Week 3 - A - Common surgical problems 2.0 Flashcards
What are the three potential surgical emergencies in a child?
Vomiting child
Abdominal pain in child
Acute scrotum
What is the most usual cause of a child with gastroenteritis?
Viral - usually rotavirus
What are the symptoms of rotavirus? What age group of child is it common in?
Diarrhoea, vomiting, fever and abdominal pain
Usually up to 3 years of age
What is the treatment of rotavirus in children?
Treat with oral rehydration (ORS - oral rehydration solution)
What is the WHO recipe for Oral rehydration solution? What week is the vaccine for rotavirus given on?
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)
6 week old baby, projectile vomiting and is noticeably eager for food, what is the diagnosis?
Pyloric stenosis
What is the term used to describe the mass at the upper right quadrant of the abdomen in pyloric stenosis?
Olive size mass
What is the treatment of pyloric stenosis?
Treat with Ramstedt’s pylormyotomy- cuts away hypertrophied muscle
What is usually carried out to diagnose pyloric stenosis? Is the child usually metabolic alkalotic or acidotic?
Ultrasound
Child is usually metabolic alkalotic
6 hour old baby with green vomit - usually non projectile What is the cause of this and what can it lead to?
This is midgut malrotation
Can cause volvulus
What are bands that can form in malrotation and what is the treatment of the bands?
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
6 months old baby, vomiting, temperature, not very well, pain comes in waves What is this?
Intussuception
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?
The mass is in the right upper quadrant of the child
Red jelly current in the nappy on intussusception
How is the bowel descibed for intussusception on ultrasound and what is treatment of this? (try to avoid surgery)
Telescoping of the bowel on US
Treat with air enema to avoid surgery
Young child, presents with pain in the right iliac fossa, hurts when going up and down bumps on roads, what is this?
This is appendicits
Where does appendicits usually begin and what is the most common point known as?
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)
most common cause of acute testicle in boy, what is this?
Torsion of the appendix testis - aka the Hydatid or Morgagni
What is the Hydatid of Morgagni a remnant of? What colour can it cause on the testis?
Remnant of the mullerian duct (female structure)
Can cause a blue dot discolouration of the testis
Another cause – testicular torsion – testicle has twisted around (spermatic cord is twisted). What can this cause if untreated?
Can cause prolonged ischaemia to testis and therefore necrosis
How do you differentiate between scrotal hernia and hydrocele? What causes a hydrocele?
Shine a light on the testis - hydrocele is transilluminable
Caused due to a patent processus vaginalis
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?
This is balantis xerotica obliterans
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?
This is hypsospadius
Describe balantis xerotica obliterans?
Atrophic white patches on foreskin and glans of penis and a ring of hardened tissue that can prevent retraction of foreskin
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?
idiopathic scrotal oedema
Treatment for idopathic scrotal oedema?
Analgesics
a condition where the foreskin is too tight to be pulled back over the head of the penis (glans). What is this?
Phimosis
How is phimosis treated?
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
Paraphimosis is where the foreskin is stuck behind the glands. What is the required treatment?
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
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
Preputial surgery may be required (surgery to the prepuce) - ie circumcision
