Surgical Conditions Flashcards
What is Balanitis Xerotica Obliterans?
Keratinisation of the Foreskin leads to scarring and a non-retractile prepuce.
What are some features of Balanitis Xerotica Obliterans?
Ballooning of Foreskin with Micturition
Urethral Scarring - Irritation, Dysuria, Haematuria, Local infection
What is seen on examination of BXO?
White, Fibrotic Foreskin
What is the management of BXO?
Circumcision and Histopathology
What are some potential complications of BXO treatment?
Surgical complications - Bleeding, infection, post-op swelling
Meatal stenosis
Phimosis
Glans/prepuce erosions
What is Hypospadias?
Congenital defect leaving the urethral meatus located elsewhere than the end of the penis
What are some features of Hypospadias?
Ventral opening for Urethral Meatus
Ventral Curvature of the Penis
Dorsal Hooded Foreskin
What could Hypospadias also be suggestive of, and how should this be managed?
Disorder of Sex development if also combined with Cryptorchidism. Investigate through Karyotype and Pelvic USS
How is Hypospadias treated?
Urethroplasty
What are some short-term complications of Hypospadias treatment?
Blockage of catheter
Pain and Bladder Spasms
Bleeding
Infection
What are some long-term complications associated with treatment of Hypospadias?
Urethral fistula
Meatal/Urethral Stenosis
What is Cryptorchidism?
Absence of 1/both testicles in the scrotum due to failure to descend
In Cryptorchidism, where can the missing testicle be found?
True Undescended - Lies along the line of descent
Ectopic - Found elsewhere within the abdomen
Ascending - Found initially within scrotum, then ascends
What are some risk factors for Cryptorchidism?
Prematurity
Low birth weight
Other genital abnormalities
FHx in a first degree relative
At what age does Cryptorchidism warrant investigation/management?
3m - Refer to surgeons for open orchidopexy or laparoscopy
What are some complications associated with Cryptorchidism?
Impaired fertility
Testicular cancer
Testicular torsion
What is Hirschprung’s Disease?
A congenital disease where ganglionic cells don’t develop in large intestine
Which types of Hirschprung’s disease are there?
Short Segment
Long Segment
Total
What are some risk factors for Hirschprung’s disease?
Male
Chromosomal Abnormalities - T21
FHx
What are some symptoms suggestive of Hirschprung’s disease?
Failure to pass Meconium in 48h Abdominal distension Bilious Vomiting Palpable mass Empty Rectum
Which investigations are appropriate for suspected Hirschprung’s disease?
AXR
Contrast Enema
Rectal Suction biopsy
How should confirmed Hirschprung’s disease be managed?
IV Abx
NG Bowel Decompression
Surgical resection of the affected area
What are possible complications of Hirschprung’s disease?
Hirschprung Associated Enterocolitis - Due to bacterial overgrowth
Surgical complications - Bleeding, infection, wound dehiscence.
What is Intusussception?
Telescoping of one aspect of bowel into another
What are some causes of Intusussception?
Idiopathic Meckel Diverticulum Polyps Henoch-Schoenline Purpura Lymphoma Post-operative
What are some symptoms of Intusussception?
Uncontrollable Crying
Pallor
Knees drawn to chest
Red Current Stools - Pathognonomic
Which investigation is recommended for suspected Intusussception, and what will it demonstrate?
Abdominal USS - Doughnut on transverse plane
What are potential management options for intusussception?
Non-surgical reduction via air enema
Surgical reduction
If untreated, what are some complications of intusussception?
Obstruction
Perforation
Dehydration
Shock
What is Pyloric Stenosis?
Progressive hypertrophy of pyloric muscle leading to gastric outlet obstruction
What are some risk factors for Pyloric Stenosis?
Male
FHx
How does Pyloric Stenosis present?
4-6w history of Forceful Non-Bilious Projectile Vomiting after every feed
Still hungry after feeds
W/loss and dehydration
What may be apparent on examination of Pyloric Stenosis?
Visible waves of peristalsis
Olive-sized pyloric mass when feeding
What investigations are appropriate for suspected Pyloric Stenosis?
Test Feed with NGT
USS - Pyloric Muscle Hypertrophy
ABG - Hypokalaemic Hypochloraemic Metabolic Alkalosis
What is the recommended management for confirmed Pyloric Stenosis?
NG Feed, Hydrate at 150ml/kg/day
Which surgical procedure is the definitive management of Pyloric Stenosis?
Ramsteadt’s Pyloromyotomy
When after surgical correction of Pyloric Stenosis can the baby feed, and which advice should be given to the relatives?
6h, post-operative vomiting is common
What are some pre-operative complications of Pyloric Stenosis?
Hypovolaemia
Apnoea
What are some post-operative complications of Pyloric Stenosis?
Bleeding
Infection
