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Y4 Paeds > Surgery > Flashcards

Surgery Flashcards

1
Q

what gender is most affected by appendicitis ?

A

males

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2
Q

does visceral or parietal peritoneum cause referred pain?

A

visceral peritoneum

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3
Q

what signs would be present for pelvic appendix ?

A

pain initially felt in RLQ, no visceral symptoms and pain on urination, may cause suprapubic pain (5). May present with profuse diarrhoea and pelvic pain.

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4
Q

what signs would be present for retrocaecal appendix ?

A

Pain may localise to psoas muscle, the flank or right upper quadrant

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5
Q

what signs would be present for retroileal appendix ?

A

May cause testicular pain due to irritation of the spermatic artery or ureter

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6
Q

if a child with suspected appendicitis has been suffering from symptoms for >48hrs what is likely to have happened?

A

perforated appendix

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7
Q

state some DD for appendicitis?

A 
gastroenteritis 
acute mesenteric adenitis
constipation 
crohns 
intussusception 
UTI
ectopic pregnancy 
ovarian torsion 
basal pneumonia and pleurisy
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8
Q

what is the risk scoring used for appendicitis in children?

A

Paediatric Appendicitis Score (PAS)

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9
Q

what investigations can be done for appendicitis ?

A

FBC, U&Es, CRP, ESR, pregnancy test

urine dipstick

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10
Q

what is the PAS score out of?

A

out of 10

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11
Q

what does a PAS score of <4 show?

A

low likelihood of appendicitis

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12
Q

what does a PAS score of 4-6 show?

A

indicates further monitoring is needed and should be used alongside clinical judgement

imaging will be helpful

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13
Q

what does a PAS score of >6 show?

A

child is referred to the surgical team for blood tests

doesn’t confirm acute appendicitis

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14
Q

what are some complications of appendicitis?

A 
perforation 
appendix mass 
abscess
generalised peritonitis 
sepsis 
death
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15
Q

is appendix perforation common in children?

A

yes

- up to 97%

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16
Q

what is the initial management of appendicitis ?

A

immediate hospital admission
IV access
fluid resuscitation
contact surgical team to discuss IV antibiotics

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17
Q

what is the gold standard surgical management of appendicitis ?

A

laparoscopy

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18
Q

for uncomplicated cases, how long do patients stay in hospital for?

A

discharged after 24-36hrs

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19
Q

What does a palpable mass at McBurneys point in the RLQ suggest?

A

appendix perforation

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20
Q

Vomiting before the onset of pain is a feature of what appendix orientation?

A

retrocaecal

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21
Q

what gender is most affected by pyloric stenosis?

A

males

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22
Q

at what age does pyloric stenosis present at?

A

4-6weeks

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23
Q

what is the vomiting described as for pyloric stenosis?

A

projectile

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24
Q

on examination what could be found for pyloric stenosis?

A

visible peristalsis and a palpable olive-sized pyloric mass, best felt during a feed

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25
Q

what are the DD for pyloric stenosis?

A 
Gastroenteritis
Gastro-oesophageal reflux, including Sandifer syndrome
Over-feeding
Sepsis
UTI
Food allergy
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26
Q

what is Sandifer syndrome?

A

combination of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements with or without hiatal hernia

27
Q

what investigation should be done for pyloric stenosis?

A

test feed with NG tube in situ

US for pyloric muscle hypertrophy >3mm thickness, >15mm length, >11mm diameter

28
Q

what do blood gases for pyloric stenosis usually show?

A

hypokalaemia, hypochloraemic metabolic alkalosis

from vomiting

29
Q

what is the management for pyloric stenosis?

A

10-20ml/kg fluid bolus
NG tube and aspirate contents
rehydration 150ml/kg/day

30
Q

what surgery is done for pyloric stenosis?

A

Ramstedt’s pyloromyotomy

31
Q

what are complications of pyloric stenosis?

