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Peads Surgery Flashcards

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1
Q

What is the most common cause of acyanotic congenital heart disease?

A

Ventricular septal defects (VSD)

VSDs account for 30% of acyanotic congenital heart disease cases.

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2
Q

List the common causes of acyanotic congenital heart disease.

A
  • Ventricular septal defects (VSD)
  • Atrial septal defect (ASD)
  • Patent ductus arteriosus (PDA)
  • Coarctation of the aorta
  • Aortic valve stenosis

VSDs are the most prevalent among these.

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3
Q

Which congenital heart defect is more common in adult patients, VSD or ASD?

A

Atrial septal defect (ASD)

ASDs generally present later, leading to more diagnoses in adults.

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4
Q

What is the most common cause of cyanotic congenital heart disease?

A

Tetralogy of Fallot

Tetralogy of Fallot is a significant cause of cyanotic congenital heart disease.

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5
Q

List the common causes of cyanotic congenital heart disease.

A
  • Tetralogy of Fallot
  • Transposition of the great arteries (TGA)
  • Tricuspid atresia
  • Pulmonary valve stenosis

These conditions lead to cyanosis in affected patients.

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6
Q

Most common cyanotic heart disease at birth?

A

TGA

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7
Q

Changes in TOF?

A

The four characteristic features are:
* Ventricular septal defect (VSD)
Right ventricular hypertrophy
Right ventricular outflow tract obstruction, pulmonary stenosis
* Overriding aorta

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8
Q

Remamant of Urachus?

A

median umbilical ligament

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9
Q

Umbilical arteries become?

A

right and left medial umbilical ligaments

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10
Q

Ductus venosus becomes?

A

ligamentum venosum

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11
Q

Ductus arteriousus becomes?

A

ligamentum arteriosum

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12
Q

Left umbilical vein becomes?

A

Ligamentum teres

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13
Q

Which arch does the ligamentum arteriosum comes from?

A

6th

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14
Q
A
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15
Q

What is pyloric stenosis?

A

Pyloric stenosis is a condition in which the pylorus, the opening from the stomach into the small intestine, becomes narrowed, leading to obstruction.

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16
Q

True or False: Pyloric stenosis primarily affects adults.

A

False: Pyloric stenosis primarily affects infants, typically presenting in the first few weeks of life.

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17
Q

Which symptom is most commonly associated with pyloric stenosis?

A

Projectile vomiting is the most commonly associated symptom of pyloric stenosis.

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18
Q

Fill in the blank: The typical age of onset for pyloric stenosis is _____ weeks.

A

3 to 12 weeks.

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19
Q

What is the main treatment for pyloric stenosis?

A

The main treatment for pyloric stenosis is surgical intervention, specifically a procedure called pyloromyotomy.

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20
Q

What is the prevalence of Biliary Atresia?

A

1 in 17,000 affected.

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21
Q

What causes the obliteration of the biliary tree lumen in Biliary Atresia?

A

An inflammatory cholangiopathy causing progressive liver damage.

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22
Q

What are the clinical features of Biliary Atresia?

A

Infant well in the first few weeks of life, no family history of liver disease, jaundice in infants > 14 days in term infants (>21 days in preterm infants), pale stool, yellow urine (colourless in babies).

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23
Q

What are the associated conditions with Biliary Atresia?

A

Cardiac malformations, polysplenia, situs inversus.

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24
Q

What laboratory findings are indicative of obstructive liver disease in Biliary Atresia?

Study These Flashcards
A

A rise in conjugated bilirubin.

