Surgical emergencies Flashcards
Differential for projectile vomiting
Pyloric stenosis Overfeeding Gastroenteritis Sepsis Reflux
Investigations for pyloric stenosis
Can palpate thickened pylorus (feels cartilaginous) slightly to the right of the midline in the epigastric region
USS to assess length and thickness of pylorus
Management of pyloric stenosis
Cannulate
Fluids to correct dehydration
Monitor electrolytes
Laparoscopic ramstedt procedure once rehydrated and blood gases are normal
What metabolic abnormality can be seen in pyloric stenosis
Hypokalaemic hypochloraemic metabolic alkalosis
Alternative to surgery for definitive treatment of pyloric stenosis
Atropine sulphate via NG tube for 4-6 weeks
What is intersussception
Invagination of one part of the bowel into the lumen of another part of the bowel
Causing bowel obstruction
Investigation for bowel intersussception
USS to confirm
Management of intersussception
Fluid resuscitation
Air enema reduction up to 120mmHg
If bowel perforated give oxygen and morphine, put cannula in abdomen and take to theatre to fix perforation and PUSH out invaginated bowel
If fails take to theatre to PUSH out invaginated bowel
Cause of bilious vomiting in a neonate
Malrotation of bowel
Management of malrotation
Theatre within 1 hour to relieve obstruction
Complications of malrotation
Necrotic midgut - need long term TPN while waiting for a bowel transplant
Management of hydatid of morgagni
Emergency operation - reduction and bilateral orchidopexy
If already necrotic - remove and contralateral orchidopexy
What is hydatid of margagni
Torsion of testicular appendix (remnant of Müllerian duct)
Clinical signs of hydatid of morgagni
Tender testis
Blue dot sign
History of pyloric stenosis
In neonates Following feeds Immediately hungry again after vomit Non bilious True projectile vomit Strong FH history Weight loss
