Week 2 - C - Common surgical problems in children Flashcards
What are the 3 main symptoms that could warrant a surgical emergency in children?
Abdominal pain
Vomiting
Acute scrotum
What is acute scrotum?
Acute scrotum is defined as an acute painful swelling of the scrotum or its contents accompanied by local signs and general symptoms.
What is the differential diagnosis of a 6-week-old child with milky vomit and bulges on their abdomen?
Pyloric stensois
What is pyloric stenosis and why is it milky vomit?
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
What is done to diagnose pyloric stenosis? Will the child have a metabolic acidosis or alkalosis?
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.
What is the treatment for pyloric stenosis? (nb. narrowing accours due to hypertrophy of pyloric muscle)
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.
What colour is bile vomit?
Bile vomit is green
Is bile coloured vomit a red flag in children?
YES
A baby with bile-coloured vomit is what condition until proven otherwise?
Intestinal malrotation
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
Intussuception
How is intestinal malrotation diagnosed?
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.
What bands may form obstructing the first part of the small intestine in intestinal malrotation?
Ladd’s bands
How is intesintal malrotation treated?
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.
What are the features of intussuception?
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)
What is the bowel described as on ultrasound in intussusception?
telescoping of the bowel
What is done to try to prevent surgery in intussuception?
Child is given an air enema
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?
Appendicitis
Where does appendicitis pain begin and where does it spread to? What is the most common point to find it?
Begins inn the umbilical region and spreads to the right iliac fossa
McBurney’s point (one third of the distance from asis to umbilicus)
What are some general symptoms of acute scrotum?
Redness
Swelling
Bruising
Pain
Abnormal position
What is the most common cause of acute scrotum?
Torsion of the Hydatid of Morgagni
What is the hydatid of margagni also known as? What is it a remnant of?
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
What is seen in the area of torsion in torsion of the appendix testis?
Pain is felt at the top of the testis often with a blue dot discolouration on the testis
What is the most common congenital defect of the penis? Causes pee to eject backwards due to abnormally placed external urethral orifice
Hypospadius
What is fluid accumulation around the testicle caused by?
Patent processus vaginalis
Condition is known as a hydrocele
What is the difference between a hydrocele and a inguinal scrotal hernia?
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
What test is done to detect undescended testis?
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.
