Surgical Problems Flashcards
A 6 week old baby presents with vomiting which is typically projectile and occurs around 30 minutes after a feed. Examination shows a distended stomach. What is the likely diagnosis?
How should this be investigated?
How should this be treated?
What is the outcome?
How common is this?
Pyloric stenosis
Ultrasound scan
Pyloromyomectomy
Good, after surgery these babies will feed normally
Pretty common
A 6 month old child presents with vomiting for a few days and episodes where the legs are drawn up, which are followed by limpness. Some areas of the abdomen are firm, and there is a sausage shaped mass. What is the likely diagnosis?
What are some other features which may or may not be present?
Intussusception
May or may not have been passing stool, and there may have been blood in the nappy
How is intussusception investigated for?
What will this show?
How is it usually treated?
What is used if the above management fails? What is the risk of this?
Ultrasound scan
‘Target appearance’ or if viewed from the other angle, a kidney bean shape
Air insufflation up the rectum under radiological control
Surgical management - risk of perforation
What actually happens in intussusception?
Where does this usually occur?
Many children of the same age often develop what less serious condition? How can you tell this apart from intussusception?
There is ‘folding in’ of the bowel which causes swelling and hence obstruction
Usually where the small and large bowels meet, it travels through the bowel and can actually come out of the rectum
Simple colic - in intussusception, babies will be limp and pale
If a child is vomiting green stuff, what is the cause until proven otherwise?
What are some other conditions which can cause this?
Malrotation with volvulus
Jejunal atresia or meconium ileus
What is malrotation?
What is volvulus?
Which artery is involved?
When does this usually occur?
How should this be investigated for?
A congenital problem meaning that the bowel is not sitting in the right place in the abdomen
When the gut twists and cuts off its blood supply
Superior mesenteric artery (midgut)
The first 3-7 days of life
Upper GI contrast and follow through
Feeding intolerance, abdominal distension and bloody stools in a preterm baby is most likely to be what diagnosis?
When does this usually present?
How is it investigated for?
What can be seen on investigation?
Necrotising enterocolitis
The second week of life
Abdominal x-ray
Bubbles of gas in the bowel wall and dilated bowel loops
How is necrotising enterocolitis treated?
It is more common on which side of the bowel?
It can cause pneumoperitoneum - what is this?
Watch for a couple of days, if the bowel perforates then surgical management is required
Right side
A hole in the bowel has caused air to escape causing free air in the abdomen
At around day 3, a child presents with bilous vomiting but has been feeding okay. They have not passed stool, and have a distended bowel which feels doughey on examination. What is the most likely diagnosis?
How is this investigated for? What will it show?
This is associated with what condition? What investigation can be used to check for this?
Meconium ileus
Abdominal x-ray with contrast, a lumenal obstruction causing upstream to be dilated and downstream to be collapsed
CF - sweat test
A baby presents with vomiting which can be bilous 6-8 hours after the first feed. The baby is initially keen to feed, but keeps vomiting. As time goes on, the abdomen distends. What is the most likely diagnosis?
What causes this?
How should it be investigated for?
What will it show?
Jejunal atresia
Vascular insufficiency in utero
Abdominal x-ray
Distended bowel loops / laddering of bowel loops
How does a hernia present?
What is the risk of this?
How should it be investigated for?
What will it show?
Loop of bowel in the scrotum
Risk of perforation from being squeezed from the outside
Abdominal x-ray
Laddering of bowel loops
What is a baby’s first poo known as?
What colour should this be?
You would be worried if this hadn’t been passed by when?
Meconium
Black
The end of day 2
Give an example or examples of bowel obstruction being caused by each of the following:
Something in the lumen?
Something on the outside of the lumen?
Something in the wall of the lumen?
Meconium ileus
Malrotation, hernia
Jejunal atresia
