Week 2 - C - Common surgical problems in children

Question 1

What are the 3 main symptoms that could warrant a surgical emergency in children?

Answer 1

Abdominal pain

Vomiting

Acute scrotum

Question 2

What is acute scrotum?

Answer 2

Acute scrotum is defined as an acute painful swelling of the scrotum or its contents accompanied by local signs and general symptoms.

Question 3

What is the differential diagnosis of a 6-week-old child with milky vomit and bulges on their abdomen?

Answer 3

Pyloric stensois

Question 4

What is pyloric stenosis and why is it milky vomit?

Answer 4

Pyloric stenosis is when the passage between the stomach and small bowel (pylorus) becomes narrower

When feeding with milk, the child may bring this up

Question 5

What is done to diagnose pyloric stenosis? Will the child have a metabolic acidosis or alkalosis?

Answer 5

Ultrasound

Will have a metabolic alkalosis

* The cardinal findings in pyloric stenosis are dehydration, metabolic alkalosis, hypochloremia, and hypokalaemia.

* Loss of gastric fluid leads to volume depletion and loss of sodium, chloride, acid (H+) and potassium. This results in a hypokalemic, hypochloremic metabolic alkalosis.

Question 6

What is the treatment for pyloric stenosis? (nb. narrowing accours due to hypertrophy of pyloric muscle)

Answer 6

A surgical procedure called pyloromyotomy, which involves cutting through the thickened muscles of the pylorus, is performed to relieve the blockage that results from pyloric stenosis also known as ramstedt’s pyloromyotomy.

Question 7

What colour is bile vomit?

Answer 7

Bile vomit is green

Question 8

Is bile coloured vomit a red flag in children?

Answer 8

YES

Question 9

A baby with bile-coloured vomit is what condition until proven otherwise?

Answer 9

Intestinal malrotation

Question 10

What is the most common abdominal emergency affecting children under 2 years old. It happens when one portion of the bowel slides into the next, much like the pieces of a telescope.? Can cause obstruction of the bowel

Answer 10

Intussuception

Question 11

How is intestinal malrotation diagnosed?

Answer 11

Upper GI contrast with follow through

• An upper GI contrast (series) is an imaging study that enables us to assess the contours and position of your child’s esophagus, stomach, and duodenum
• A small bowel follow through is an imaging study that enables us to assess the jejunum and ileum, the second and third sections of the small intestine.

Both the upper GI series and small bowel follow through are fluoroscopy exams. This type of X-ray imaging enables us to capture a real-time, moving image of your child swallowing and digesting, much like an X-ray movie.

Question 12

What bands may form obstructing the first part of the small intestine in intestinal malrotation?

Answer 12

Ladd’s bands

Question 13

How is intesintal malrotation treated?

Answer 13

A surgical procedure called Ladd’s procedure - the intestine is straightened out, the Ladd’s bands are divided, the small intestine is folded into the right side of the abdomen, and the colon is placed on the left side.

Question 14

What are the features of intussuception?

Answer 14

It is the most common cause of intestinal obstruction in children usually occurring less than 2 years old

Child may present with Episodic intermittent inconsolable crying with drawing of the legs up vomiting and temperature

bloodstained stool - ‘red-currant jelly’ - is a late sign

sausage-shaped abdominal mass may be palpated (right side, often in RUQ)

Question 15

What is the bowel described as on ultrasound in intussusception?

Answer 15

telescoping of the bowel

Question 16

What is done to try to prevent surgery in intussuception?

Answer 16

Child is given an air enema

Question 17

A 6-year-old boy complains of abdominal pain and “not liking the bumps en route to hospital”. He is reluctant to stand up. What is top of your differential list?

Answer 17

Appendicitis

Question 18

Where does appendicitis pain begin and where does it spread to? What is the most common point to find it?

Answer 18

Begins inn the umbilical region and spreads to the right iliac fossa

McBurney’s point (one third of the distance from asis to umbilicus)

Question 19

What are some general symptoms of acute scrotum?

Answer 19

Redness

Swelling

Bruising

Pain

Abnormal position

Question 20

What is the most common cause of acute scrotum?

Answer 20

Torsion of the Hydatid of Morgagni

Question 21

What is the hydatid of margagni also known as? What is it a remnant of?

Answer 21

Also known as the appendix testis

The appendix testis (or hydatid of Morgagni) is a vestigial remnant of the Müllerian duct (aka paramesonephic duct) which forms the female reproductive tract

Question 22

What is seen in the area of torsion in torsion of the appendix testis?

Answer 22

Pain is felt at the top of the testis often with a blue dot discolouration on the testis

Question 23

What is the most common congenital defect of the penis? Causes pee to eject backwards due to abnormally placed external urethral orifice

Answer 23

Hypospadius

Question 24

What is fluid accumulation around the testicle caused by?

Answer 24

Patent processus vaginalis

Condition is known as a hydrocele

Question 25

What is the difference between a hydrocele and a inguinal scrotal hernia?

Answer 25

Hydrocele is due to accumulation of fluid due to a patent processus vaginalis

Hernia is due to loop of bowel going down into the scrotum

Question 26

What test is done to detect undescended testis?

Answer 26

Soap test

Place soap between ASIS and pubic tubercle and slide thumb along line to palpate the testicle: if palpable surgery is performed, if not palpable laparoscopic procedure is performed to locate the testicle

If the testis is non-palpable, a “soap test” is often useful; soap applied to the inguinal canal and hand significantly reduces friction and facilitates identification of inguinal testis.