Surgery Flashcards by Emmy Beever

What is the typical presentation of acute appendicitis? (4)

Abdo pain
Reduced appetite
Poss vom
Low-grade fever

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Describe 3 features about abdo pain in acute appendicitis?

Central → RIF (less localised in younger)
Aggravated by moving (e.g. jump, cough, speed bumps)
Tenderness/guarding at McBurney’s

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What are some features of an atypical presentation of acute appendicitis? (2) which may seem like other DDx

Diarrhoea + RIF pain (Gastroenteritis)

Abnormal urine dip (UTI)

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What are some features of a late presentation of acute appendicitis? (2)

Abscess/palpable mass

Perforation

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What is meckel’s diverticulum + what is its incidence in the general population?

What conditions may it lead to? (4)

How is it treated?

Ileal remnant of vitello-intestinal duct (gastric+panc)
2% all people

→ intussusception / volvulus (obstruction)
→ diverticulitis (abdo pain mimicks appendicitis)
→ lower GI bleeding

Tx: surgical resection

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What is intussusception + what age group does it occur in?

Part of bowel invaginating into distal

B/wn 3m-2yrs

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How does intussusception present? (3)

What are some late signs? (4)

Sudden episodes
Colicky pain
Abdo mass

Bloody/mucus (redcurrant jelly) stool (late sign)
Lethargy
Hypotonia
Shock

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How is intussusception treated? (2)

Rectal air insufflation

If fails → surgery

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What causes malrotation?
What is the commonest form/ what condition occurs as a consequence

How does malrotation present? (3)
How treated

Unfixed mesentery (duodenojejunal / ileocaecal) = shorter mesenteric base
Caecal fixation to high posterior wall
→ Ladd bands cross duodenum (Obstruction) + Volvulus

Presents: Abdo pain, Bilious vomiting, Obstruction
Tx: urgent surgical correction

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What is pyloric stenosis
What are the RFs ? (3)

What are the features/presentation? (5)

Pylorus hypertrophy → gastric outlet obstruction
RFs: Male (4:1), 1st born, FH (esp maternal)

2-7wks (regardless gestation)
Projectile + progressively frequent VOMITING
Hunger after vom → dehydration → lost interest (Wt loss if delayed)
Visible gastric peristalsis

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What Ix are done for pyloric stenosis?

How is it managed? (2)

Test feed (palpable abdo mass + vom)
USS
U&Es (hyponat/kal/chlor)

Immediate fluid resuscitation (saline/gluc/K+)
Pyloromyomotomy (preserves mucosa)

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What would be seen on AXR in duodenal atresia?

Double bubble + absence of air distally

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How does an inguinal hernia occur?

What are the RFs (2) / incidence

Incomplete obliteration of processus vaginalis

Boys/ Premature (1 in 50 boys)

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What situations would indicate more urgent surgery for inguinal hernia? (2)

Firm/tender/irreducible

Infant irritable/vomiting (risk strangulation/testes damage) (but delay 48hrs allowing oedema to resolve)

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How does a hydrocele occur?
How does it present (5)
How managed?

Patent processus vaginalis (not wide enough for inguinal hernia but enough for peritoneal fluid to pass)

Present at birth /early childhood (post-viral/GI illness)
Asymp (usually bilateral) scrotal swelling
Transilluminable
Non-tender
Bluish discolouration

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What is a varicocele?
How does it present? (2)
What are the complications? (2)

Varicosities of testicular vv’s

Usually L sided
Drag/ache/asymp

Risk impaired testicular growth / infertility

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What is the incidence of undescended testis (cryptochordism) in term babies? + by 3m old?

What Ix (other than clinical Ex) can be done? (3)

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4% term babies
1.5% by 3m

USS (obese boys)
Testosterone levels (HCG stimulated) (if suspect absent)
Laparoscopy

What conditions (2) may appear to have a ‘missing’ testicle later in life? (school/adolescence)

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Retractile
Ascending (relative shortening of cord during growth)

What 2 possible operations are done in undescended testis?

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Orchidoplexy (mobilised + preserves vas)

Orchidectomy (for intra-abdo testis in older)

What complications may occur if an undescended testicle is not operated on? (3)

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Sub/Infertility (plexy by 2y/o = normal; bilateral plexy = 50%)
Malignancy (histologically abn)
Cosmetic / psychological

What are the DDx of acute scrotal pain? (5)

What age group does each usually present in?

