Surgery Flashcards

Question

management hirschsprung's

Answer 1

IV abx NG bowel decompression definitive - surgery - resecting aganglionic section and connecting unaffected bowel to dentate line

Answer 2

Hirschsprung associated enterocolitis (HAEC) - c.diff, s.aureus complications of surgery - constipation, enterocolitis, perianal abscess, faecal soiling, adhesions

Answer 3

prematurity male fhx

Answer 4

surgical repair - herniotomy on ful term male infants with asx reduciable hernias emergency surgery if irreducible...testicular ischaemia

Answer 5

the movement or ‘telescoping’ of one part of the bowel into another. The proximal bowel segment is referred to as the intussuceptum whilst the distal segment as intussucipiens

Answer 6

5-7 mths of age boys twice as more likely

Answer 7

leads to intestinal obstruction up to 90% are ileo colic type -distal ileum passes into caecum through ileo-caecal valve

Answer 8

most are idiopathic rotaviruses increase risk pathological causes include Meckel diverticulum (most common) Polyps Henoch-Schönlein purpura Lymphoma and other tumors Post-operative

Answer 9

if child older high recurrence rate

Answer 10

sudden onset inconsolable crying episodes pallor draw up kneeds normal inbetween episodes lethargic anorexic red current consistency - blood and mucus stooll older - obstruction features

Answer 11

Distention A palpable ‘sausage-shaped’ abdominal mass which can be found in the right upper quadrant (ileo-ceceal type) Signs of peritonism Presence of bowel sounds dehydration and shock

Answer 12

colic testicular torsion appendicitis

Answer 13

abdo USS - dougnut/target sign on transverse plane and pseudokidney sign on longitudinal plane AXR - distented small bowel loops, outline intussuception, rigler's sign contrast enema

Answer 14

fluid resus NG tube non op reduction - air or contrast enema. c/i if perforation or peritonitis surgical reduction - manually reduce and resection of necrotic bowel

Answer 15

obstruction -surgical emergency perforation - venous congestion and oedema within bowel wall..necrosis and perforation dehydration and shock

Answer 16

a congenital, abdominal wall defect at the insertion of the umbilical cord. Abdominal contents herniates outside the abdomen within a membranous sac consisting of the peritoneum and amnion

Answer 17

1 in 5000 live births

Answer 18

During normal development of the intestines, the midgut begins to elongate at around 6 weeks gestation. However, at this time the liver and stomach are also growing, meaning there is not enough room in the abdomen to accommodate the midgut. In order to continue developing, the midgut herniates through the umbilical ring out of the abdomen into the umbilical cord (called physiological umbilical herniation). During the 10th week, the abdomen has enlarged enough for the midgut to return (3). The exact cause of omphalocele is unknown (4), however the main theory is failure of this normal intestinal migration back into the abdominal cavity, and persistence of the physiological umbilical herniatio

Answer 19

maternal smoking maternal age >40 yrs chromosomal abnormalities - triosomy,turners, klinefelters

Answer 20

4-12cm abdo wall defects located centrally within umbilical cord protective membranes surroudning healthy intestines

Answer 21

gastroschisis cloacal exstrophy physiological gut herniation

Answer 22

clinical diagnosis prenatal USS or birth alpha fetoprotein elevated chromosomal abnormalities - chronic villus sampling or amniocentesis

Answer 23

fluid resus temp NG tube neonatal ICU

Answer 24

reduction of bowel into abdo cavity and closure of skin and fascia agents to promote epithelisiation - silver impregnated dressings or povidone iodine solutions if ruptured membrnaous sac - immediate surgery

Answer 25

ruptured abdominal compartmental syndrome

Answer 26

1 in 500-1000 live births 4 males for every 1 female

Answer 27

progressive hypertrophy of the pyloric muscle, causing gastric outlet obstruction. The aetiology remains unknown

Answer 28

male family hxl

Answer 29

4-6 weeks of age non bilious vomiting after every eed projectile vomiting haematemesis weight loss dehydration visible peristalysis and palpable olive shaped pyloric mass

Answer 30

Gastroenteritis Gastro-oesophageal reflux, including Sandifer syndrome Over-feeding

Answer 31

test feed with NG in situ and stomach aspirated. while feeding palpated for mass and observe for visible peristalsis USS - hypertrophy blood gas - low K, low Cl, met alkalosis from vomiting

Answer 32

correct underlying metabolic abnormalities 10-20ml/kg fluid boluses NG tube - aspirated every 4 hrs Ramstedt's pyloromyotomy

Answer 33

Pre-operative: Hypovolaemia Apnoea – secondary to hypoventilation associated with metabolic acidosis Post-operative: Wound dehiscence Infection Bleeding Perforation Incomplete myotomy

Answer 34

all primary brain tumours that originate from neuroepithelial glial cells (including ependymal cells, astrocytes, oligodendrocytes and astrocytes)

Answer 35

low grade glioma

Answer 36

seizures*, cranial nerve palsies or visual field defects, language dysfunction, or features of raised intracranial pressure.

