
  2. Abdo distension
  3. Vomiting

+/- explosive gas and stool after DRE

+/- enterocolitis signs (fever, V, distension, lethargy)

70
Q

What is the gold standard to dx Hirschsprung? Findings?

A

Rectal Bx

  1. No ganglion cells
  2. Hypertrophic nerves
  3. Increased acetylcholinesterase staining
71
Q

What is an imaging test you can do in Hirschsprung?

A

Contrast enema

Sigmoid > rectum.

Funnelling = Transition zone

72
Q

When do you use anorectal manometry in suspected Hirschsprung?

A

Older kids/infants

= recto-inhibitory reflex

73
Q

How do we treat Hirschsprung?

A
  1. NS rectal decompression via saline irrigation
    +/- IV ABX if enterocolitis
  2. Sx (pull-through)
  3. +/- rare emergency colostomy if BAD enterocolitis
74
Q

Pt with hirschsprung disease present with fever, diarrhea, foul stool. What Dx to consider?

A

Enterocolitis!!

  • admit
  • ABX
  • rectal irrigation
  • dilate bowel
75
Q

Which is the following feature to BEST distinguish omphalocele from gastroschisis:

  • location of umbilical cord relative to abdo wall defect
  • co-existent intestinal obstruction
  • co-existent intestinal malrotation
  • prenatal dx
A

Location of umbilical cord relative to abdo wall defect

  • thru umbilicus= omphalocele
  • R of umbilicus= gastroschisis
76
Q

Most common cardiac malformation associated w/ omphalocele:

a. Ebstein’s anomaly
b. VSD
c. ASD
d. TOF
e. Hypoplastic L heart syn

A

TOF

Cardiac anomaly most common w/ omphalocele; of that TOF most common.

77
Q

T or F: highest rate of inguinal hernia occur in prem infants.

A

True

78
Q

What is risk factor for inguinal hernia?

A

Prematurity

Male

79
Q

When do you refer for inguinal hernia?

A

Immediately.

high risk ASAP (esp prem)

80
Q

What is the ONLY indication for CONTRALATERAL exploration during hernia repair?

A

PREM infant

81
Q

List 2 post-op inguinal hernia complications:

A
  1. Scrotal Swelling/hematoma
  2. Wound infection

Other

  • recur 1%
  • iatrogenic cryptorchidism
  • infertility (due to vas deferens injury)
  • testicular atrophy
82
Q

What is the MAIN indication for orchidopexy?

A

INFERTILITY risk

83
Q

T or F: spontaneous descend of testes after 9 month rare?

A

True

84
Q

When to refer for Sx if undescended testis?

A

9 month

85
Q

T or F: you should always do US for undescended testes?

A

False.

  • may consider to confirm presence if b/l and DSD suspicion
86
Q

Refer earlier for undescended testes if:

A
  • M but b/l non palpable
  • unilateral w/ hypospadias
  • DSD suspicion

RC: Specialties Woo Hoo (31 decks)

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