Surgery

Question 1

Define Atresia?

Answer 1

Normal passageway in the body is closed or absent

blind end in the gut

Question 2

Define paralytic ileus?

Answer 2

Obstruction of the intestine due to paralysis of the intestinal muscles

Question 3

What is meconium ileus and what is the usual cause?

Answer 3

Meconium is the first stool of a newborn and it is stickier than normal, obstruction can occur when it is even stickier which often happens if a baby has CF

Question 4

Earliest signs of meconium ileus?

Answer 4

abdominal distention (a swollen belly), bilious (green) vomit and no passage of meconium.

Question 5

X-ray for meconium ileus?

Answer 5

Soap bubble sign

Question 6

What is jejunal atresia?

Answer 6

Partial or complete absence of the membrane connecting the small intestines to the abdominal wall (the mesentery). It causes a portion of the small intestines (the jejunum) to twist around an artery that supplies blood to the colon (the marginal artery). This leads to an intestinal blockage.

Question 7

Early signs of jejunal atresia?

Answer 7

feeding difficulties, failure to thrive, vomiting bile (a yellowish-green fluid), abdominal swelling, and/or absence of bowel movements after birth

Question 8

Describe intestinal malrotation and volvulus in the newborn?

Answer 8

Malrotation happens when the baby’s intestine doesn’t turn like it should. This can cause a volvulus after the baby is born. In this condition, the baby’s intestine gets twisted which can cause obstruction and infarction if blood supply is cut off.

Question 9

Define volvulus?

Answer 9

obstruction caused by twisting of the stomach or intestine.

Question 10

What colour is bile when vomited?

Answer 10

Mossy green

Question 11

What is the danger with inguinal hernias in neonates?

Answer 11

Intestine can get stuck in the hernia and push out of the abdominal wall and the blood supply is cut off

Question 12

What is the pylorus?

Answer 12

Lower part of stomach that connects to the duodenum.

Question 13

Explain what happens in pyloric stenosis?

Answer 13

The muscles around the pylorus enlarge causing the opening of the pylorus to narrow

Question 14

What age does pyloric stenosis usually present?

Answer 14

2-12 weeks old

Question 15

Symptoms and signs of pyloric stenosis?

Answer 15

Projectile vomiting- milky vomit (suggestion of upper GI obstruction)
Moving bumps in abdomen (can see the peristalsis in the stomach)
Dehydration
Persistent hunger

Question 16

In infant projectile vomiting what is the worry?

Answer 16

Pyloric stenosis

Question 17

How can pyloric stenosis be investigated?

Answer 17

USS

Question 18

Treatment of pyloric stenosis?

Answer 18

Treated with surgery but important to first treat any metabolic upset

Question 19

Explain what intussusception is?

Answer 19

One segment of intestine “telescopes” inside of another causing obstruction. Often occurs at junction between small and large intestines. May be related to viral illness

Question 20

What age tends to present with intussusception?

Answer 20

Mainly in toddlers - 3 yo

Question 21

Red currant jelly stool?

Answer 21

Intussusception

Question 22

Signs and symptoms of intussusception?

Answer 22

Stool mixed with blood and mucus (currant jelly), vomiting, lump in abdomen, abdominal pain (colicky in nature), lethargy, diarrhoea and fever

Question 23

Treatment of intussusception ?

Answer 23

Mostly successful with guided enemas but can do surgery

Question 24

Symptoms and signs of appendicitis?

Answer 24

Central pain radiating to the RIF, mild pyrexia, rebound tenderness and guarding, may not have moved bowels, vomited once or twice
Rosvigs sign: palpation on the left increases pain on the right
McBurneys: 1/3 of way in diagonal line from ASIS to umbilicus (this is where the most common position of appendix thought to be) is point of maximal tenderness

Question 25

Signs of peritonitis?

Answer 25

Severe, continuous abdominal pain, child cannot jump, v serious as can get multi organ failure

Question 26

Acute scrotum presentations in paediatrics? What is emergency?

Answer 26

Torsion of the testes (emergency)
Hydatid of Morgani (female part left over)
Infection (epidydidmal orchitis)
Hypospadius (urethra not coming out of penis)