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Testicular torsion (adolescent 12-18)
Hyatid torsion (pre-adolescent 8-12)
Epididymal cyst torsion/ epididymitis (middle aged men)
Epididymo-orchitis (<35 - STI/UTI)
Idiopathic scrotal oedema (<10)

What 2 anatomical features are often present in testicular torsion?

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Bell-clapper testis (not anchored properly)

Usually L sided (higher)

List the indications for circumcision? (3)

List the complications? (4)

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Pathological phimosis (Lichen sclerosis - unretractable foreskin)
Recurrent UTIs
Recurrent balanoposthitis

Bleeding
Infection
Glans damage
Psychological trauma

How may labial adhesions present? (3)

How treated?

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Appears absent vagina (minor adhered)
Perineal soreness
Urinary irritation

Topical oestrogen for 1-2wks

What are some RFs of cleft lip/palate? (2) | Some associated conditions/problems with it? (2)

RFs: chromosomal disorders (polygenic), maternal anticonvulsants Feeding difficulties Secretory/acute otitis media

How would a diaphragmatic hernia present? (3) How Dx What associated problems

Newborn resp distress Displaced apex beat (to R) Displaced heart sounds (to R) CXR/AXR Pulm hypoplasia

How may trachea-oesophageal fistula ± atresia present after birth? (4) How is it managed?

Persistent salivation / drooling Cough/choke when feed Aspirations of milk/saliva/gastric acid (fistula) Cyanotic episodes Continuous suction + surgery

What is trachea-oesophageal fistula ± atresia assoc w.?

Polyhydramnios | VACTERL

What is the difference b/wn exomphalos + gastroschisis? How are they both managed? (3)

Exomphalos = abdo contents portruding thru umbilical ring WITHIN peritoneal sac. Often csome abns Gastroschisis = no covering sac - abdo wall defect adjacent to umbilicus. No assoc congen abns NG tube + freq aspirations IV dextrose + colloid Surgical closure

What is exomphalos also assoc w.? (3)

``` Csome abnormalities (Trisomy, Turner, Kleinfelter) Bladder + cloacal exostrophy Pentalogy of Cantrell (exomph, ant diaph hernia, cleft sternum, ectopic cord, cardiac defect) ```

What are the different types of congenital neck cysts in children? (6)

``` Thyroglossal (midline) Branchial (front/side) Dermoid/teratoid Lymphatic malformation Ectopic thymus Cystic vascular abn ```

How may a Wilm's tumour present? (4)

Large abdo mass in well child Abdo pain Anorexia Haematuria

How may a Neuroblastoma present? (7)

``` Abdo mass crossing midline Spinal cord compression Bone pain Wt loss Malaise Pallor Bruising ```

What is the incidence of Hirschprungs? | List some RFs/associated conditions (6)

1 in 5000 ``` Boys FH Down's Multiple endocrine neoplasia Malrotation Gastric diverticulum ```

Describe the pathophysiology behind Hirschprungs

Due to absence of ganglion cells from myenteric + submucosal plexuses in colon → Contracted segment from rectum to colon (varies) (75% rectosigmoid)

How does Hirschprung's disease present in neonates? (3) | What seen O/E (PRE)

Failure to pass meconium in 1st 24hrs ``` Neonatal intestinal obstrn: Abdo distension Bilious vom (seen more in obstrn above ampulla of vater) ``` O/E: narrow segment + withdrawn finger → gush

If Hirschprungs is missed in the neonate, how may it present in infants / older children?

Chronic constipation resistant to Tx | Early satiety + abdo discomfort → poor nutrition / wt gain

How is Hirschprung's Dx / managed?

Dx - suction rectal biopsy (shows absent ganglion cells) To estimate aganglionic segment → anorectal manometry / barium enema Surgical Tx: initial colostomy → anastomose normal innv bowel to anus

What are some complications of Hirschprungs? (3)

Hirschprung's enterocolitis in 1st wks of life (C.Diff) Sepsis Transmural intestinal necrosis / Perforation

What are the features of Hirschprungs enterocolitis (a complication)? (4) How it is managed?

Fever Abdo pain Vomiting Bloody/foul diarrhoea → Urgent broad spec IV Abx + fluids

Surgery Flashcards

(40 cards)