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Paediatric surgery and GI Flashcards

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1
Q

Common GI presentation in children

A

Crying
Vomiting
Abdo pain
Poor feeding
Abdo distension

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2
Q

What is intussuception

A

Section of bowel telescopes into another usually around lymph nodes following a viral illness

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3
Q

Intessuception presention

A

3-9 months age
Following viral illness

Sx
- Pain
- non bilous vomiting
- drawing of legs in pain
- RECURRENT JELLY STOOL

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4
Q

Intussuception Ix and findings

A

Tender sausage shaped mass palpable

Blood tests - FBC, CRP
Abdominal X Ray
USS - target sign

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5
Q

Intussuception treatment

A

Antibiotics
Analgesia
Fluids
Barium air enema reduction during X ray - if fails surgery due to risk of bowel perforation

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6
Q

What is appendicitis

A

Inflammation of appendix

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7
Q

Appendicitis symptoms

A

Generalised abdominal pain that moves to right iliac fossa

Diarrhea and vomiting
Fever
Reduced appetite
Lethargy

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8
Q

Appendicitis investigation and examination findings

A

Tenderness in RIF
Rebound or percussion tenderness
Psoas sign
Rosvings Sign
Oburator sign
McBurneys point
Signs of shock

Ix
- Bloods
- Urine dipstick and MC&S
- Stool MC&S
- USS

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9
Q

Appendicitis treatment

A

Surgery

IV fluids
IV abx
IV analgesia
NBM

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10
Q

Meckel’s diverticulum presentation

A

same as appendicitis

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11
Q

Complications of meckel’s diverticulum

A

ecoptic gastric cells may lead to ulceration = blood stools
may lead to intussuception or volvulus

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12
Q

Meckel’s diverticulum diagnosis

A

Meckel’s scan

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13
Q

What is meckel’s diverticulim

A

congenital outpouching or bulge in the lower part of the small intestine - leftover of umbilical cord

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14
Q

DDx of bilious vomiting

A

Volvulus
Duodenal atresia / stenosis
Necrotising entercolitis
Meconium ileus
Hirschsprung’s disease
Post op ileus
Incarcerated hernia

  • all signs of bowel obstruction
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15
Q

What is volvulus and what can it lead to (complications)

A

Twist in intestine (malrotated gut)

RED FLAG BOWEL OBSTRUCTION - CAN LEAD TO DEATH OF SMALL BOWEL - TIME CRITICAL

COMPLICATIONS
- DEATH
- adhesions
- small gut syndrome

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16
Q

Ix and Tx for volvulus

A

Abdo XR
Bloods
Barium swallow if able

Tx
- resuscitate fluids
- analgesia
- abx
- NG TUBE INSERTION to decompress abdo distention
- EMERGENCY LAPAROTOMY FOR LADDS PROCEDURE (MAY ALSO PUT IN STOMA)

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17
Q

Sx of volvulus

A

Bilious vomiting
sever abdo pain
irritability
poor feeding
diarrhoea
fever

distended abdo
v tender
dehyrdated
tachycardic
signs of shock

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18
Q

DDx of non bilious vomiting

A

Reflux/GORD
Cows milk intolerance
Normal posseting
Pyloric stenosis
Sepsis / infection
Excessive feeding
Duodenal stenosis
Appendicitis
Gastroenteritis
Raised ICP
Intussusception
Incarcerated hernia

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19
Q

What is pyloric stenosis

A

Hypertrophy of pylorus muscle - resultis in narrow channel and obstruction

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20
Q

Pyloric stenosis presentation

A

PROJECTILE NON BILIOUS VOMITING
poor feeding
signs of dehydration

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21
Q

Ix and investigation findings of pyloric stenosis

A

Palpable olive mass in midline

Bloods
BLOOD GAS - METABOLIC ALKALOSIS, RAISED PH AND HCO3, HYPOCHLORAEMIA, HYPOKALAEMIA (due to vomiting and dehydration and loss of electrolytes)
USS

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22
Q

Pyloric stenosis treatment

Study These Flashcards
A

NBM
NG Tube insertion
IV fluids - electrolyte correction

Surgery - pylorectomy
Post op - build feeds slowly

23
Q

Umbilical hernia tx

Study These Flashcards
A

May close spontaneously by 2 yrs old - not concerning if reducible

IF NOT RESOLVED BY 5 YRS OLD, IF NOT REDUCIBLE OR SIGNS OF BOWEL OBSTRUCTION = SURGERY

24
Q

What is Wilms tumour and how does it present and treatment

Study These Flashcards
A

Unilateral renal tumour

May have haematuria
Palpable abdominal mass
Abdo distension
May have hypertension

