Surgery

Question 1

6 weeks old with projectile vomiting

Answer 1

pyloric stenosis

Question 2

what causes the lumps on the abdomen in pyloric stenosis

Answer 2

normal peristalsis waves pushing against the pylorus

Question 3

why do you get pyloric stenosis at 6 weeks

Answer 3

pylorus muscle thickens and causes a physical obstruction to the milk being taken in

Question 4

what is the treatment for a pyloric stenosis

Answer 4

pyloromyotomy - cutting the muscle of the pylorus (care taken not to breach the mucosa underneath)

Question 5

what is this presentation: 6 months vomiting food then yellow and then green. sausage like mass in the abdomen . blood (red current jelly) in nappy

Answer 5

intussusception

Question 6

what is intussusception

Answer 6

where bowel acts like a telescope- folds in on itself

Question 7

what signs suggest intussusception

Answer 7

target sign- looks like a bullseye on ultrasound

pseudo kidney- from opposite view looks like a kidney

Question 8

what is the treatment for intussusception

Answer 8

radiology push air into colon to blow out the folds- works in 70-80% of cases, if not need surgery

need to be fully resuscitated before this happens- can loose fluids as cant take any in

Question 9

what is this presentation: 6 years old, stomach pain, painful during bumps in the car, cant jump, mild temperature

Answer 9

appendicitis

unable to jump means they have peritonitis

Question 10

what investigations into appendicitis

Answer 10

ultrasound

Question 11

what is the treatment for appendicitis

Answer 11

appendectomy- 95% laparoscopic

Question 12

what is this presentation: baby vomiting green

Answer 12

EMERGENCY MIGHT BE MALROTATION WITH VOLVULUS

Question 13

what colour vomit in volvulus, why

Answer 13

green- fairly liquid

due to bile and pancreatic juice

Question 14

what happens in malrotation

Answer 14

fixed points in abdomen (jejunum and cecum) form the longest line in the abdomen- path of the superior mesentic artery

if this points fixed in wrong place then unstable and can bowels can twist causing a vulvulus

Question 15

how do you tell if its a vulvulus

Answer 15

contrast scan

Question 16

what does a blue/ black scrotum suggest

Answer 16

torsion, testicles have died

Question 17

what can cause the scrotum to be inflamed

Answer 17

infection

Question 18

what can cause a blue/ black dot on testicles

Answer 18

torted hydatid

Question 19

what is a hydatid

Answer 19

embryological remnant of the ovarian duct

Question 20

what cause inflammation on scrotum that goes down to perineum and up into groin

Answer 20

idiopathic scrotal oedema - cures itself

Question 21

what is Balanitis Xerotica Obliterans (BXO)

Answer 21

when penile head is scarred, white or fissured

Question 22

what can help loosen foreskin

Answer 22

steroid cream

Question 23

what is hypospadias

Answer 23

congenital problem where the opening of the urethra is on the underside of the penis

Question 24

can you differentiate a hydrocele and a hernia in testes via transillumination

Answer 24

no will both glow

Question 25

what is orchidopexy

Answer 25

surgery to move an un-descended testicle into the scrotum

Question 26

why are un-descended testes operated on

Answer 26

as might form tumour, unexaminable in groin. no difference for fertility. improved cosmesis

Question 27

what should be seen in inguinal canal in laproscopy

Answer 27

testicular artery and vas deferens meeting at (closed) deep ring if normal

if no testicle then arteries will be spidery

Question 28

what does the testicular artery come off

Answer 28

aorta

Question 29

why might the deep ring be open

Answer 29

no testicle or undescended

Question 30

what can get trapped in the deep ring

Answer 30

bowel- hernias

Question 31

how do you operate to descend testicles

Answer 31

cut blood supply from testicular artery so that blood supply from below strengthens - some testicles will be lost

then relocate to scrotum