What are common presentations requiring paediatric surgery?
Vomiting child
Acute abdomen
Acute scrotum
What factor influences the presentations you see in paediatrics?
Age
When does pyloric stenosis usually occur?
around 6 weeks
What happens in pyloric stenosis?
pyloric stenosis causes OBSTRUCTION and abdominal muscle contracts trying to push it into duodenum
What is the result of pyloric stenosis?
abdominal mass, vomiting after eating/drinking
what happens histologically in pyloric stenosis?
abdominal muscle hypertrophies around pyloric stenosis and can be measured on ultrasound
what causes the stenosis of pyloric stenosis?
hypertrophied circular muscle layer of stomach
what is the surgical treatment for pyloric stenosis?
pyloromyotomy
what age does intusseption occur usually?
around 6 months
describe the symptoms of intussuseption
abdominal pain (pulling legs up) > limpness
pale
struggling to pass stool (which is bloody)
what does the abdominal mass look like in intussuseption?
hard "sausage-shaped"
"Target sign" (kidney bean laterally) on ultrasound - layers of bowel on top of one another
what differentiates intussuseption from colic?
paleness, in colic they're pink
where does intussuseption occur?
Occurs around iliocaecal junction and travels along large bowel
how is intussuseption treated?
air enema
Explanation of intussceception
bowel is "telescoping" on itself, swelling, then obstructing
what age do children suffer from appendicitis?
6 years and older
what type of pain is associated with appendicitis?
peritonitis
symptoms and signs of appendicitis
hand on abdomen
bent over in pain
cant jump and pain on movement (ask about journey)
low grade fever
what can happen in a viral infection if a viruse is swallowed and accumulates at appendix?
mesenteric lymphadenitis
symptoms and signs of mesenteric lymphadenitis
right inguinal pain like in appendicitis but they can jump!
kids may describe their pain as abdominal and then have pneumonia
important question to ask kids with abdominal pain
can they pee normally?
what colour is bile when nenonates vomit it?
green due to the digestion by stomach acid
what happens in malrotation?
duodenum and caecum aren't fixed in normal places
allows rotation of large bowel around duodenum (where the bile duct enters)
so bile can enter the stomach and be vomited up
(also the blood supply is cut off and bowel starts to die off due to ischaemia)
what to assume in a newborn vomiting bile (green)
MALROTATION
what are the 3 things that most commonly cause acute scrotum in children?
testicular torsion
epidifymitis
mullerian duct remnants
what happens in mullerian duct remnants?
blue dot and less pain than torsion
what are the symptoms of idiopathic scrotal oedema?
red, swollen, itchy scrotum, rash on groin and perineum
is closed foreskin normal?
yes it can be
what is the diagnosis which requires circumcision?
BXO
what to do if swelling is ridiculous
squeeze it
