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Flashcards in Paeds Surgery Deck (26):
1

What is the most common hernia in children?

Indirect (though process vaginalis)
60% on the right

2

What on examination can strongly suggest its an ingunial hernia?


Can't get above it
Does not trans-illuminate
Reducible

3

What is anorchia?

Absences of both testes at birth

Find negative hcg stimulation with raised lh and fsh

4

What is hypospadias?

The urinary meatus is not in the usual location

5

What are the possible causes for undescended testis at 6months old?

Absent testis
Intra-abdominal
Non-palpable ingiunal testis

The higher th testis the lower the fertility

6

What are phimosis, paraphimosis and balanitis?

Phimosis- irretractile foreskin (normal <5yrs)
Paraphimosis- tight prepuce stuck behind corona of glans-> oedema
Balanitis- inflammationnof foreskin

7

What are the indications for male circumcision?

Balanitis xerotica obliterans (bxo)- atrophic white patches on penis - like lichen sclerosis in women.
Recurrent balanitis with scarred foreskin

8

At what age would it be appropriate to close an umbilical hernia?

4years old, unlikely to spontaneously close

9

How may a neonate present with malrotation?

Bile stained vomiting
Shock/ acidosis

10

What is the Ladds procedure for malformation?

De-rotation of volvulus
Widening of mesentary into non-rotated position
Appendicectomy

11

At what age should a boy with undecended testis be referred to a surgeon for possible orchidopexy?

Referral from 3 months, seeing urological surgeon by 6months.
Most procedures are performed about 1 year of age

12

What percentage of undescended testis spontaneously descend by 4-6m?

75%

13

What hormones regulate testicular decent?

Phase 1- trans abdominal- leydig cell hormone INS3

Phase 2- inginal scrotal - 24-35wks - androgens and genitofemoral nerve.

14

Which vessel is compromised in a intestinal volvulus?

Superior mesenteric artery

15

What most always be excluded in people with painful red scrotums?

Torsion - requires urgent scrotal exploration
Most commonly around puberty

16

What are the most common causes of scrotal swelling in primary care?

Epididymal cysts - found in posterior testical - dx by us

17

What is the incidence and presentation of pyloric stenosis?

3-4/1000
Males x4 > females

Projectile vomiting after feeds,
Dehydration and constipation
Palpable mass- visable peristalsis
Hypochlorimic, hypokalemiac alkalosis.

Rx- ramstedt pyloromyotomy

18

What are the features of intussusception?

Telescope bowel, proximal or at the level of ilelo-ceacal valve.
3-12months normally
Crying, vomiting, drawing up legs,
Red current jelly stools

Rx- reduction with air insufflation (85% success)
If unsuccessful operation

19

What is meckeks diverticulum and how does it arise?

Congenital dierticulum of the small intestine. The reminant of the vitelloinstestinal/ omphalomesenteric duct. (Connection from the yolk sac to the intestine)

Rule of 2s - 2% population, 2 feet from ileocaecal vavle, 2 inches long

20

How many type of oesophageal atresia are there? And which is the most common?

5 types
Type c - 87%, full upper oesophageal pouch, connection/ fistula between lower oesophagus and trachea.

Presentation- polyhydramnious. Choking and coughing, pneumonia, cyanosis. Picked up early in life.
Associated with VACTERL

21

What are the 2 types of diaphragmatic hernias?

Morgagni - anterior. Minamal damage, later presentation, good prognosis

Bochdalek hernia - posterior, larger defect, often diagnosed antenatally, pulmonary hypolasia, poor prognosis.

Heart lung bypass machine ECMO (extra corporeal membrane oxygenation)

22

What are the different approaches to ano-rectal malformations?

Surgery - 3 stage approach

Psarp - posterior sagital ano-rectoplasty (pull through procedure)

Depends on where the abnormality is.
Higher malformation - less become continent

23

What are the absolute indications for surgery in NEC?

Pneuoperitoneum
Clinical deterioration despite max Rx
Abdominal mass with obstruction or sepsis

24

What is the gold standard of diagnosis for Hirschsprung's disease?

Rectal/colonic biopsy
Showing aganglionic bowel

Failure of the parasympathetic Auerbach and Meisser plexus

Contrast enema shows funnel shaped transistion zone.

25

Why is the incidence gastroschisis increasing?

Teenage mums
Recreational drug use

26

Spina bifida

Hmm