Common surgical problems in children - part 1 Flashcards Preview

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What is pyloric stenosis ?

Narrowing of the opening from the stomach to the first part of the small intestine known as the duodenum, due to enlargement of the muscle surrounding this opening


What are the signs/symptoms of plyoric stenosis ?

Presents usually at 3-8 weeks - typically 6 

Kid will have vomiting (projectile) that is milky in colour, occurring after feeds. On palpitation a olive sized mass can be felt. Often has a metabolic alkalosis. Possibly malnourished and dehydrated 

Distinguished from other causes of vomiting by:

  • No bile in vomit as obstruction high up 
  • No diarrhoea 
  • Vomiting characteristically mins after feed. 


What are the investigations done to diagnose pyloric stenosis ?

It is difficult but can be felt on palpation (due to the characteristic olive sized mass) but if not then US is done to diagnose it. 


What is the management of pyloric stenosis ?

Management is surgery:

  • Correct electrolyte distrubances 
  • Ramstedt's pyloromyotomy (pyloroplasty) - first choice 


What is intussusception ?

Most common cause of intestinal obstruction in kids - where a part of the intestine invaginates (folds into) into another section of intestine, similar to the way the parts of a collapsible telescope retract into one another. 

Result is obstruction


What are the signs/symptoms of intussusception?

  • Vomiting 
  • Temp 
  • Pain that comes in waves 
  • Sausage shaped mass in the abdomen 
  • Might see red currant jelly in the faeces 


What is the investigation of choice to diagnose intussusception?



What is the management of intussusception ?

First-line - US with reduction by air enema (least invasive)

Second-line - reduction by laproscopy or laparotomy 


What is appendicitis and who is it most common in ?

Inflam of appendix - most common in young people 10-20


What are the signs/symptoms of appendicitis ?

Usually presents with intermittent umbilical pain which travels to your RIF becoming constant and severe. 

Additional symptoms:

  • Feeling/being sick
  • Loss of appetite
  • Diarrhoea
  • High temp and a flushed face
  • Rebound tenderness


What are the tests/examminations for suspected appendicitis ?

  • On examination have the kid hop - if they cant then appendicitis unlikely 
  • US imaging is useful
  • In women of child bearing age pregnancy test is needed to rule out ectopic pregnancy 


What is the management of appendicitis ?

Appendectomy (laproscopic surgery)


What is a severe complication of appendicitis ?

Peritonitis - due to appendix bursting 


What is peritonitis and its symptoms ?

Inflam of peritoneum caused by infection 


  • Rigid abdomen
  •  Nausea
  • Vomiting
  • Minimal urine output.


What is malrotation?

 Congenital anomaly of rotation of the midgut


What is the potentially life-threatening complication of malrotation?

Volvulus - where the bowel twists so the blood supply to that part of the bowel is cut off. 


What are the signs/symptoms of malrotation/volvulus ?

  • Swollen abdomen that's tender to the touch.
  • Diarrhea and/or bloody stools (or sometimes no stools at all)
  • Irritability or crying in pain, with nothing seeming to help.
  • RapidHR and breathing.
  • Little or no urine because of fluid loss.
  • Fever.


What is the characteristic sign of malrotation/volvulus ?

Vomiting bile (this is GREEN)


When does malrotation usually present ?

  • 60% of cases in 4-6 weeks
  • 90% of cases by 1 year 


What is appendix testis torsion?

Its when the appendix testis (left over female part) torts 


What are the signs/symptoms of appendix tortis ?

  • Pain at the top of the testicle 
  • Sometimes a blue dot over the area