Neonatal surgical problems

Question 1

Aetiology of cleft lip +/- palate (3)

Answer 1

Maternal smoking and alcohol
Genetic factors
Certain drugs e.g. phenytoin, sodium valproate, benzos, steroids

Question 2

Failure of the diaphragm to fuse properly allowing abdominal organs to migrate into the chest, displacing the mediastinum

Answer 2

Diaphragmatic hernia

Question 3

Diaphragmatic hernias more commonly occur on what side, and are associated with what other conditions (2)?

Answer 3

Usually the left, and associated with pulmonary hypoplasia and heart defects

Question 4

X-ray appearance of diaphragmatic hernia

Answer 4

Loops of bowel in the chest cavity

Question 5

Management of diaphragmatic hernia (2)

Answer 5

Gut decompression, surgical repair

Question 6

Persistentbilious vomiting within hours of birth, and “double bubble” appearance of duodenum and stomach on X-ray

Answer 6

Duodenal atresia

Question 7

Noisy respiration, with inspiratory stridor worse lying down, and normal cry

Answer 7

Laryngomalacia

Question 8

Difference between gastroschisis and exomphalos

Answer 8

Both are congenital defects with extrusion of bowel contents; in exomphalos there is a covering of peritoneum and amnion, whereas in gastroschisis there is no peritoneum

Question 9

Hirchsprung’s disease is also known as

Answer 9

congenital megacolon

Question 10

Underlying pathology of Hirchsprungs disease

Answer 10

Absence of parasympathetic ganglia in the colon, often extending to the rectum, causing functional colonic obstruction

Question 11

Diseases associated with Hirchsprungs (2)

Answer 11

Multiple endocrine neoplasia

Downs syndrome

Question 12

Presentation of Hirchsprungs (2)

Answer 12

Failure to pass meconium first 24 hours

Megacolon on X-ray/barium enema

Question 13

Surgical treatment of Hirchsprungs (2)

Answer 13

Resection of the aganglionic segment and end-to-end anastamosis. Colostomy (either temporary or permanent) may be required

Question 14

Excess of fluid between the two layers of the tunica vaginalis due to failure of closure of processus vaginalis, or impaired reabsorption of fluid after closure

Answer 14

Hydrocele (communicating hydrocele if processus vaginalis still open)

Question 15

Inguinal hernias in young boys are usually…

Answer 15

Indirect

Question 16

Most common sites for the testicle in testicular maldescent

Answer 16

Within inguinal canal, at the external ring, or “high rectractile”

Question 17

“Telescoping” of proximal bowel into distal

Answer 17

Intussusception

Question 18

Aetiology of Intussusception

Answer 18

viral hypertrophy of Peyer’s patches

Question 19

Presentation of Intussusception (4)

Answer 19

Children aged 3 months to 2 years
crampy abd pain
vomiting
“redcurrant jelly” stools

Question 20

What is Meckel’s diverticulum?

Answer 20

Congenital diverticulum in the small intestine

Question 21

How does Meckels diverticulum present? (2)

Answer 21

Painless rectal bleeding (from ulcer). Usually around 2 years old

Question 22

4 week year old with non-bilious projectile vomiting and “olive-shaped” mass just above the umbilicus

Answer 22

Pyloric stenosis

Question 23

Treatment of pyloric stenosis

Answer 23

Rmastedt pylorotomy

Question 24

Where does intussusception most commonly occur?

Answer 24

Proximal to/ at the level of the ileocaecal valve