Surgical Flashcards
Three differentials for acute abdominal pain in child
- Non specific (e.g. anxiety)
- Appendicitis
- Viral/ gastroenteritis
- Constipation
What investigation must you always perform in child with abdo pain?
urinalysis
Why must you examine ENT in child with abdominal pain?
ENT infection can be a source for mesenteric adenitis
What is mesenteric adenitis?
Mesenteric adenitis is a syndrome characterized by right lower quadrant pain secondary to an inflammatory condition of mesenteric lymph nodes.
Two organisms associated with mesenteric adenitis?
E.coli
Salmonella
Streptococci
How to demonstrate whether child has peritonism when assessing/examining?
ask patient to blow up tummy like a balloon
Which system must you always examine in male child with abdominal pain?
testicular
Name two medical differentials for abdominal pain
UTI
Basal pneumonia
Gastro/viral
How long to wait before taking bloods in patient with suspected appendicitis?
8 hours. If taken before then no abnormalities will be found ..?
Why can appendicitis mimic UTI symptoms and findings on urinalysis?
due to proximity of right ureter and appendix, leading to painful urination and blood + WCC in urine
How can you distinguish between mesenteric adenitis and appendicitis?
temperature +- vomiting comes first in mesenteric adenitis, then abdo pain
abdo pain is the first symptom in appendicitis
First imaging investigation for appendicitis? Name two signs that indicate appendicitis
USS
Fluid, increased size
Compressibility?
Name three more uncommon differentials for acute abdominal pain in a child
testicular torsion
meckel’s diverticulum
basal pneumonia
malrotation of bowel
mittleschmertz
What is mittleschmertz?
ovulation pain
Name two causes of vomiting in baby?
overfeeding
small bowel obstruction
viral illness
Is weight loss normal in a baby?
normal the first week to lose weight, however this period it would be concerning
For which condition is there a separate growth chart?
down’s syndrome
What does green vomit indicate in a newborn?
bilious vomiting- bowel obstruction
What is the management of newborn with bilious vomiting?
always needs surgical review
Three differentials for vomiting in baby?
reflux, Hirschprung’s, food intolerance
Which electrolyte disorder can pyloric stenosis cause?
metabolic alkalosis
What is the cause of metabolic alkalosis in pyloric stenosis?
Decreased potassium and chloride due to vomiting
Why is family history important in pyloric stenosis?
strong FH link, therefore ask if any parent had pyloric stenosis/surgery as a child
Three differentials for bilious vomiting?
sepsis, malrotation, ischaemic bowel
2 day old infant present to GP with one episode of dark green vomit. He was born at term and there were no antenatal issues. He handles well on examination.
What is the most appropriate next step?
Refer to paeds surgical team
Bilious vomiting in a baby is always serious. This early in life duodenal atresia is a significant diagnosis that must be excluded.
A 1-week-old infant is referred following episodes of vomiting, feeding intolerance , and abdominal distension. Examination reveals watery stools with specks of blood present within the nappy. An abdominal X-ray is requested which reveals gas cysts in the bowel wall. What is the most likely diagnosis?
Necrotising enterocolitis
Two signs of necrotising enterocolitis on AXR?
dilated bowel loops (often asymmetrical in distribution)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
pneumoperitoneum resulting from perforation
air both inside and outside of the bowel wall (Rigler sign)
A 6-week old baby has been brought in to the hospital. Her Dad is worried because she has had problems retaining feeds. He says that soon after being fed she vomits up uncurdled milk quite forcefully. He is worried because she does not appear to be gaining weight. Given the likely diagnosis, which metabolic abnormality would the patient most likely present with?
Hypochloraemic hypokalaemic metabolic alkalosis
The most likely diagnosis here is pyloric stenosis. Due to vomiting up stomach contents which is acidic (hydrogen chloride - HCl), the patient will be hypochloraemic. Potassium is also lost in the vomitus.
The loss of hydrogen ions due to the vomiting up of stomach acid is the cause of the metabolic alkalosis.
Difference between atresia and stenosis?
atresia is worse- complete blockage
stenosis= narrowing
