Surgical Flashcards
What is appendicitis
Inflammation and infection of appendix
What can untreated appendicitis lead to
Peritonitis
Clinical features of appendicitis
Moderate fever Look unwell Vomiting Pain: Middle moving toward right iliac fossa
Rx for appendicitis
Analgesia
Appendectomy:
Laproscopically
Who is non-specific abdominal pain more common in boys or girls
Girls
Features of non-specific abdominal pain
Central pain Constant pain Not exacerbated by movement No GIT disturbance No temp
What is a very important cause of abdominal pain in children
Functional abdominal pain
Most common cause of mesenteric adenitis
Viral infections
What is there often a history of in mesenteric adenitis
URTI
What is mesenteric adentiis
Inflammation of mesenteric LN
Symptoms of mesenteric adenitis
High fever
Abdo. pain
Rx for mesenteric adenitis
Often self limiting
Analgesi
What is pyloric stenosis
Narrowing of the pylorus
RF for pyloric stenosis
Male
FH
4-16 wks old
Symptoms of pyloric stenosis
Vomiting: Projectile Occurs mins after feeding Olive mass in abdomen Multiple formula changes Decreased wet nappies Constipation Poor w.t gain Irritability Lethargy
Describe vomiting in pyloric stenosis
Projectile
Occurs mins after feeding
What can sometimes be felt on palpation in pyloric stenosis
Olive mass in abdomen
Is for pyloric stenosis
Test feed
USS
Rx for pyloric stenosis
IV fluids
Surgical:
Periumbilical pyloromyotomy
What is malrotation
Intestinal Malrotation is a term used to describe an entire spectrum of rotational and fixation disturbances that can occur during embryonic development
What is volvulus
Complication of Malrotation
Bowel twists -> blood supply is cut off
Clinical features of malrotation
Can be asymptomatic
Vomiting (may contain bile – green)
Crying
Pulling the legs into body
Passing little/no stool
What is the most common cause of intestinal obstruction in children
Intussusception
What is intussusception
Prolapse of one part of the intestine into the lumen of adjoining distal part
Typical picture of intussusception
9 months
M>F
Clinical features of intussusception
Intermittent colic:
Abdominal pain that comes and goes
‘Dying’ spells
Bilious vomiting
Bloody mucous in stools:
Redcurrant jelly stool
Characteristic stools in intussusception
Bloody mucous
Redcurrant jely
Ix for intussusception
USS abdo
X-ray
Diagnostic enema
Sign on x-ray seen in intussusception
Target sign
Rx for intussusception
Pneumostatic reduction by air enema
Laporotomy is that fails
RX for umbilical hernia
Low birth w.t Trisomy 21 Hypothyroidism African populations M
Appearance of umbilical hernia
Bulge at belly button
Usually more prominent when baby cries or strains
Ix for umbilical hernia
Clinical O/E
Rx for umbilical hernia
Leave alone until 4yrs and see for spontaneous closure
Repair if
Complicated
No closure by 4yrs
Large defect
How long should yo u leave an umbilical for
4yrs
Pathology of epigastric hernia
Defect in linea alba above the umbilicus
Protrusion of preperitoneal fat
Which gender is epigastric hernia more common in
Male
Clinical features of epigastric hernia
Mass in epigastrum
Commonly enlarges
Rx for epigastric hernia
Often leave alone
Sometimes surgery
What is gastroschisis
Abdominal wall defect
Intestines develop outside and are open to air when the child is born
RF for gastroschisis
Smoking in pregnancy
Alcohol in pregnancy
Maternal age <20yrs
In gastroschisis is there any membrane covering on the intestines
No
Ix for gastrochisis
Ofen Dx pre natal USS 2nd trimester
Rx for gastrochisis
Bowel protection
Primary/delated closure
TPN
Complications of gastrochisis
Short gut (as sometimes damaged bowels occur and need to be removed)
What is exomphalos
Abdominal wall defect Intestines remain inside the umbilical cord/membrane
But develop out with the abdomen
Is there a membrane covering on the intestines in exomphalos
Yes
Associated anomilies with exomphalos
Cardiac Chromosomal (trisomy 13,18,21) Renal Neurological Beckwith-Weidman Syndrome
Ix for exomphalos
Pre-natal USS
2nd trimester Dx in many cases
Rx for exomphalos
Bowel protection
Primary/delayed closure
