Common surgical problems in children - part 1 Flashcards Preview

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1

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

2

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. 

3

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. 

4

What is the management of pyloric stenosis ?

Management is surgery:

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

5

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

6

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 

7

What is the investigation of choice to diagnose intussusception?

US

8

What is the management of intussusception ?

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

Second-line - reduction by laproscopy or laparotomy 

9

What is appendicitis and who is it most common in ?

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

10

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

11

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 

12

What is the management of appendicitis ?

Appendectomy (laproscopic surgery)

13

What is a severe complication of appendicitis ?

Peritonitis - due to appendix bursting 

14

What is peritonitis and its symptoms ?

Inflam of peritoneum caused by infection 

Symptoms:

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

15

What is malrotation?

 Congenital anomaly of rotation of the midgut

16

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. 

17

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.

18

What is the characteristic sign of malrotation/volvulus ?

Vomiting bile (this is GREEN)

19

When does malrotation usually present ?

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

20

What is appendix testis torsion?

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

21

What are the signs/symptoms of appendix tortis ?

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