Pediatrics 1 Flashcards
(28 cards)
What is VACTERL?
syndrome combining Vertebral anomalies Anal anomalies Cardiac anomalies Trachea anomalies Esophagus anomalies Renal anomalies Limb anomalies
What should be done incase of trauma in children?
- avoid overextension of the neck (obstructs airway)
- fluid replacement = 20ml/kg -> could be repeated twice then blood
- use long saphenous vein at ankle for IV access, or scalp veins in babies
- intraosseous infusion is useful in children
- elastic ribs that deform can cause lung contusions
What are the causes of hernia?
CONGENITAL
- preformed sac
- congenital defect (UNOBLITERATED PROCESSUS VAGINALIS)
ACQUIRED
- predisposing factors (weak abdominal wall)
- precipitating factors (increase intra-abdominal pressure)
How is a congenital inguinal hernia diagnosed?
- complete from the start
- testis is felt as a part of hernial content
diagnosed clinically
How should a congenital inguinal hernia be treated?
- perform herniotomy once diagnosed
hernioplasty is contra-indicated
What are the types of hydrocele?
- congenital: inguinoscrotal
- infantile: inguinoscrotal
- encysted: scrotal or inguinoscrotal, separated from testis
- vaginal: purely scrotal & not separated from testis
What investigations & treatment should be done for hydrocele?
SCROTAL US
- congenital -> only surgical: excision of processus vaginalis with closure of peritoneal connection
- infantile -> conservatuve
- encysted -> excision
- vaginal -> excision, eversion, or plication
What is the pathway of the descent of the testis?
- START -> renal angle opposite L2
- 5th week -> starts descent
- 7th month -> internal ring
- 9th month -> in scrotum
What are the factors that affect the testicular descend?
MECHANICAL
- gabernaculum
- high intra-abdominal pressure
HORMONAL
- testosterone
- maternal HCG
- fetal Mullerian inhibiting factor
what are the types of imperfectly descended testis?
- Undescended testis: arrested at any point of the normal descend pathway
- ectopic testis: present at any site away from normal pathway
- retractile testis: descend normally then retract into inguinal region
What are the causes for undescended testis?
UNILATERAL (mechanical)
- dysgenetic testicle
- large testicle
- short spermatic cord
- short testicular artery
- band of adhesion
- associated congenital inguinal hernia
BILATERAL (hormonal)
- bilateral mechanical cause
- defect in maternal HCG
- defect in pituitary gonadotropin or testicular sensitivity to it
What side is more likely to be affected by undescended testis?
right side & in pre matures
What are the sites where the descend of the testes will stop?
- intra abdominal
- inguinal canal
- at the neck of the scrotum
What is the clinical picture of an undescended testis?
- empty scrotum
- poorly developed scrotum
- deviated median raphe towards affected side
Why are undescended testis difficult to palpate?
- could be dysgenetic
- external oblique aponeurosis infront of it
- lax fascia transversalis behind it
What are the complications of undescended testis?
- reduced fertility
- torsion
- testicular tumor
- epididymo-orchitis
What investigations should be done for undescended testis?
INITIALLY -> US (difficult to see gonads)
BEST -> MRI
MOST VALUABLE -> exploratory laparoscopy (diagnostic & therapeutic)
How should undescended testis be treated?
NO interference before 6 months
androgens contraindicated
BILATERAL -> bHCG for 4 weeks (2months max)
-> bilateral orcheopexy in 2 sets with 6 months in between
UNILATERAL -> orcheopexy at 6-24months (divide any adhesions & excise any hernial sac & fix testis in dartos pouch)
How should undescended testis be treated if discovered late?
adults -> ORCHEOPEXY (works as endocrine)
intra-abdominal -> if orcheopexy is difficult -> subcutaneous
What are the sites an ectopic testis is found in?
- superficial inguinal pouch
- femoral triangle
- root of the penis
- perineum
LOOKWOOD THEORY
How does an ectopic testis differ from an undescended one?
- well developed
- easily palpable
- more palpable with contraction of anterior abdominal wall muscles
- long cord & well developed scrotum
- orcheopexy is less challenging
What is a retractile testis?
exaggerated cremasteric reflex leading to retraction into the inguinal region in exposure to cold & scratching of medial aspect of the thigh
How is retractile testis diagnosed & treated?
- examine patient in warm room in squatting position
- try to milk the testis down
reassurance or divide cremasteric muscle if severe
What are the types of congenital umbilical hernia?
EXOMPHALOS MAJOR
- large >5cm
- covered by amniotic membrane
- contains any a of abdominal viscera up to liver
- treated by complex & staged repair
EXOMPHALOS MINOR
- small <5cm
- covered by amniotic membrane & Warton’s jelly
- contains small loop of intestine
- simple, reduction, herniotomy & herniorraphy