Answer 37

CT with IV contrast biopsy to confirm

Answer 38

watch aand wait total or partial debulking radiotherapy

Answer 39

total or partial decompressive tumour debulking both chemo and radiotherapy

Answer 40

low grade - 15-16yrs high - 15-18 mths

Answer 41

the accumulation of cerebrospinal fluid (CSF) within the cerebral ventricles

Answer 42

obstructive - blockage to natural ventricular drainage system and CSF flow - tumour, cysts communicating - reduced absorbance of CSF by arachnoid villi - infective menginitis, SAH, normal pressure hydrocephalus

Answer 43

triad of Parkinsonian gait, urinary incontinence, and dementia.

Answer 44

N+V headache worse in morning altered GCS blurred vision abnormal gait incontineence papilloedema

Answer 45

CT - enlargement of ventricles, loss of sulcal gyral pattern, CSF exudation

Answer 46

Generalised ventricular dilatation suggests a communicating hydrocephalus Dilated lateral and third ventricle: With a normal fourth ventricle suggests aqueduct stenosis With dilated fourth ventricle suggests a posterior fossa mass

Answer 47

insertion of external ventricular drain debulking of tumour, endoscopic third ventriculostomy or choroid plexis resection

Answer 48

1) haematogenous spread via the choroid plexus, (2) direct extension from adjacent tissues, and (3) inoculation from interventional procedures or surgery

Answer 49

develops following neurotrauma, surgery (such as following a craniotomy), or direct spread from sinusitis or mastoiditis. The condition often presents with localised pain over the affected region and can present concurrently with osteomyelitis of the cranial vault. The most common causative organisms are Streptococci and S. aureus.

Answer 50

develops as direct spread from sinusitis (particularly frontal sinusitis) or from chronic otitis media, extending to the subdural space via the emissary veins or as a result of retrograde thrombophlebitis.

Answer 51

direct spread from sinusitis, haematogenous spread from a septic focus*, or following a penetrating wound to the head or following neurosurgical procedures. The most common causative pathogens are S. pneumoniae and S. aureus. On cross-sectional imaging, cerebral abscesses will present as discrete lesions with an enhancing rim

Answer 52

inflammation of the ependymal cells which lines the cerebral ventricles. It often develops secondary to pre-existing infections (e.g. meningitis), however may develop from those with external ventricular drains (EVD) in-situ or following intracranial surgery

Answer 53

new onset confusion reduced GCS headache features of sepsis raised ICP seizures pyrexia focal neurological deficit

Answer 54

extremes of age, recent neurosurgical procedure, intravenous drug use, the presence of any long-term intracranial devices, or immunosuppresion

Answer 55

routine bloods blood cultures CSF samples CT

Answer 56

fluid resus IV abx hyperosmolar agents anti epileptics surgical intervention is definitive

Answer 57

adhesions between prepuce and glans of penis. over time - gradually breaks down. mean age of foreskin retraction is 10.4 yrs, can be normal up to age of 8 and 1% have phsyiological phimosis at age 16. Around 95% of pathological phimosis is due to the process ‘Balanitis xerotica obliterans’ (BXO); where keratinisation of the tip of the foreskin causes scaring and the prepuce remains non-retractile

Answer 58

ballooning of foreskin during micrturition irritation dysuria haematuria local infection

Answer 59

white, fibrotic scarred preputial tip hard to visualise meatus

Answer 60

circumcision foreskin to histopathology to confirm diagnosis

Answer 61

day case procedure...dissolvable stitches small risk of bleeding and infection swelling and serous discharge if left untreated - meatal stenosis, phimosis, erosions of glans and prepuce

Answer 62

failure of testicular descent into scrotum

Answer 63

True undescended testis: where testis is absent from the scrotum but lies along the line of testicular descent Ectopic testis: where the testis is found away from the normal path of decent Ascending testis: where a testis previously identified in the scrotum undergoes a secondary ascent out of the scrotum.

