Abdominal Mass Flashcards
At what age do children present mostly with cystic mesoblastic nephroma
<6months
At what age do children present mostly with hepatoblastoma
6-18months
At what age do children present mostly with nephroblastoma
1-2years
At what age do children present mostly with rhabdomyosarcoma
3-5years
At what age do children present mostly with fibromellar hepatocellular carcinoma
Teenagers
Non-specific markers of increased cell turnover
LDH, Ferritin, uric acid
Which tumour markers are elevated in liver tumours
AFP, beta hCG
Which tumour markers are elevated in testicular tumoirs
AFP, LDH
Which tumour markers are elevated in adrenal neuroblastoma
Urinary catecholamines
What is the gold standard initial investigation of an abdominal mass in paeds
US
-tram track appearance of duplication cysts (hyperechoic mucosa outlining both sides of a muscularis wall) May be pathogmonic
What investigations would you do in a paeds presenting with abdo mass
US
AXR- obstruction eg worm bolus, air in GIT, calcification in teratoma or neuroblastoma, meconium pseudocyst, renal stones or biliary stones
MRI-further anatomical definition of mass to plan for respectability
CT Scan- ionisation radiation is avoided in children and where MRI is available do it instead, CT is used to assess pulmonary metastasis disease however
Biopsy after radiological definition of mass, often Us guided. Fine needle aspiration, truculent/core needle or open laparoscopic assisted surgical biopsy
List the different types of cryptochidism
True
-Abdominal
-Inguinal
-Suprascrotal
Ectopic
-prepenile
-superficial ectopic
-transverse scrotal
-femoral
-perineal
Discuss management of cryptochidism
-not an emergency unless torted/ tender
-some descent may still take place in first 3 months
-when baby is 6 months, refer for surgery: Orchidopexy
-patients with rectractile testes can be reassured, should be assessed in 1 year
-Retractile testis: No surgery is needed, monitor annually.
-Canalicular testis: Exploration and open orchidopexy via a groin incision. After removal of the hernial sac, the testis is delivered into the scrotum and anchored in a sub-dartos pouch.
-Non palpable testis:Laparoscopy is the procedure of choice.
Complications of cryptochidism correction
Bkeeding
Infection
Infertility
Tumourgenesis (orchidopexy does not alter the risk of malignant transformation)
Seminoma is the most common
Most common type of testicular tumours (as seen in cryptochidism)
Seminoma
