Week 3 - A - Common surgical problems 2.0

Question 1

What are the three potential surgical emergencies in a child?

Answer 1

Vomiting child

Abdominal pain in child

Acute scrotum

Question 2

What is the most usual cause of a child with gastroenteritis?

Answer 2

Viral - usually rotavirus

Question 3

What are the symptoms of rotavirus? What age group of child is it common in?

Answer 3

Diarrhoea, vomiting, fever and abdominal pain

Usually up to 3 years of age

Question 4

What is the treatment of rotavirus in children?

Answer 4

Treat with oral rehydration (ORS - oral rehydration solution)

Question 5

What is the WHO recipe for Oral rehydration solution? What week is the vaccine for rotavirus given on?

Answer 5

Recipe - 1litre water, 1/2tsp salt and 6 teaspoons of sugar

Vaccine is given at 8 and 12weeks of child development (2 and 3 months)

Question 6

6 week old baby, projectile vomiting and is noticeably eager for food, what is the diagnosis?

Answer 6

Pyloric stenosis

Question 7

What is the term used to describe the mass at the upper right quadrant of the abdomen in pyloric stenosis?

Answer 7

Olive size mass

Question 8

What is the treatment of pyloric stenosis?

Answer 8

Treat with Ramstedt’s pylormyotomy- cuts away hypertrophied muscle

Question 9

What is usually carried out to diagnose pyloric stenosis? Is the child usually metabolic alkalotic or acidotic?

Answer 9

Ultrasound

Child is usually metabolic alkalotic

Question 10

6 hour old baby with green vomit - usually non projectile What is the cause of this and what can it lead to?

Answer 10

This is midgut malrotation

Can cause volvulus

Question 11

What are bands that can form in malrotation and what is the treatment of the bands?

Answer 11

Ladd’s bands can form - treat with 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 12

6 months old baby, vomiting, temperature, not very well, pain comes in waves What is this?

Answer 12

Intussuception

Question 13

Description of the tummy is there is a sasuage shaped mass in intussucetion, where is the mass?

What is the contents on the nappy described as?

Answer 13

The mass is in the right upper quadrant of the child

Red jelly current in the nappy on intussusception

Question 14

How is the bowel descibed for intussusception on ultrasound and what is treatment of this? (try to avoid surgery)

Answer 14

Telescoping of the bowel on US

Treat with air enema to avoid surgery

Question 15

Young child, presents with pain in the right iliac fossa, hurts when going up and down bumps on roads, what is this?

Answer 15

This is appendicits

Question 16

Where does appendicits usually begin and what is the most common point known as?

Answer 16

Usually begins in the umbilicus and spreads to right iliac fossa

Pain is most commonly felt in McBurney’s point (1/3rd from ASIS to umbilicus)

Question 17

most common cause of acute testicle in boy, what is this?

Answer 17

Torsion of the appendix testis - aka the Hydatid or Morgagni

Question 18

What is the Hydatid of Morgagni a remnant of? What colour can it cause on the testis?

Answer 18

Remnant of the mullerian duct (female structure)

Can cause a blue dot discolouration of the testis

Question 19

Another cause – testicular torsion – testicle has twisted around (spermatic cord is twisted). What can this cause if untreated?

Answer 19

Can cause prolonged ischaemia to testis and therefore necrosis

Question 20

How do you differentiate between scrotal hernia and hydrocele? What causes a hydrocele?

Answer 20

Shine a light on the testis - hydrocele is transilluminable

Caused due to a patent processus vaginalis

Question 21

Slightly older boys. Affects foreskin and glans – atrophic white patches appear on affected area and a white-ish ring of indurated (hardened) tissue (sclerosis) usually forms near tip that may prevent retraction. Regarded as identical to lichen sclerosus of the penis What is the other name for lichen sclerosus of the penis?

Answer 21

This is balantis xerotica obliterans

Question 22

Birth defect of the urethra in male where the urinary opening is not at the usual location on the head of the penis. May cause boy to urinate backwards. So meatus (opening) can be on underside of penis. What is this?

Answer 22

This is hypsospadius

Question 23

Describe balantis xerotica obliterans?

Answer 23

Atrophic white patches on foreskin and glans of penis and a ring of hardened tissue that can prevent retraction of foreskin

Question 24

Red, inflamed looking scrotum. Not sore but often Itchy. Redness extends downwards and upwards into groin/unguinal area too. Doesn’t require operation. Self-limiting What is this?

Answer 24

idiopathic scrotal oedema

Question 25

Treatment for idopathic scrotal oedema?

Answer 25

Analgesics

Question 26

a condition where the foreskin is too tight to be pulled back over the head of the penis (glans). What is this?

Answer 26

Phimosis

Question 27

How is phimosis treated?

Answer 27

Strectch foreskin daily in the bath and apply topical steroids for 3 months - steroids thin the skin to allow the foreskin to go over the penis

Question 28

Paraphimosis is where the foreskin is stuck behind the glands. What is the required treatment?

Answer 28

Squeeze the glans of the penis ASAP and the foreskin should return to normal position.

Try for at least 1 minute.

Can use lidocaine as analgesia

Analgesics may be required

Question 29

In cases of phimosis (foreskin unable to be retracted) and paraphimosis (foreskin stuck behind the glans), what may be required as treatment if the initial treatment steps do not work? * phimosis - stretch foreskin daily in bath and apply topical steroids for 3 months * paraphimosis - squeeze glans of penis to allow glans to retract

Answer 29

Preputial surgery may be required (surgery to the prepuce) - ie circumcision