Answer 64

the testis descends from the abdomen to the scrotum, pulled by the gubernaculum, within the processes vaginalis. This process is incomplete in the context of true undescended testis; or tracks to an abnormal position in an ectopic testis. However, particularly with bilateral cryptorchidism, hormonal causes such as androgen insensitivity syndrome or disorder of sex development must also be excluded

Answer 65

prematurity, low birth weight, having other abnormalities of genitalia (i.e. hypospadias) having a first degree relative with cryptorchidism.

Answer 66

if the testis has ever been seen or palpated within the scrotum, such as in the newborn check - warm bath?

Answer 67

To start, have the infant/child laid flat on the bed, aim to keep the child as comfortable and relaxed as possible. With warm hands, palpate laterally with your left hand, from the inguinal ring and work along the inguinal canal to the pubic symphysis, from there your other hand can be used to palpated the testis in the scrotum. If found, one should attempt to see if the testis can be gently milked down to the base of the scrotum, in which case a diagnosis of retractile testis can be made, if it is pulled down but under tension in the base, this commonly referred to as a ‘high scrotal’ or simply ‘high testis’. Sometimes the testis may be found within the groin, along the inguinal canal, but cannot bring it further, therefore an ‘inguinal undescended testis’ has been found.

Answer 68

normal retratile testis true undescended testis ectopic testis

Answer 69

undescended testis associated with ambiguous genitalia or hypospadias, or bilateral undescended testis are found: urgent referral to senior paediatrician within 24 hours

Answer 70

At birth – review at 6-8 weeks of age At 6-8 weeks – if fully descended, no further action. If unilateral, re-examine at 3 months At 3 months – If testis is retractile, advise annual follow up (due to risk of ascending testis). If undescended, refer to paediatric surgery/urology for definitive intervention – ideally occurring 6 – 12 months of age.

Answer 71

examination under anaesthesia followed by laprascopy open orchidopexy if palpable if intra abdo - fowlder stephens procedure groin exploration if atrophic testis

Answer 72

infection bleeding wound dehiscence resricular atrophy testicular re ascent

Answer 73

impaired fertility testicular cancer -2-3x more common torsion

Answer 74

collection of fluid that builds up in the remnants of the processus vaginalis

Answer 75

communicating - the persistence of a patent processus vaginalis (PPV), allowing the free flow of peritoneal fluid from peritoneum to the tunica vaginalis. If the connection is large enough, an inguinal hernia may occur due to the protrusion of intra-abdominal content non communicating - imbalance between production and absorbance of serous fluid

Answer 76

congenital malignancy testicular torsion trauma inection

Answer 77

non-tender, smooth and transilluminates. There is notable scrotal enlargement following exertio

Answer 78

inguinal hernia testicular cancer epididymitis

Answer 79

USS scan but clinical diagnosis

Answer 80

reassurance surgery - open/laparoscopic PPV (patent processus vaginalis) ligation is offered electively to children in whom hydrocele persists beyond 2 years. Exploratory laparoscopy can be indicated if the hydrocele is large, infected, recurrent or to rule out secondary pathology

Answer 81

a congenital defect causing the urethral meatus to be located at an abnormal site, usually on the under side of the penis rather than at the tip

Answer 82

1 in 300 male births incidence increasing

Answer 83

due to arrest of penile development, leading to hypoplasia of the ventral tissue of the penis

Answer 84

abnormal urine flow - not from tip abnormal penile curvature during erections 1) Ventral opening of the urethral meatus 2) Ventral curvature of the penis or “Chordee” 3) Dorsal hooded foreskin

Answer 85

Glandular, coronal, shaft (distal, mid, proximal), scrotal, perineal

Answer 86

Congenital Adrenal Hyperplasia is a diagnosis that must not be missed and should be considered in females with ambiguous genitalia. If not detected early this can lead to a salt wasting crisis due to cortisol and aldosterone deficiency with androgen excess.

Answer 87

Detailed history and examination Karyotype Pelvic ultrasound scan Urea and Electrolytes Endocrine hormones: Testosterone, 17 alpha-hyroxyprogesterone, LH, FSH, ACTH, renin, aldosterone

Answer 88

urethroplasty Performed as a single stage or a 2-stage repair, using a graft. This is preferentially a preputial graft harvested from the foreskin hence the need to advise against circumcision

Answer 89

This urethral catheter may block, requiring further management such as flushing. The urethral catheter may also become displaced or kinked and therefore there should be careful inspection if not draining. also may cause pain and bladder spasms tx with anticholingerics bleeding, infection

Answer 90

urethral fistula meatal and urethral stenosis

Surgery Flashcards

(115 cards)