Paediatric Surgery

Question 1

A distended abdomen is a sign of what?

Answer 1

Obstruction

Question 2

A 6 week old child presents with vomiting, abdominal swelling and a distended stomach. What is the most likely diagnosis?

Answer 2

Pyloric stenosis

Question 3

Why does vomiting occur in pyloric stenosis?

Answer 3

The stomach tries to push food through the pylorus but it can’t. You may be able to see the muscles of the stomach peristalsing.

Question 4

What test should you use to investigate pyloric stenosis?

Answer 4

Ultrasound

Question 5

How can you tell there is something wrong when looking at an ultrasound of pyloric stenosis?

Answer 5

If you could measure the pylorus because it is so inflamed (normally this wouldn’t be possible)

Question 6

What is the treatment for pyloric stenosis? What are the outcomes?

Answer 6

Pyloromyotomy (cut the pyloric muscle)- they will then be able to feed normally

Question 7

Is pyloric stenosis rare?

Answer 7

No, it is pretty common

Question 8

How may you be able to tell that an infant is in pain?

Answer 8

They will draw their legs up

Question 9

A 6 month old child presents with vomiting for a few days and episodes where the legs are drawn up which is then followed by limpness. Some areas of the abdomen are firm and there is a sausage shaped mass. The child has been passing a little stool and there has been some blood in the nappy. What is the diagnosis?

Answer 9

Intussusception

Question 10

Intussusception presents usually at around the same age as which other, much less serious condition?

Answer 10

Simple colic

Question 11

What differentiates intussusception from simple colic?

Answer 11

These children will be limp and pale

Question 12

What is intussusception?

Answer 12

A type of obstruction which involves folding of the bowel (which causes swelling and obstruction)

Question 13

Where is the obstruction in intussusception usually found?

Answer 13

Where the small and large bowels meet

Question 14

What happens to the obstruction in intussusception?

Answer 14

It travels through the bowel and occasionally out of the rectum

Question 15

What is the correct investigation for intussusception?

Answer 15

Ultrasound

Question 16

This ultrasound appearance is seen in what condition?

If it is taken from the other angle, what will it look like?

Answer 16

Intussusception (target sign)

Kidney bean shaped

Question 18

How should you treat intussusception?

Answer 18

Blow air into the rectum to move the obstruction up and out

Question 19

Why is surgery not really used for intussusception?

Answer 19

Risk of bowel perforation

Question 20

A 6 year old child presents with tummy pains, and tells you that going over the speedbumps in the car was very painful. What is the diagnosis?

Answer 20

Some kind of peritonitis, likely appendicitis

Question 21

Will children with appendicitis have a high fever?

Answer 21

They will have a fever, but not particularly extreme

Question 22

Tummy pain in a child could actually be coming from where else? What diagnosis could this suggest?

Answer 22

Coming from the chest - pneumonia

Question 23

If a child is admitted with tummy pains and a fever, what should you always test for?

Answer 23

UTI

Question 24

A child is vomiting bile. What is the diagnosis until proven otherwise?

Answer 24

Malrotation

Question 25

What is malrotation?

Answer 25

A congenital problem of the gut- the bowel is not sitting in the right place so the gut twists and loses blood supply to the midgut from the superior mesenteric artery

Question 26

What is the most worrying presentation of an acute scrotum? Is this common?

Answer 26

Testicular torsion - not the most common presentation of acute scrotum

Question 27

A boy presents with an acute scrotum. It is red, swollen and sore. What is the most likely diagnosis?

Answer 27

Epididymitis

Question 28

It can be hard to distinguish epididymitis from testicular torsion, how do you check?

Answer 28

Have to open the scrotum to check

Question 29

A boy presents with an acute scrotum. There is a black, blobby extra part which does not look nice. What is the most likely diagnosis?

Answer 29

Mullerian duct remnant

Question 30

What is the treatment for a Mullerian duct remnant if it is... a) sore? b) not sore?

Answer 30

a) Removal b) Leave it to fall off

Question 31

A boy presents with a red, itchy, swollen scrotum which is not particularly sore and can come on acutely though it comes and goes. What is the most likely diagnosis and what can you give to help?

Answer 31

Idiopathic scrotal oedema, can give an anti-histamine

Question 32

In idiopathic scrotal oedema, where may the redness spread to? How may the tissues appear?

Answer 32

Groin and perineum Waterlogged

Question 33

A boy presents with a whitish appearance of the scrotum. There is no movement on retraction of the foreskin. What is the most likely diagnosis and what is the treatment?

Answer 33

Balanitis Xerotica Obliterans (BXO) - needs a circumcision

Question 34

Why do cases of BXO require a circumcision?

Answer 34

Can cause urethral stenosis

Question 35

A boy presents with a swelling in the groin which is so bad the penis has almost disappeared. What is the diagnosis? What is the treatment and why?

Answer 35

Hernia Operate quickly so the bowel doesn't get obstructed by the hernia

Question 36

What is hypospadias?

Answer 36

Where the urethra is on the underside of the penis

Question 37

Why is it important to find an undescended testes?

Answer 37

They can become malignant

Question 38

A child presents with bilous vomiting a few hours after birth. An AXR shows a double bubble sign. What is the most likely diagnosis?

Answer 38

Duodenal atresia

Question 39

Who is duodenal atresia more common in?

Answer 39

Babies with Down's syndrome

Question 40

When does malrotation usually present?

Answer 40

3-7 days after birth

Question 41

A baby presents 24 hours after birth with bilous vomiting. AXR shows air-fluid levels. What are the 2 most likely diagnoses?

Answer 41

Jejunal/ileal atresia Mecoium ileus

Question 42

Meconium ileus has a close relationship with what condition?

Answer 42

CF

Question 43

A baby presents in the 2nd week of life with bilous vomiting. There are dilated bowel loops. She was premature. What is the most likely diagnosis?

Answer 43

Necrotising enterocolitis