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Flashcards in Common Surgical Problems Deck (27)
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1
Q

6 week old baby
projectile vomiting of milk after feed
no wet nappies
large lumps in abdomen

A

pyloric stenosis

lumps are just the waves of peristalsis in the stomach pushing against the closed pyloric sphinctor

2
Q

why is pyloric stenosis common at 6 weeks?

A

pyloric muscle thickens and can cause a physical obstruction

3
Q

how is pyloric stenosis managed surgically?

A

pyloromyotomy

4
Q

stereotypical presentation of pyloric stenosis?

A

6 weeks old

projectile vomiting milk

5
Q
6 months old
vomiting - began with food, then yellow, then green
not been very well for a few days
lumps in the lower abdomen
- sausage like mass in the abdomen
blood in the nappy (red currant jelly)
A

intussusception

can cause child to become very sick very quickly so need quick diagnosis

6
Q

US image of intussusception?

A

target like appearance on cross section

kidney like appearance from side on view

7
Q

description of intussusception?

A

where part of the tubing of the bowel telescopes into another causing a blockage

8
Q

how is intussusception managed?

A

radiologically
child is fully resuscitated and then air is blown into the bowel via rectum
air travels backwards around large bowel and pushes intussuscepted bowel back out
works in most
surgery used is unsuccessful

9
Q

6 years old
tummy pain
vomiting
journey to hospital - didn’t like the bumps on the road

A

peritonitis due to appendicitis

10
Q

investigation of the 6 year old child with abdominal pain?

A

get them up and out of bed - ask if they can jump
- can distinguish whether peritonitis is present
US - if you can see the appendix then its probably inflamed

11
Q

features of peritonitis in children?

A

cant jump
mild temperature
severe abdominal pain
vomiting

12
Q

baby

vomiting green

A

could me malrotation with volvulus

medical emergency

13
Q

what diagnosis must be excluded in a child which is vomiting green and how can this be done?

A

malrotation
clarify with parent whether vomit it yellow or green (often range of colours called “green”)
babies with malrotation vomit green due to obstruction just after where bile enters small bowel

14
Q

what is the largest distance across the abdomen and what 2 points is this between?
what is the significance of this?

A

two fixed points between splenic flexure to beginning of ascending colon
supply to midgut (from superior mesenteric) is between these 2 points
gut hangs from these two fixed points
if these 2 fixed points are not in the right place and the distance between them is small, then all the blood supply comes between them and rest of mid-gut can be deprived of blood
the rest of the gut hanging from these two points can also become twisted if hanging from these 2 close fixed points
= malrotation

15
Q

what are the risks of malrotation?

A

ischaemic bowel/death of bowel

16
Q

main causes of acute scrotum?

A

testicular torsion - can cause ischaemia and death of the testical
infection/inflammation of the testicle (e.g inflamed epididymis)
torsion of the hydatid? - black dot on top of the testicle - must be removed

17
Q

what is the most common acute scrotum presentation?

A

torsion of the hydatid

18
Q

what is the (hydatid?)

A

remnants of the females parts

19
Q

inflammation of scrotum spreading down over perineum and into abdomen?

A

idiopathic scrotal oedema

usually disappears with analgesia

20
Q

balanitis xerotica (BXO)

A

white scarring around opening of the penis

managed with circumcision

21
Q

hypospadias?

A

opening not on the penis but below it

penis is shortened and slightly bent

22
Q

what can cause huge scrotal swelling in the scrotum in a baby?

A

herniation of the bowel into the scrotum

23
Q

what is the management if a baby is born with a testicle in the groin and why?

A

remove testicle and place into scrotum
so the testicle can be examined
can have fertility issues

24
Q

where is testicle likely to be found if not in the scrotum?

A

along the inguinal ligament

25
Q

blood supply to the testicle?

A

testicular artery (branches off the aorta)

26
Q

sign on imaging which can indicate a missing testicle?

A

lack of formed testicular artery

instead lots of spidery blood vessels that don’t really go anywhere

27
Q

how is a testicle moved down into the scrotum?

A

cut the testicular artery and leave for a few months to try and get the blood supply from below to become the main blood supply
therefore the testicle is no longer tethered by the testicular artery and can be swung around and moved down into the scrotum