Surgery Flashcards
Hypospadeuis
Ventrallly def foreskin
Chordee >15 degrees erect
Prox urinary meatus
Hydrocele and inguinal hernia
Part of the same process
Incomplete closure of the process vaginalis
Testicles descends 32-36 weeks embryo
Inguinal hernias
Increased risk in prem infants
More likely to strangulate in prem infants
Males:females 10:1
If not reducible surgical emergency
Hydrocele
Common in the neonatal period
90% reduce in the first year
Undescended testis
USS NOT helpful gives high rate of false neg ( retractible)
If T down at birth likely retractible
If not down at birth likely undescended and will need laparaoscopy
Acute scrotum 7
Torsion of testicular appendage Torsion of the testicle Hernia Trauma Infection Scrotal edema Tumor HSP
Torsion of the testicular appendage
Just before puberty 8-11 years Males
95% Hydatid of Morgagni
Blue dot sign
Pain upper pole of the T quickly becomes everywhere and that is indistinguishable from T of T
Torsion of Testis
Peaks Neonate and 13-15 year but can happen any time
Rapid onset acute severe pain Abdo pain Vomiting
Unable to walk
Neonatal t of T likely happened inutero and the T is not salvageable
Testis is red and swollen possible with a reactive Hydrocele
Elevated lost the cremastic reflex
Contralateral testicle can like horizontally and it has an increased risk of T of T
Management of T of T
Early exploration of T <6 hours of pain 85-97% survive >24 hours of pain <10% survive USS NOT Recommended delays Surgery High risk of false neg Esp not accurate in a small child
Midline neck lumps 4
Thyroglossal cyst ( poke out tongue/drink h2O)
Dermioid cyst
Pre- tracheal cyst
Ran UCLA
Lateral neck lumps
Lymph nodes 4
Sternomastoid tumor lump in the SM muscle
Dermoid cyst ( lateral angular dermoid lat eyebrow common site)
Lymphoid proliferation (present birth/later avoid surgery)
Brachial remnant brachial sinus or fistula anterior to the SM muscle
Lymph nodes in the neck 4 causes
1 reactive ln
2 inflammatory
3 MAIS
4 Cancer rare but important esp teenagers
MAIS
Mycobacterium lymphadenitis Submandibular position Hard and red 6-8/52 Asymptomatic no fever no pain Ix Mantoux test positive Dd reactive ln <2cm soft and spongy
Pre auricular sinus
In front of the ear
Can be bilateral
Run in the family
Treatment is elective surgical excision when ‘cold’
Pyloric stenosis dd
Sepsis and GOR
In GOR the child thrives as it continues to vomit
In PS the child gets sicker as it continues to vomit
