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Child Health > Surgery > Flashcards

Surgery Flashcards

1
Q

What is pyloric stenosis?

A

Hypertrophy of the pyloric muscle causes a gastric outlet obstruction

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2
Q

How does pyloric stenosis present?

A

6 weeks old, projectile vomiting, visible peristalsis, metabolic alkalosis can occur due to vomiting of stomach acid

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3
Q

How is pyloric stenosis managed?

A

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

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4
Q

What is intussusception?

A

Invagination of proximal bowel into a distant segment (telescoping)

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5
Q

How does intussusception present?

A

Episodic pain, c 6 months old, unwell for the past few days, vomiting, blood stained mucus in nappy, sausage shaped mass in abdomen

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6
Q

What does an X-ray of intussusception show?

A

Target lesion from front view

Kidney bean shape from side view

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7
Q

How is intussusception managed?

A

Usually require IV fluids then radiological rectal insufflation helps to push bowel back into place

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8
Q

When is surgery required for intussusception?

A

If visible peristalsis or fail of radiological method

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9
Q

What is malrotation?

A

Abnormality in which the intestine doesn’t form in the correct way in the abdomen

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10
Q

What is volvulus?

A

When the mesentery twists, so the superior mesenteric artery is occluded and blood supply to the midgut is compromised

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11
Q

How does malrotation and volvulus present?

A

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

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12
Q

How is malrotation and volvulus managed?

A

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

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13
Q

What GI condition do patients with CF often present with?

A

Meconium ileus

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14
Q

What is a meconium ileus?

A

Thick inspissated meconium of dough like consistency becomes impacted in the lower ileum

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15
Q

What does inspissated mean?

A

Sticks to the walls

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16
Q

How does meconium ileus present?

A

48 hours of vomiting, no passage of meconium, history or symptoms of CF

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17
Q

How is meconium ileus managed?

A

Contrast abdominal x-ray

May spontaneously pass, gastrografin can dislodge it otherwise snuggery is required

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18
Q

What does a meconium ileus look like on x-ray?

A

Distention
Soap bubble sign
Knotted bowel

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19
Q

What is intestinal atresia?

A

Segments of bowel are not connected, there may also be a fistula present

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20
Q

How does an intestinal atresia present?

A

Vomiting, no passage of meconium although may be gut secretions from lower down, enlarged bowel

21
Q

What investigation is done for children with suspected atresia?

A

Lower GI contrast - shows double bubble due to distension of the stomach

22
Q

How is intestinal atresia treated?

A

Surgical repair

23
Q

What is the typical presentation of appendicitis?

A

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

24
Q

How is suspected appendicitis managed?

A

If seen on ultrasound = inflammation

Laparoscopic or open surgery

25
Q

What condition presents with a non-painful red itchy scrotum where the redness spreads down and up?

A

Idiopathic scrotal oedema

26
Q

How do you treat idiopathic scrotal oedema?

A

Analgesia and antihistamines

27
Q

Name a female structure that can be left over in utero and be present on a boy

A

Mullerian duct known as a hydatid of morgagni

28
Q

Describe hydatid of morgagni

A

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

29
Q

What is the most common cause of acute scrotum?

A

Hydatid of Morgagni

30
Q

How is hydatid of morgagni treated?

A

Analgesia or operation

31
Q

Define phimosis

A

tight foreskin

32
Q

What can be done to help phimosis?

A

Dabbing urine after urination, stretch under the bath, steroid cream

33
Q

What is another name for lichen sclerosis?

A

Balanitis Xerotica Obliterans

34
Q

How does BXO present?

A

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.

35
Q

How is BXO managed?

A

Steroid cream can be given but circumcision more likely

36
Q

Describe paraphimosis

A

Tight foreskin is retracted and becomes irreplaceable therefore preventing venous return leading to oedema and ischaemia of the glans

37
Q

How is paraphimosis treated?

A

Ice or squeezing helps to restore flexibility if unsuccessful surgery is required

38
Q

Name the condition whereby the urethra is on the underside of the penis

A

Hypospadias

39
Q

What is the common cause of an inguinal hernia?

A

Patent processus vaginalis

40
Q

How does an inguinal hernia present?

A

Lump in the groin which may extend to the scrotum, contents become irreducible which causes pain, intestinal obstruction or even damage to the testes.

41
Q

How can an inguinal hernia be treated?

A

Surgery

42
Q

Describe hydrocele

A

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.

43
Q

How will hydrocele present?

A

Oedema that comes and goes, may appear blue/bruised, will transilluminate

44
Q

How is hydrocele managed?

A

PPV usually closes up on its own if not then surgery is required

45
Q

Why is surgery necessary for undescended testes?

A

Cosmetic reasons
Reduces risk of torsion
Spermatogenesis cannot occur inside body as the temperature is too high
Reduces risk of testicular cancer

46
Q

Describe testicular torsion

A

Painful, red, oedematous scrotal skin. Pain is localised to groin/lower abdomen. Testes may appear discoloured

47
Q

How long does it take for the testicle to die?

A

4 hours

48
Q

How is biliary atresia managed?

A

Palliative surgery or liver transplant

Child Health (12 decks)

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