Surgical Paediatrics Flashcards
6 week old baby vomiting, mass in abdomen which fluctuates in size
What should you be thinking?
Pyloric stenosis
Projectile vomiting, soon after feeding, baby hungry, milky vomit. Very dehydrated, metabolically upset, thin, sunken fontanelle.
What should you be thinking?
Pyloric stenosis
How can you diagnose pyloric stenosis simply?
Make diagnosis with fingertips – feel something hard just to the left of the umbilicus – feel like an olive (feel with your left hand).
What imaging is used to diagnose pyloric stenosis?
USS – if you can see the pylorus, then it’s abnormal. 4mm and above is going high.
What should you think about before operating to correct pyloric stenosis?
Have to fix the metabolic upset before you operate – metabolic alkalosis, treat with fluid resuscitation.
What is the surgery for treatment of pyloric stenosis?
Make an incision deep into the pylorus, then spread it open – Ramstead pyloral myotomy. Can also do laparoscopically.
6 month old baby – vomiting for 2 days, temperature, seem to be in pain, abdominal mass (sausage shape). Pain comes in waves.
What should you be thinking?
Intussusception
Red current jelly in nappy
What is this a sign of?
Intussusception
Sign that the inside mucosal layer is sloughing off
What imaging is used in intusussception?
USS - target lesion
Bright bit is mucosa and dark bit is muscle
Treatment of intussusception?
Air enema reduction – put tube into bottom, blow up balloon, and pump air around the colon.
Child stooped holding onto abdomen
What should you be thinking?
Appendicitis
What can you ask to see if there is peritonitis?
What was their journey like to the hospital? “I had to slow down on the corners and bumps in the road” or “the bumps are really sore” – indicates peritonitis. You can also ask the child to jump – causes pain. Can use the jump test for safety netting.
What are the two types of pain in appendicitis?
Not just appendix which is inflamed – visceral pain, i.e. in the middle of their abdomen. Only when the peritoneum (parietal pain) gets inflamed does the pain become localized.
How can you diagnose appendicitis?
Diagnose with fingertips (USS to confirm) – on USS if you can see the appendix then it is inflamed.
Baby vomiting mossy green bile
What should you be thinking?
Malrotation
Which artery is commonly affected in malrotation?
Superior mesenteric artery
How do you investigate malrotation?
Do an upper GI contrast with follow through.
Top of testicle painful on prodding with pen
What should you be thinking?
Appendage on testicle - remnant of female embryology
Odematous, diffusely red scrotum
What should you be thinking?
Idiopathic scrotal oedema. May be allergic, not very sore, doesn’t need an operation.
Mucosa pouting on penis - treatment?
Use some steroid and ask the parents do dab the area with some tissue paper when he’s peed. Ask them to have a daily bath and stretch the area. Ask them to rub in steroid – will slightly loosen the collagen. Will get some opening of the foreskin.
Mucosa scarred on penis
Treatment?
Requires circumcision – may go into urethra and cause urethral stenosis.
What is parathenosis?
Foreskin is constricting the band, causing obstruction with oedema. Treatment – grab it and squeeze it really hard.
Hypospadias
- What is it?
- Treatment?
Birth abnormality of the urethra where the urinary opening is not at the usual location on the head of the penis
Doesn’t require circumcision – instead they require surgery to move the hole along the anterior surface of the penis – required use of the foreskin.
How can you exmaine for an undescended testicle?
If you take some soap and run it along the groin, then take your finger and feel along the inguinal canal – as you sweep down, you will feel the testicle flip under your finger. If you cannot feel the testicle, then you can do an operation to go and search – if not in the groin, then it will be in the abdomen. Testicle might be absent.
