Paediatric Surgery

Question 1

what does bilious vomiting suggest until proven otherwise?

Answer 1

bowel obstruction

Question 2

outline the pain ladder management in children

Answer 2

• paracetamol
  
  • 20mg/ kg 4-6hourly
• ibuprofen
  
  • 10mg/kg 8 hourly
• weak opioids- codeine NOT to be used in <12y/o
• strong opioids

Question 3

what are the sentinel signs of pathology in children? ie markers of disease

Answer 3

• abdominal pain
• bilious vomiting
• temperature
• tone
• colour
• reduced feeding

Question 4

main investigations?

Answer 4

urine - always

FBC- only if diagnostic uncertainty

electrolytes- only if child dehydrated / very sick

X-Ray- rarely

Question 5

features of classical appendicitis in children?

Answer 5

• murphy’s triad
  
  • fever
  • pain
  • vomiting
• tenderness over McBurney’s point
• unusual >4years old

Question 6

Features of Non-Specific Abdo Pain?

Answer 6

• central and constant
• short duration
• no temperature
• not worse on movement

Question 7

main diagnoses linked to NSAP?

Answer 7

• mesenteric adenitis
  
  • inflammation/swelling of lymph nodes in abdomen
• pneumonia

Question 8

pathophysiology of Pyloric Stenosis?

Answer 8

hypertrophy of gastric pylorus causing upper GI obstruction

Question 9

when does pyloric stenosis typically present?

Answer 9

3-6 weeks

Question 10

in who is PS more likely?

Answer 10

boys > girls

Question 11

presenting features of PS, including O/E?

Answer 11

• projectile milky non-bilious vomiting after every feed
• weight loss
• palpable olive mass in RUQ

Question 12

investigations and findings of PS?

Answer 12

• Capillary Blood Gas
  
  • hypochloraemic, hypokalaemic metabolic alkalosis
• Test feed first
• USS to confirm (thickened pylorus)

Question 13

management of PS?

Answer 13

• NBM
• IV fluids
• surgical pyloromyotomy

Question 14

at what age is malrotation more common?

what is the pathology?

Answer 14

• first few months of life
• failure of midgut to rotate during embryogenesis

Question 15

presentation of malrotation?

Answer 15

bilious vomiting (green)

Question 16

Ix of malrotation?

Answer 16

upper GI contrast study

Question 17

Management of malrotation?

Answer 17

surgery

Question 18

complication of malrotation?

Answer 18

volvulus

Question 19

when does intussusception present?

Answer 19

6-12months

• often preceded by viral infection

Question 20

how does intussusception present?

Answer 20

• bilious vomiting
• recurrent episodes of screaming & drawing up of the legs
• redcurrant jelly stools

Question 21

examination findings in intussusception

Answer 21

• sausage shaped mass
• prolonged capillary refill

Question 22

why do you get a prolonged capillary refill?

Answer 22

because of third space fluid loss, child is very dehydrated

Question 23

investigation + management of intussusception

Answer 23

investigation: USS abdo
management: air enema, surgery only if failed reduction / suspected strangulation

Question 24

what is gastroschisis + management

Answer 24

gastroschisis is a defect in the abdominal wall which leads to the herniation & expsoure of the gut contents

management: early / delayed closure & TPN

Question 25

what is exomphalos? what is it associated with?

Answer 25

umbilical defect which leads to the expsure of abdominal organs, covered by viscera

-associated with trisomies, cardiac neuro and renal abnormalities

Question 26

pathology of biliary atresia?

Answer 26

congenital condition where section of extrahepatic bile duct is narrowed or absent –> disrupted excretion of billirubin

Question 27

presentation of biliary atresia?

Answer 27

• jaundice beyond 2 weeks
• pale stools
• dark urine

Question 28

signs of biliary atresia O/E?

Answer 28

• jaundice
• hepatomegaly
• splenomegaly

Question 29

Ix of biliary atresia?

Answer 29

• raised ALP
• raised liver enzymes
• raised conjugated billirubin

Question 30

Mx of biliary atresia?

Answer 30

kasai procedure