Surgery in Children Flashcards
When do children with pyloric stenosis present?
At about 6 weeks old
How does pyloric stenosis present?
Projectile vomiting of milk, was previously feeding normally, bumps on abdomen that move downwards, peristalsis visible
Why does obstruction occur with a pyloric stenosis?
Hypertrophy of muscle of pylorus wall blocks outlet of stomach
How is pyloric stenosis investigated?
Ultrasound scan
How does metabolic disturbance arise in pyloric stenosis?
Babies vomit acid which causes metabolic disturbance
How is pyloric stenosis treated?
Correct metabolic disturbance with fluid before surgery
Cut slit in hypertrophic muscle
How old are most children when they present with intussusception?
6 months old
How does intussusception present?
Tummy pain that comes in cycles, vomiting food, not pooing, blood coming out of bottom
What may be seen on the abdomen of a child with intussusception?
Bumps above pubic region and in abdomen itself = can feel sausage-like structures on palpation of abdomen
What appearance does the blood in a nappy of a child with intussusception have?
Looks like red currant jelly
How does intussusception appear on USS?
Swirl = target lesion appearance front on, pseudo-kidney appearance from side view
What is intussusception?
Part of intestine folds into the next part, causing an obstruction
What intervention is tried before surgery to try to correct intussusception?
Blow air up anus into intestines = works in 80% of cases
How may pain arise in intussusception?
Peyer’s patches in bowel wall become inflamed
How does appendicitis present?
Older child (able to talk), sore tummy, pain is worse with movement, moderate temperature , pain on right side
What does pain on movement usually indicate in a child with appendicitis?
Associated peritonitis = child usually reports going over speed bumps at hospital made pain worse
What is a useful test for peritonitis associated with appendicitis?
Ask child to jump up and down = child will either refuse because its too sore or will report pain
What treatment does peritonitis call for?
Surgery
Why may appendicitis cause peritonitis?
Inflamed appendix causes local irritation of peritoneum
What should you always assume the underlying cause of a baby vomiting moss green fluid is until proven otherwise?
Malrotation with volvulus
How can you test for malrotation with a volvulus?
Put contrast down bowel = if it swirls then there is malrotation
Is testicular tortion a surgical emergency?
Yes = requires urgent surgery to save testicle
How long do you have to save a testicle that has undergone tortion?
4 hours
What are some causes of a sore scrotum?
Testicular tortion, twisted hydatid of Morgagne, epididymo-orchitis
How may a twisted hydatid of Morgagne present?
Sore swollen scrotum, may be able to see blue dot under skin
What is the main cause of the acute scrotum?
Twisted hydatid of Morgagne = embryological remnant
What may be seen in a patient with epididymo-orchitis?
Swollen and red epididymis
How does idiopathic scrotal oedema present?
Redness extending to peritoneum and groin, not sore, may be achy, tissue may look water-logged
What may idiopathic scrotal oedema be related to?
Allergic reaction
How is idiopathic scrotal oedema treated?
Self resolves = may be given anti-histamines and pain killers (no operation needed)
What does BXO stand for?
Balanitis xerotica obliterans
What is BXO?
Thin white scaly patch on foreskin = usually scarring, may extend into urethra, often difficulty passing urine
How is BXO treated?
Circumcision
What is hypospadias?
Urethra doesn’t come out of the tip of the penis = needs surgery to correct
How does a patent processus vaginalis present?
Unilateral swelling that isn’t there in the morning but reappears at night, not sore, may appear blue, transilluminates
What causes the symptoms of patent processus vaginalis?
Tunnels that the testes used to descend of abdomen remains open and fluid is able to fill this space
When should a patent processus vaginalis be operated on?
If it persists beyond age 4
Why is transillumination not a reliable test for patent processus vaginalis in babies?
Many things (ie hernias) will transilluminate in babies as the structures in this age group are thin
What is a useful test when feeling for a testicle that is “unpalpable”?
Smear liquid soap on child and sweep thumb down the canal = teste should bounce back up against thumb if present
