Surgery - pyloric stenosis, lymphadenopathy, head injury, solid tumours Flashcards
What are the clinical features of pyloric stenosis. (including epidemiology)
Due to hypertrophy of pyloric muscle.
Boys:girls = 4:1
There may be family history
Projectile vomiting in first few weeks of life (2-7 weeks)
Hunger after vomiting - until there is dehydration
Weight loss if delayed
Vomiting can result in hypochloric metabolic alkalosis (with hyponatraemia and hypokalaemia)
How is pyloric stenosis diagnosed
Test feed (milk)
Gastric peristalsis may be seen as a wave moving from left to right.
Pyloric mass (feels like olive) usually palpable in RUQ
If doubt, US is helpful
How is pyloric stenosis managed?
Correct fluids and electrolytes (with 0.45% saline and 5% dextrose with Potassium supplement)
Once corrected, pyloromyotomy can be performed
What are the differentials of cervical lymphadenopathy in children?
Infectious: EBV, CMV
rubella
Aadenovirus, enterovirus (viral URTI)
Bacterial lymphadenitis - staph, strep,
TB Kawasaki disease (unilateral >1.5 cm)
Toxoplasmosis
Granulomatous disease:
Sarcoidosis
Hyper IGM syndrome
Neoplastic disease:
Most common >6 years:
Non-Hodgkin lymphoma ()
Hodgkin’s lymphoma
Most common in <6 year olds:
Acute lymphoblastic leukaemia
Acute myeloid leukaemia
Rhabdomyosarcoma
Neuroblastoma
Also non-Hodgkins
What investigations are indicated in cervical lymphadenopathy?
FBC
ESR
Monospot for EBV, CMV, toxoplasmosis
TB skin test
Anti-HIV test
Hepatic and renal function + urinalysis (systemic disease)
Lactate dehydrogenase, uric acid, calcium, phosphate, Mg if malignancy suspected
Bone marrow
Liver biopsy
CT or US guided LN biopsy
What are the causes of suppurative lymphadenitis?
Can be a consequence of strep pharyngitis
Staphylococcus aureus Strep pyogenes Yersinia Bartonella henselae TB Lymphogranuloma venerum
What is suppurative lymphadenitis?
Invasion of LN by neutrophils, resulting in rapid swelling, capsular distension, edema, and eventual tissue necrosis.
There may be erythema
Which investigations may be indicated in lymphadenitis > 2 weeks?
FBC/ESR Blood culture/ film Serology - EBV, CMV, (monospot) HIV, toxoplasmosis Tuberculin test CXR Excision biopsy
What are indications for admission and CT scan in a head injury? (need for spinal imaging?)
Loss of consciousness >5min Abnormal drowsiness 3 or more episodes of vomiting Clinical suspicion of NAI Post-traumatic seizure without history of epilepsy GCS <15 (<14 if <1 year old)
Signs of basilar skull fracture (CSF leak from nose/ears, panda eyes, blood behind tympanic membrane)
<1 year old and bruise/swelling >5cm on head
Dangerous mechanism of accident (eg. high-speed road traffic accident)
Outline the evaluation of a child with head injury?
Always admit for 4-6 hours to observe any change in behavior.
ABCDE
Neuro exam.
Inspect for signs of basilar skull fracture (raccoon eyes, CSF leak from ear/nose, blood behind tympanic membrane)
What secondary damage can be caused by head injuries? (may need to know)
Airway obstruction leading to hypoxia.
Hypo or hyperglycaemia.
Reduced cerebral perfusion due to raised ICP or hypotension from bleeding.
Haematoma: extradural, subdural, intracranian
Infection from open wound
What is Wilm’s tumour
From embryonal renal tissue.
Commonest renal tumour of childhood.
80% present < 5 year old.
Large abdominal mass.
Otherwise usually well, but can have pain. anorexia, haematuria, HTN
80% cured
What is a neuroblastoma
Arise from adrenal medulla and sympathetic NS.
Most common < 5 years old.
Spectrum from benign (ganglioneuroma) to malignant (neuroblastoma)
Abdominal mass or along sympathetic chain.
Metastatic disease - bone pain
What is a sacrococcygeal teratoma
In Fetus/Infant.
On coccyx.
Usually BENIGN.
Can grow quite large. This can lead to polyhydramnios.
Usually presents before 5 months. The later, the higher the chance of malignancy.
