Common Surgical Problems

Question 1

Describe Jejunal Atresia

Answer 1

Incomplete formation of part of the small intestine.

Question 2

List some symptoms of Jejunal Atresia

Answer 2

• Vomiting
• Swollen abdomen
• Constipation
• May be jaundiced

Question 3

How is Jejunal Atresia diagnosed?

Answer 3

• Signs of obstruction

- X-ray contrast which cannot pass through blockage

Question 4

What is meconium

Answer 4

The first stool that a newborn passes

Question 5

What is meconium ileum?

Answer 5

When bowel obstruction occurs due to thicker and sticker meconium.

Question 6

Symptoms of Meconium ileus

Answer 6

• Vomiting
• Not opened bowels
• Distended Abdomen
• Abdomen feels doughy

Question 7

How do you diagnose meconium ileus?

Answer 7

Solid contract on X-ray - soap bubble sign

Question 8

What causes an inguinal hernia?

Answer 8

Patent processus vaginalis

Question 9

Symptoms of inguinal hernia

Answer 9

• Swelling in the groin area

- Loop of bowel projecting as a bulge

Question 10

What is Malrotation?

Answer 10

Abnormality where the intestine does not form properly.

Question 11

What is a volvulus?

Answer 11

Caused by malrotation where the intestine loops around itself resulting in obstruction

Question 12

Symptoms of malrotation?

Answer 12

• Frequent vomiting
• Swollen abdomen
• Pale colour
• Poor appetite
• Blood in stools

Question 13

What is necrotising enterocolitis?

Answer 13

Inflammatory bowel necrosis where the tissue becomes inflamed resulting in damage and kills intestinal tissues.

Question 14

Symptoms of Necrotising enterocolitis?

Answer 14

• Abdominal distension
• Tenderness
• Bloody bowel movements

Question 15

How to diagnose necrotising enterocolitis

Answer 15

Presence of gas or air bubbles in the wall of the intestine.

Question 16

3 Causes of obstruction

Answer 16

1. Something in the lumen
2. Something affecting the wall
3. Compression from the outside

Question 17

What causes pyloric stenosis?

Answer 17

Thickening of the pylorus which does not permit the passage of milk through.

Question 18

Symptoms of pyloric stenosis

Answer 18

• Vomiting around 6-8 weeks after birth
• Projectile vomiting
• Bumps in the abdomen
• No diarrhoea
• Constipation

Question 19

Diagnosing pyloric stenosis?

Answer 19

• Ultrasound

- Check metabolic state of baby

Question 20

Treatment of pyloric stenosis?

Answer 20

Ramstedt’s Pyloromyotomy

Question 21

What is intussusception?

Answer 21

Where part of the bowel slots into another part like a telescope.

Question 22

When does intussusception present?

Answer 22

Around 6 months

Question 23

If intussusception is suspected, describe what you would feel on palpation?

Answer 23

Sausage like mass

Question 24

What would you see on USS if intussusception was the diagnosis?

Answer 24

Target lesion and pseudo-kidney sign

Question 25

Management of intussusception

Answer 25

Air blown up bottom to try and push intussusception out

Question 26

What is Peritonitis?

Answer 26

Inflammation of the peritoneal cavitys

Question 27

What causes peritonitis?

Answer 27

Infection or chemical irritation by organic fluid

Question 28

Symptoms of peritonitis?

Answer 28

- Pain made worse by jumping and bumps - Moderate temperature - +/- vomiting

Question 29

What is a volvulus?

Answer 29

Bowel twists on itself and the blood supply may be compromised

Question 30

Symptoms of a volvulus?

Answer 30

- Green vomit (bilious) | - Passage of blood (indicated mid gut necrosis)

Question 31

How to diagnose a volvulus

Answer 31

Contrast bowel and if swims = malrotation

Question 32

What happens in testicular torsion?

Answer 32

Spermatic cord and testes become twisted around each other. Can compromise blood supply

Question 33

What are some signs/symptoms of testicular torsion

Answer 33

- acute onset of pain - classical blue dot sign - atrophy if blood supply cut off >6 hours - Change in scrotum colour

Question 34

What is the 'blue dot sign'?

Answer 34

Hydatid of Morgagni

Question 35

What is idiopathic scrotal edema?

Answer 35

Acute scrotal edema and erythema

Question 36

What is idiopathic scrotal edema caused by

Answer 36

Allergy related release of histamine

Question 37

Two Classical sign of idiopathic scrotal edema

Answer 37

1. Erythema on both testes, extending up into the groin | 2. Fountain sign on USS due to hypervascularity

Question 38

Does idiopathic scrotal edema require surgery?

Answer 38

No - resolves pithing 3-5 days

Question 39

What is balanitis Xerotica Obliterans?

Answer 39

Chronic inflammatory disease - male genitalia variant of lichen sclerosis

Question 40

How does Balanitis Xerotica Obliterans present?

Answer 40

- foreskin not able to be pulled back - pain - itchiness - difficulty passing urine

Question 41

What is Paraphimosis?

Answer 41

When the foreskin gets stuck behind the head of the penis.

Question 42

How can paraphimosis be treated?

Answer 42

- Manually work the foreskin loose | - Squeeze the penis to push the fluid out and foreskin can return to normal place

Question 43

What is Hypospadias?

Answer 43

A congenital abnormality where the urethra does not open up in the normal position.

Question 44

What does a patent process vaginalis cause

Answer 44

An abnormal communication between peritoneum and scrotum

Question 45

How does patent process vaginalis present?

Answer 45

- swollen scrotum | - intermittent bulge

Question 46

What is a hydrocele?

Answer 46

Fluid filled sac within the testes which causes swelling

Question 47

How can a hydrocele be identified?

Answer 47

- transillumination of scotum displays fluid | - silk glove sign

Question 48

Can hydroceles spontaneously resolve in infancy?

Answer 48

Yes - so can be left alone in some cases