Surgery in Children

Question 1

When do children with pyloric stenosis present?

Answer 1

At about 6 weeks old

Question 2

How does pyloric stenosis present?

Answer 2

Projectile vomiting of milk, was previously feeding normally, bumps on abdomen that move downwards, peristalsis visible

Question 3

Why does obstruction occur with a pyloric stenosis?

Answer 3

Hypertrophy of muscle of pylorus wall blocks outlet of stomach

Question 4

How is pyloric stenosis investigated?

Answer 4

Ultrasound scan

Question 5

How does metabolic disturbance arise in pyloric stenosis?

Answer 5

Babies vomit acid which causes metabolic disturbance

Question 6

How is pyloric stenosis treated?

Answer 6

Correct metabolic disturbance with fluid before surgery

Cut slit in hypertrophic muscle

Question 7

How old are most children when they present with intussusception?

Answer 7

6 months old

Question 8

How does intussusception present?

Answer 8

Tummy pain that comes in cycles, vomiting food, not pooing, blood coming out of bottom

Question 9

What may be seen on the abdomen of a child with intussusception?

Answer 9

Bumps above pubic region and in abdomen itself = can feel sausage-like structures on palpation of abdomen

Question 10

What appearance does the blood in a nappy of a child with intussusception have?

Answer 10

Looks like red currant jelly

Question 11

How does intussusception appear on USS?

Answer 11

Swirl = target lesion appearance front on, pseudo-kidney appearance from side view

Question 12

What is intussusception?

Answer 12

Part of intestine folds into the next part, causing an obstruction

Question 13

What intervention is tried before surgery to try to correct intussusception?

Answer 13

Blow air up anus into intestines = works in 80% of cases

Question 14

How may pain arise in intussusception?

Answer 14

Peyer’s patches in bowel wall become inflamed

Question 15

How does appendicitis present?

Answer 15

Older child (able to talk), sore tummy, pain is worse with movement, moderate temperature , pain on right side

Question 16

What does pain on movement usually indicate in a child with appendicitis?

Answer 16

Associated peritonitis = child usually reports going over speed bumps at hospital made pain worse

Question 17

What is a useful test for peritonitis associated with appendicitis?

Answer 17

Ask child to jump up and down = child will either refuse because its too sore or will report pain

Question 18

What treatment does peritonitis call for?

Answer 18

Surgery

Question 19

Why may appendicitis cause peritonitis?

Answer 19

Inflamed appendix causes local irritation of peritoneum

Question 20

What should you always assume the underlying cause of a baby vomiting moss green fluid is until proven otherwise?

Answer 20

Malrotation with volvulus

Question 21

How can you test for malrotation with a volvulus?

Answer 21

Put contrast down bowel = if it swirls then there is malrotation

Question 22

Is testicular tortion a surgical emergency?

Answer 22

Yes = requires urgent surgery to save testicle

Question 23

How long do you have to save a testicle that has undergone tortion?

Answer 23

4 hours

Question 24

What are some causes of a sore scrotum?

Answer 24

Testicular tortion, twisted hydatid of Morgagne, epididymo-orchitis

Question 25

How may a twisted hydatid of Morgagne present?

Answer 25

Sore swollen scrotum, may be able to see blue dot under skin

Question 26

What is the main cause of the acute scrotum?

Answer 26

Twisted hydatid of Morgagne = embryological remnant

Question 27

What may be seen in a patient with epididymo-orchitis?

Answer 27

Swollen and red epididymis

Question 28

How does idiopathic scrotal oedema present?

Answer 28

Redness extending to peritoneum and groin, not sore, may be achy, tissue may look water-logged

Question 29

What may idiopathic scrotal oedema be related to?

Answer 29

Allergic reaction

Question 30

How is idiopathic scrotal oedema treated?

Answer 30

Self resolves = may be given anti-histamines and pain killers (no operation needed)

Question 31

What does BXO stand for?

Answer 31

Balanitis xerotica obliterans

Question 32

What is BXO?

Answer 32

Thin white scaly patch on foreskin = usually scarring, may extend into urethra, often difficulty passing urine

Question 33

How is BXO treated?

Answer 33

Circumcision

Question 34

What is hypospadias?

Answer 34

Urethra doesn't come out of the tip of the penis = needs surgery to correct

Question 35

How does a patent processus vaginalis present?

Answer 35

Unilateral swelling that isn't there in the morning but reappears at night, not sore, may appear blue, transilluminates

Question 36

What causes the symptoms of patent processus vaginalis?

Answer 36

Tunnels that the testes used to descend of abdomen remains open and fluid is able to fill this space

Question 37

When should a patent processus vaginalis be operated on?

Answer 37

If it persists beyond age 4

Question 38

Why is transillumination not a reliable test for patent processus vaginalis in babies?

Answer 38

Many things (ie hernias) will transilluminate in babies as the structures in this age group are thin

Question 39

What is a useful test when feeling for a testicle that is "unpalpable"?

Answer 39

Smear liquid soap on child and sweep thumb down the canal = teste should bounce back up against thumb if present