25
What imaging study is used to exclude extrahepatic causes in Biliary Atresia?
Ultrasound of the liver.
26
What is a notable finding on ultrasound in infants with Biliary Atresia?
The infant may have a tiny or invisible gallbladder.
27
What is the purpose of a Hepato-iminodiacetic acid radionuclide scan in Biliary Atresia?
Good uptake but no excretion usually seen.
28
Why is early recognition of Biliary Atresia important?
To prevent liver transplantation.
29
What nutritional support is provided in the management of Biliary Atresia?
Nutritional support.
30
What surgical procedure is performed for Biliary Atresia?
Roux-en-Y portojejunostomy (Kasai procedure).
31
What is the alternative option if the Kasai procedure fails or is recognized late?
A liver transplant becomes the only option.
32
What is an umbilical hernia?
Up to 20% of neonates may have an umbilical hernia, more common in premature infants. The majority will close spontaneously (may take between 12 months and three years). Strangulation is rare. Fix after 2 years
33
What is a paraumbilical hernia?
These are due to defects in the linea alba near the umbilicus. The edges are more clearly defined than those of an umbilical hernia and are less likely to resolve spontaneously.
34
What is omphalitis?
This condition consists of infection of the umbilicus, commonly caused by Staphylococcus aureus. It can be serious as infection may spread rapidly through umbilical vessels in neonates, risking portal pyaemia and portal vein thrombosis. Treatment is usually with topical and systemic antibiotics.
35
What are umbilical granulomas?
These consist of cherry red lesions surrounding the umbilicus, which may bleed on contact and discharge seropurulent fluid. Infection is unusual and they often respond favorably to chemical cautery with silver nitrate.
36
What is a persistent urachus?
This is characterized by urinary discharge from the umbilicus due to persistence of the urachus, which attaches to the bladder. It is associated with other urogenital abnormalities.
37
What is a persistent vitello-intestinal duct?
This typically presents as umbilical discharge containing small bowel content. Complete persistence is rare; more common is partial persistence (Meckel's diverticulum). Best imaged using a contrast study and managed by laparotomy and surgical closure.
38
39
What are inguinal hernias?
Inguinal hernias are a common disorder in children, particularly in males due to the migration of the testis through the inguinal canal.
40
What is the risk of strangulation in infants with inguinal hernias?
Children presenting in the first few months of life are at the highest risk of strangulation and the hernia should be repaired urgently.
41
What is the risk of strangulation in children over 1 year of age?
Children over 1 year of age are at lower risk and surgery may be performed electively.
42
What type of surgery is sufficient for paediatric hernias?
For paediatric hernias, a herniotomy without implantation of mesh is sufficient.
43
What is the typical procedure for most cases of paediatric hernias?
Most cases are performed as day cases.
44
What is the protocol for neonates and premature infants undergoing hernia surgery?
Neonates and premature infants are kept in hospital overnight due to an increased risk of post-operative apnoea.
45
What percentage of young girls may experience UTIs?
5% ## Footnote The incidence is higher in premature infants.
46
What percentage of UTI cases in children are caused by E-Coli?
80% ## Footnote E-Coli is the most common pathogen in pediatric UTIs.
47
What should be established in children with UTI?
Underlying urinary stasis or vesico-ureteric reflux ## Footnote Both conditions may contribute to recurrent UTIs.
48
What is the risk of renal scarring in children with pyelonephritis?
10% ## Footnote This translates into a 10% risk of developing end stage renal disease.
49
What mandates urine testing in cases of pyrexia lasting more than three days?
Pyrexia lasting more than three days ## Footnote This is a key indicator for potential UTI.
50
What types of samples can be taken for urine testing?
Mid-stream urine samples or supra pubic aspiration ## Footnote Samples from nappies usually have faecal contaminants.
51
What indicates a UTI in urine samples?
>10^5 colony forming units of a single organism ## Footnote This is a standard criterion for diagnosing UTIs.
52
How should a single isolated UTI in girls be managed?
Managed expectantly ## Footnote Monitoring may be appropriate if there are no further complications.
53
What should prompt further testing in children with UTIs?
>2 UTIs in 6 months (or 1 in males) ## Footnote This indicates a potential underlying issue requiring investigation.
54
What is the ideal first line test for males suspected of having a urinary issue?
Voiding cystourethrogram (VCUG) ## Footnote VCUG provides detailed anatomical information.
55
What is the first line test for girls suspected of having a urinary issue?
Isotope cystography ## Footnote This test has a lower radiation dose.
56
What should be performed when renal scarring is suspected?
Renal cortical scintigraphy ## Footnote This imaging helps assess renal function and structure.
57
What is the commonest cause of infravesical outflow obstruction in males?
Posterior urethral valves ## Footnote This condition can be diagnosed via antenatal ultrasonography.
58
What percentage of boys may present with renal impairment due to posterior urethral valves?
70% ## Footnote This highlights the severity of the condition if untreated.
59
What is the definitive treatment for posterior urethral valves?
Endoscopic valvotomy ## Footnote This is often accompanied by bladder catheterization and follow-up.

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