Surgery Flashcards
Define Atresia?
Normal passageway in the body is closed or absent
blind end in the gut
Define paralytic ileus?
Obstruction of the intestine due to paralysis of the intestinal muscles
What is meconium ileus and what is the usual cause?
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
Earliest signs of meconium ileus?
abdominal distention (a swollen belly), bilious (green) vomit and no passage of meconium.
X-ray for meconium ileus?
Soap bubble sign
What is jejunal atresia?
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.
Early signs of jejunal atresia?
feeding difficulties, failure to thrive, vomiting bile (a yellowish-green fluid), abdominal swelling, and/or absence of bowel movements after birth
Describe intestinal malrotation and volvulus in the newborn?
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.
Define volvulus?
obstruction caused by twisting of the stomach or intestine.
What colour is bile when vomited?
Mossy green
What is the danger with inguinal hernias in neonates?
Intestine can get stuck in the hernia and push out of the abdominal wall and the blood supply is cut off
What is the pylorus?
Lower part of stomach that connects to the duodenum.
Explain what happens in pyloric stenosis?
The muscles around the pylorus enlarge causing the opening of the pylorus to narrow
What age does pyloric stenosis usually present?
2-12 weeks old
Symptoms and signs of pyloric stenosis?
Projectile vomiting- milky vomit (suggestion of upper GI obstruction)
Moving bumps in abdomen (can see the peristalsis in the stomach)
Dehydration
Persistent hunger
In infant projectile vomiting what is the worry?
Pyloric stenosis
How can pyloric stenosis be investigated?
USS
Treatment of pyloric stenosis?
Treated with surgery but important to first treat any metabolic upset
Explain what intussusception is?
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
What age tends to present with intussusception?
Mainly in toddlers - 3 yo
Red currant jelly stool?
Intussusception
Signs and symptoms of intussusception?
Stool mixed with blood and mucus (currant jelly), vomiting, lump in abdomen, abdominal pain (colicky in nature), lethargy, diarrhoea and fever
Treatment of intussusception ?
Mostly successful with guided enemas but can do surgery
Symptoms and signs of appendicitis?
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
