Surgery - Other Flashcards
What are the clinical features of pyloric stenosis?
vomiting - becoming increasingly frequent and forcefulness over time ultimately becoming projectile
hunger after vomiting until dehydration
weight loss if presentation is delayed
What is pyloric stenosis?When does it present?
hypertrophy of the pyloric muscle causing gastric outlet obstruction presents at 2-8 weeks of age, irrespective of gestational age more common in boys
How is a diagnosis made of pyloric stenosis?
- diagnosis can be made through ultrasound
- test feed is performed
- calms the hungry infant and allows examination to be performed
- gastric peristalsis can be seen across the abdomen and pyloric mass which feels like an olive is usually palpable in the right upper quadrant
- ultra sound examination can be helpful
How is pyloric stenosis managed?
1) correct fluid and electrolyte disturbance with IV fluids
2) pyloromyotomy operation (division of hypertrophied muscle) can be performed
What fluid and electrolytes imbalance occurs in pyloric stenosis?
vomiting contents from the stomach causes:
- a hypochloraemic metabolic alkalosis
- hyponatraemia
- hypokalaemia
What are the differential diagnosis of cervical lymphadenopathy in children?
TB Toxoplasmosis SLE Syphilis Infection - chickenpox, HIV, rubella Lymphoma Leukaemia
How is lymphadenopathy investigated?
examination
biopsy for large nodes
What is suppurative adenitis/lymphadenitis?
common form of soft tissue caused by staph aureus or strep pyogenes
How does cleft lip present?
may be unilateral or bilateral
failure of fusion of the frontonasal and maxillary processs
What are the common associations with cleft lip/palette?
may be part of a syndrome of abnormalities (chromosomal disorders) may be detected on antenatal ultrasound
What are the problems associated with cleft lip/palette?
feeding is more difficult and in bottle fed babies though some breast fed babies can be successfully fed surgical repair of the lip occurs at 3 months and palette at 6-12 months
How does congenital diaphragmatic hernia present?
- failure to respond to resuscitation
- respiratory distress
- heart and bowel sounds are displaced
- usually picked up on antenatal scan
- x ray shows left sided herniation of abdominal contents through posterolateral foramen of the diaphragm
How is diaphragmatic hernia treated?
avoid mask ventilation intubate immediately use NG to deflate bowel surgical repair mortality is high if lungs are hypoplastic
How does a trachea-oesophageal fistula present?
if not suspected before birth then presents with
- persistent salivation
- drooling from the mouth
- infant will cough and choke when fed
- may be aspiration into the lungs
How is the diagnosis of oesophageal fistula made?
pass NG tube and x ray is checked to see if it reaches the stomach
see polyhyramnios antenatally as baby can’t swallow amniotic fluid
What conditions is oesophageal atresia associated with?
VACTERL conditions
vertebral ano-rectal cardiactracheo-oesophageal atresia/fistula renal limb
How is oesophageal atresia managed?
1-2 days after birth, tie off fistula post repair risk of strictures is high and RF for GORD later
- NG drainage, tracheostomy, gastrostomy, IV hydration + abx
- If no pulmonary complications, repair within first few days of life
- Complications – parenteral nutrition, gastrostomy + upper pouch suction until lower risk
- Palliative – treatment is relief of obstruction + diversion of contamination away from respiratory tract
What is an ano-rectal malformation?
imperforate anus and fistula to vagina or scrotum classified as high or low (low easier to treat)
How are anorectal malformations surgically managed?
colostomy initially and pull through later
long term issue of continence
What are the differential diagnoses of a congenital neck cyst based on anatomical location?
thyroglossal duct cysts brachial cleft cysts dermoid cyst vascular malformations hemangiomas
How should a child with a head injury be assessed and investigated?
(long)
ABCDE
Is the child responsive/unresponsive?
Is the child breathing?
Then: Suspicion of non-accidental injury Post-traumatic injury Glasgow coma scale Suspected open or depressed skull fractures Sign of basal skull fracture Focal neuro signs Bruise or swelling in <1 year olds if YES --> CT
Then:
loss of consciousness >5 min
drowsiness
3 or more discrete episodes of vomiting
Dangerous mechanism of injury
Amnesia lasting >5 mins
if YES - admit and observe, CT if further concerns
What are the indications for admission and imaging in a head injury?
no symptoms/signs and benign mechanism of injury = discharge home with written advice
minor symptoms or dangerous mechanism of injury = monitor for evolution of symptoms
significant or progressive symptoms or signs - resuscitate (if necessary), CT scan, and neurosurgical referral if appropriate
What are the differentials for a solid tumour?
Sarcomas Carcinomas Neuroblastoma Wilms tumour Rhabdomyosarcoma Retinoblastoma Osteosarcoma and Ewing sarcoma
What is Wilms tumour?
originates form embryological renal tissue
uncommon after 10 years
presents with large abdominal mass and haematuria
What is neuroblastoma?
tumours arise from neural crest tissue in the adrenal medulla and sympathetic nervous system can be benign or highly malignant more common before the age of 5 can present with metastatic disease
What is a sacrococcygeal teratoma?
presents in the newbron, tumour is located at the base of tail bone
they are not ususally malignant
