Surgery in Paediatrics Flashcards
Which is the important age to keep in mind for kids?
6 weeks 6 months 6 years
Which part of the bowel might be affected in projectile vomiting of milk?
pyloric stenosis
What are the bumps seen in the abdomen in pyloric stenosis?
the peristalsis in the bowels pushing against the pylorus
Why is 6 weeks crucial for pyloric stenosis in babies?
as the pylorus thickens in 6 weeks, it causes a physical obstruction that prevents the breastmilk from getting digested
What surgery is done to treat pyloric stenosis?
Pyloromyotomy (cutting the pyloric muscle –> as far as the x, or else you will cut through the mucosa) open or laparoscopic
Common features of pyloric stenosis
projectile vomiting 6 weeks rumbling bumps in the stomach usually in winter
6 months, child vomits yellow, food, slightly floppy, , sausage-like mass in the abdomen (right or left), blood/ redcurrant jelly in the nappy
intussusception
How serious is intusseption?
very serious kids can die due to dehydration
What investigations will be helpful in intusseption?
US
What are the features seen in intusseption US?
-bulls-eye sign - concentric - 6 months -pseudo-kidney shape -one part of the bowel folds into the other part like a telescope -causes a blockage
How do you manage intusseption?
- Resuscitation to prevent dehydration and shock
- Barium/ Air enema: No laparoscopy or surgery usually - resuscitate them - take them to radiology, push a tube in and push the air into the bottom and push the folding out and stretch it -
- if it doesn’t work use laparoscopy - dark colour circle - folded in part
What does the fact that “jouney into the hospital with lumps and bumps on the roads feeling bad” indicate?
peritonitis - inflammation of the peritoneum
Which condtition is common in 6 year olds?
peritonitis and appendicitis
What is an important thing to do to find out more info in children with abdominal pain?
Observation ask them to jump (many can’t/ some can) if they can’t jump –. indicative
What are the features of peitonitis?
mild fever apprehension to movement (jumping, bumps on roads)
What investigations are done in peritonitis?
US
What surgery is done
Laparoscopic open surgery - rare
What is the important key to note if babies come in vomiting green at night?
DO NOT USE the word BILE
differentiate btw yellow or green!!!
green - dark like fairy liquid
exclude - Malrotation/ midgut volvulus ** IMPORTANT - ask for help
What are the important of the two fixed points in the bowel?
the longest distance in the stomach and the blood supply to the mid-gut –> SMA stable - if the bowel is in the area What ahppens if the mi
What happens if the 2 fixed points are changed?
the mid-gut area is not stable and likely to twist Mid-gut volvulus and Malrotation
What does a baby vomiting green imply?
can be a malrotation, leading to mid-gut volvulus hence bile comes
How do you investigate green vomit?
using Contrast Imaging (from pylorus to duodenum) like corkscrew
What surgery do you do for malrotation?
Laparoscopic
What happens if the mid-gut is black
the gut is necrotic, can’t save it
What are some common clinical signs seen in scrotum?
-blue dots on the top of the testicle -red inflammation - torsion and twisitng of the testicle - black dot on the testicle (twisted and necrotic)
What is a very serious condition of the scrotum in kids?
torsion of the testicle
Which is the most common cause of an acute scrotum with a black dot?
testis hydatid/ Appendix of the testis
What should be done if the scrotum is inflammed?
scrotal oedema usually just an allergy not serious
What is a normal genitourinary condition in boys?
no scar slight shouldering, pink
What is an abnormal but common genitourinary condition in boys?
scarred, fissured, small opening BXO (Balanitis xerotica obliterans/ Lichen sclerosus)
Which system shows the most common genital abnormalities in kids?
Urinary
How can you identify a Hydrocoel?
Transillumination ( clear fluid surrounding the testicle) but not always right -> do US to rule out hernias or malignancies don’t be reassured (can be just hydrocele or something else as well)
Name the condition in which the testicle is not in the scrotum by 6 months of age?
Unilateral or bilateral cryptorchidism Surgery (orchidopexy) and put the testicle in a place where it can be examined -> o (as it can lead to tumours in the future)
How is fertility improved if the testicle is brought down from the groin?
not much if surgery has been done
but if caught early before 6 months of age, better prognosis in the a young boy
What do you do if the testicle hasn’t come down into the scrotum?
Try feel it along the tract upwards and Do a Laparoscopy can’t leave testicle on the inside
what should be looked for in the laparoscopy
-blood supply to the testicle (testicular artery from aorta) - white tube (vas deferens)
what should be looked for in the laparoscopy
-blood supply to the testicle (testicular artery from aorta) - white tube (vas deferens) - testicle at the end of the blood vessels
Where do the testicular artery and vas deferens meet?
closed deep ring
What happens if there are spider webs but blood supply to the testicle okay?
okay, reassure them, no tumour in the future
What if the deep ring is open and what surgery is done?
chop the testicular artery from aorta, come back in 3-6 months (blood supply from below has become stronger has stronger) swing the testicle down to the scrotum
What is testis hydatid/ hydatid of Morgnani/ appendix of the testis?
It is the vestigial remnants of the Mullerian duct in males, present on the upper pole of the testis, attached to the tunica vaginalis.
Very common
Significant if there is pain and can lead to one-sided testicular torsion palpable blue dot discolouration on the scrotum
What test is done to investigate pyloric stenosis?
US
