Common surgical problems in children - part 1

Question 1

What is pyloric stenosis ?

Answer 1

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

Question 2

What are the signs/symptoms of plyoric stenosis ?

Answer 2

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.

Question 3

What are the investigations done to diagnose pyloric stenosis ?

Answer 3

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.

Question 4

What is the management of pyloric stenosis ?

Answer 4

Management is surgery:

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

Question 5

What is intussusception ?

Answer 5

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

Question 6

What are the signs/symptoms of intussusception?

Answer 6

• Vomiting
• Temp
• Pain that comes in waves
• Sausage shaped mass in the abdomen - right sided, usually RUQ
• Might see red currant jelly in the faeces

Question 7

What is the investigation of choice to diagnose intussusception?

Answer 7

US

Question 8

What is the management of intussusception ?

Answer 8

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

Second-line - reduction by laproscopy or laparotomy

Question 9

What is appendicitis and who is it most common in ?

Answer 9

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

Question 10

What are the signs/symptoms of appendicitis ?

Answer 10

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

Question 11

What are the tests/examminations for suspected appendicitis ?

Answer 11

• 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

Question 12

What is the management of appendicitis ?

Answer 12

Appendectomy (laproscopic surgery)

Question 13

What is a severe complication of appendicitis ?

Answer 13

Peritonitis - due to appendix bursting

Question 14

What is peritonitis and its symptoms ?

Answer 14

Inflam of peritoneum caused by infection

Symptoms:

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

Question 15

What is malrotation?

Answer 15

Congenital anomaly of rotation of the midgut

Question 16

What is the potentially life-threatening complication of malrotation?

Answer 16

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

Question 17

What are the signs/symptoms of malrotation/volvulus ?

Answer 17

• 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.

Question 18

What is the characteristic sign of malrotation/volvulus ?

Answer 18

Vomiting bile (this is GREEN)

Question 19

When does malrotation usually present ?

Answer 19

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

Question 20

What is the investigation of choice to rule out malrotation/volvulus ?

Answer 20

Upper GI contrast with follow

Question 21

What is appendix testis torsion?

Answer 21

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

Question 22

What are the signs/symptoms of appendix tortis ?

Answer 22

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