DO NOT LEAVE UNTREATED (HIGH MORTALITY)
CHEMO AND SRUGICAL RESECTION

25
Define Nueroblastoma, presentation and treatment
Tumour starting from adrenal or paraspinal sites Abdominal distension / mass Anorexia CATECHOLAMINE IN URINE Tx - Chemo, surgery, radiotherapy
26
What is rhabdomyosarcoma
Soft tissue sarcoma around muscular structures
27
Rhabdomyosarcoma presentation
mass - esp in head / neck associated to li fraumeni syndrome
28
DDx of neonatal GI surgical conditions
 Gastroschisis  Exomphalos/Omphalocele  Tracheo-oesophageal Fistula  Oesophageal atresia  Necrotising enterocolitis  Duodenal atresia  Hirschsprung's disease  Anorectal malformation  Meconium ileus  Congenital lung malformation  Volvulus  Spina Bifida
29
Main time critical emergencies
bilious vomiting testicular torsion emergency referral to paediatric surgery
30
Define gastroschisis and its treatment
Defect in abdominal wall, gut exposed, urgent tx required, bowel may be ischaemic Wrap in plastic to prevent fluid loss
31
Define omphalocele and its treatment
Failure of viscera to return into abdo cavity, covered in sac Tx: silo formation, gradual reduction into abdo cavity
32
Sx and Tx of button battery or ball bearing magnet ingestion + complication
Drooling Poor orla intake Distress when feeding EMERGENCY ADMISSION RISKS - corrosion to trachea, oesophagus, aorta, fistula formation between bowel wall
33
Types of stoma
Colostomy - solid contents Ileostomy - liquid contents End colostomy - one end is stoma and other is mucuous fistula Loop stoma - halved stoma for temporary use
34
DDx of scrotal swelling
Testicular torsion Hydrocele Epididymo orchitis Inguinal hernia Incarcerated hernia Acute idiopathic scrotal oedema Trauma
35
Testicular torsion Tx
NBM IV analgesia Refer to surgery - to untwist, if necrotic = orchidectomy
36
What is a incarcerated hernia
Irreducible hernia
37
Clinical findings and Tx of incarcerated hernia
Lump on groin/abdomen - more prominent when crying/coughing Feels separate to testis Urgent referral to surgery - manual reduction - delay may cause bowel strangulation and bowel death
38
What is a hydrocele - how does it present and Tx
Fluctuant scrotal swelling - not tender - no erythema - gradual onset swelling Should go away by 2 yrs, if not refer to surgery
39
Epidiymoorchitis presentation and tx
quick onset testicular pain, redness and swelling associated to STI or UTI Penile discharge Dysuria antibiotics
40
Acute idiopathic scrotal oedema presentation and treatment
Scrotal skin in red and tender NO hydrocele Testis normal Erythema spreads to perineum Tx - antibistamine and steroids
41
Penile pathologies in children
Balanitis Balanitis xerotica obliterans Para phimosis Trauma phimosis
42
Balanitis symptoms and signs
Head of penis is sore and itchy and red Exudate on penis head Bleeding from foreskin Odour Dysuria Tightening of foreskin Inability to retract foreskin (phimosis)
43
Balanitis treatment
Lukewarm spoks Topical steroids, antifungals or antibiotics
44
What is balanitis xerotica obliterans
Chronic often progressive inflammation of glans penis
45
Complications and cause of balanitis xerotica obliterans
Leads to - phimosis - urethral stenosis - scarred white foreskin with pinhole opening Lichen sclerosis may cause it
46
Tx of balanitis xerotica obliterans
Topical steroid + circumcision+/- meatal dilatation
47
What is paraphimosis and how does it present
Tight prepuce is retracted and then unable to be replaced Erythema, swelling and pain
48
Paraphimosis Tx
Urgent referral to surgeons manual reduction osmotic reduction (sugar water) Surgery
49
What is phimosis and presentation
Irretractable foreskin - normal until 2 yrs old - incidence of balanitis
50
Tx of phimosis
Avoid retraction if congenital - can cause scar formation If issue is after 2 yrs of age - surgery
51
What is hypospadias and tx
Meatus on underside of penis Repair TELL PARENTS DO NOT CIRCUMCISE - FORESKIN IS USED IN THE REPAIR
52
UTI treatment in children
Under 3 - safeguarding, urine urgent MC&S (no urine dip), refer to paediatric specialist (may be congenital malformation) Over 3 - Urine dip - abx tx and urine mc&s
53
Pyelonephritis sx and tx
Systemically unwell with urinary symptoms Paeds urgent referral Long course of abx

Paediatrics (12 decks)

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