Surgery Flashcards
What is pyloric stenosis?
Hypertrophy of the pyloric muscle causes a gastric outlet obstruction
How does pyloric stenosis present?
6 weeks old, projectile vomiting, visible peristalsis, metabolic alkalosis can occur due to vomiting of stomach acid
How is pyloric stenosis managed?
Ultrasound can be used to diagnose, rehydration and electrolyte correction is vital prior to surgery. Surgery involved division of the muscle to allow the pylorus to spring open
What is intussusception?
Invagination of proximal bowel into a distant segment (telescoping)
How does intussusception present?
Episodic pain, c 6 months old, unwell for the past few days, vomiting, blood stained mucus in nappy, sausage shaped mass in abdomen
What does an X-ray of intussusception show?
Target lesion from front view
Kidney bean shape from side view
How is intussusception managed?
Usually require IV fluids then radiological rectal insufflation helps to push bowel back into place
When is surgery required for intussusception?
If visible peristalsis or fail of radiological method
What is malrotation?
Abnormality in which the intestine doesn’t form in the correct way in the abdomen
What is volvulus?
When the mesentery twists, so the superior mesenteric artery is occluded and blood supply to the midgut is compromised
How does malrotation and volvulus present?
Bilious green vomit in first few days of life, if volvulus occur the blood supply to the small bowel and proximal large bowel is compromised
How is malrotation and volvulus managed?
Contrast upper GI study to assess rotation unless there are signs of vascular compromise where a laparotomy is necessary. Surgery untwists bowel and puts in back in place
What GI condition do patients with CF often present with?
Meconium ileus
What is a meconium ileus?
Thick inspissated meconium of dough like consistency becomes impacted in the lower ileum
What does inspissated mean?
Sticks to the walls
How does meconium ileus present?
48 hours of vomiting, no passage of meconium, history or symptoms of CF
How is meconium ileus managed?
Contrast abdominal x-ray
May spontaneously pass, gastrografin can dislodge it otherwise snuggery is required
What does a meconium ileus look like on x-ray?
Distention
Soap bubble sign
Knotted bowel
What is intestinal atresia?
Segments of bowel are not connected, there may also be a fistula present
How does an intestinal atresia present?
Vomiting, no passage of meconium although may be gut secretions from lower down, enlarged bowel
What investigation is done for children with suspected atresia?
Lower GI contrast - shows double bubble due to distension of the stomach
How is intestinal atresia treated?
Surgical repair
What is the typical presentation of appendicitis?
Anorexia, vomiting, severe abdominal pain starts in the centre and moves to the side, fever, guarding (McBurney’s point), patient cannot jump/go over speed bumps without severe pain
How is suspected appendicitis managed?
If seen on ultrasound = inflammation
Laparoscopic or open surgery
What condition presents with a non-painful red itchy scrotum where the redness spreads down and up?
Idiopathic scrotal oedema
How do you treat idiopathic scrotal oedema?
Analgesia and antihistamines
Name a female structure that can be left over in utero and be present on a boy
Mullerian duct known as a hydatid of morgagni
Describe hydatid of morgagni
Autosomal recessive condition which results in a skin tag like structure sitting on top of the testicle - it can twist and become necrotic therefore appearing blue
What is the most common cause of acute scrotum?
Hydatid of Morgagni
How is hydatid of morgagni treated?
Analgesia or operation
Define phimosis
tight foreskin
What can be done to help phimosis?
Dabbing urine after urination, stretch under the bath, steroid cream
What is another name for lichen sclerosis?
Balanitis Xerotica Obliterans
How does BXO present?
Usually in older boys (9/10 years old), phimosis with scarring which can extend up the urethra and cause urinary problems. Difficult to retract foreskin, itchy/burning sensations or pain during intercourse later in life.
How is BXO managed?
Steroid cream can be given but circumcision more likely
Describe paraphimosis
Tight foreskin is retracted and becomes irreplaceable therefore preventing venous return leading to oedema and ischaemia of the glans
How is paraphimosis treated?
Ice or squeezing helps to restore flexibility if unsuccessful surgery is required
Name the condition whereby the urethra is on the underside of the penis
Hypospadias
What is the common cause of an inguinal hernia?
Patent processus vaginalis
How does an inguinal hernia present?
Lump in the groin which may extend to the scrotum, contents become irreducible which causes pain, intestinal obstruction or even damage to the testes.
How can an inguinal hernia be treated?
Surgery
Describe hydrocele
If the patent processus vaginalis is not wide enough for bowel to fall through then fluid can. Fluid drains at night and fills during the day.
How will hydrocele present?
Oedema that comes and goes, may appear blue/bruised, will transilluminate
How is hydrocele managed?
PPV usually closes up on its own if not then surgery is required
Why is surgery necessary for undescended testes?
Cosmetic reasons
Reduces risk of torsion
Spermatogenesis cannot occur inside body as the temperature is too high
Reduces risk of testicular cancer
Describe testicular torsion
Painful, red, oedematous scrotal skin. Pain is localised to groin/lower abdomen. Testes may appear discoloured
How long does it take for the testicle to die?
4 hours
How is biliary atresia managed?
Palliative surgery or liver transplant
