Flashcards in Common surgical problems Deck (17)
presentation of pyloric stenosis
recurrent projectile, non-bilious vomiting after feeding
general age of presentation of pyloric stenosis
3-6 weeks but may present later
investigation for pyloric stenosis
ultrasound scan, may have an upper abdominal mass
treatment of pyloric stenosis
IV fluids, pyloromyotomy
What is an intussusception?
one piece of bowel 'telescopes' inside another piece of bowel resulting in obstruction and possibly ischaemia
most common location for intussusception
common age of presentation for intussusception?
3months - 3years, majority before 1 year
Risk factors for intussusception
cystic fibrosis, intestinal mass i.e. polyp, lymphoma, meckels diverticulum
presentation of intussusception
colicky abdominal pain, sausage shaped mass which is palpable, *red currant jelly stools *, abdominal distention, shock, peritonitis
Diagnosis of intussusception
abdominal xray show dilated small bowel +/- the absence of gas in the large bowel
Treatment of intussusception
IV fluids, insufflation, surgery
What is insufflation?
air is pumped into the anus in an attempt to stretch the walls of the bowel and reduce the intussusception. Successful in 75% and is first line if no peritonitis
Patients who will always recieve surgery for intussusception first line?
those with peritonitis
What causes intestinal malrotation?
failure of the midgut mesentery to attach to the retroperitoneum and thus cause midgut volvulus or obstruction possibly leading to ischaemia (due to SMA obstruction)
Diagnostic factors for intestinal malrotation
bilious vomiting, abdominal pain, <1 year, passage of blood PR
Which sign is most concerning in intestinal malrotation?
passage of blood PR is a late sign and suggests necrosis which requires emergency surgical decompression