A 
Hypovolaemia
Apnoea 
Wound dehiscence
Infection
Bleeding
Perforation
Incomplete myotomy
32
Q

How many hours after surgery can the baby resume feeding?

A

6hrs

33
Q

what is cryptorchidism ?

A

congenital absence of one or both testes in the scrotum

34
Q

what are the three types of cryptorchidism?

A

true undescended testis
ectopic testis
ascending testis

35
Q

during embryology, what pulls the testis down from the abdomen ?

A

gubernaculum within the processes vaginalis

36
Q

what causes bilateral cryptorchidism ?

A

hormonal causes such as androgen insensitivity syndrome or disorder of sex development must also be excluded.

37
Q

what are risk factors of cryptorchidism?

A

prematurity,

low birth weight,

having other abnormalities of genitalia (i.e. hypospadias)

having a first degree relative with cryptorchidism.

38
Q

how many undescended testis are palpable ?

A

80%

39
Q

what are some DD of cryptorchidism?

A 
normal retractile testis 
true undescended testis 
ectopic testis 
absent testis 
bilateral impalpable testes
40
Q

what are the two locations of ectopic testis ?

A

prepenile

femoral

41
Q

what are the three locations of true cryptochidism testis ?

A

abdominal
inguinal
suprascrotal

42
Q

what is the management of cryptochidism at birth?

A

review at 6-8weeks

43
Q

what is the management of cryptochidism at 6-8weeks?

A

if fully descended, no further action. If unilateral, re-examine at 3 months

44
Q

what is the management of cryptochidism at 3months?

A

If testis is retractile, advise annual follow up (due to risk of ascending testis). If undescended, refer to paediatric surgery/urology for definitive intervention – ideally occurring 6 – 12 months of age.

45
Q

what is the surgery preformed for cryptorchidism when the testes are palpable ?

A

orchidopexy

46
Q

what are three complications of undescended testis?

A

impaired fertility
testicular cancer
torsion

47
Q

what is the incidence of hypospadias?

A

1 in 300

48
Q

is the incidence of hypospadias increasing or decreasing ?

A

increasing

49
Q

what are three key features of hypospadias?

A

1) Ventral opening of the urethral meatus
2) Ventral curvature of the penis or “Chordee”
3) Dorsal hooded foreskin

50
Q

what are the different locations of hypospadias ?

A 
glandular 
coronal 
shaft 
scrotal 
perineal
51
Q

what is a diagnosis that must not be missed with hypospadias?

A

congenital adrenal hyperplasia

52
Q

what investigations can be done if there are concerns over disorder of sex development?

A 
Detailed history and examination
Karyotype
Pelvic ultrasound scan
Urea and Electrolytes
Endocrine hormones: Testosterone, 17 alpha-hyroxyprogesterone, LH, FSH, ACTH, renin, aldosterone
53
Q

what is the treatment for hypospadias?

A

Urethroplasty

54
Q

what are long term complications of surgery to correct hypospadias?

A

urethral fistulas

urethral stenosis

55
Q

what is BXO?

A

balanitis xerotica obliterates

56
Q

what happens during BXO?

A

where keratinisation of the tip of the foreskin causes scaring and the prepuce remains non-retractile

57
Q

what age is most affected by BXO?

A

9-11 years

58
Q

with what symptoms does BXO present?

A

scaring of the urethral meatus presents with irritation, dysuria, haematuria and local infection.

in extreme cases of scarring patients can present with urinary obstruction and retention.

59
Q

what is the management of BXO?

A

circumcision

- the foreskin is sent off to histopathology in order to confirm the diagnosis

60
Q

what are complications of untreated BXO?

A

meatal stenosis
phimosis
erosions of glands and prepuce

61
Q

What is the mean age for when first foreskin retraction occurs?

A

10.4 years

62
Q

What percentage of pathological phimosis is due to the process ‘Balanitis xerotica obliterans?’

A

95%

63
Q

At what age is it normal phenomena to have non-retractile foreskin?

A

2-4years

Y4 Paeds (15 decks)

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