Surgery in Paediatrics

Question 1

Which is the important age to keep in mind for kids?

Answer 1

6 weeks 6 months 6 years

Question 2

Which part of the bowel might be affected in projectile vomiting of milk?

Answer 2

pyloric stenosis

Question 3

What are the bumps seen in the abdomen in pyloric stenosis?

Answer 3

the peristalsis in the bowels pushing against the pylorus

Question 4

Why is 6 weeks crucial for pyloric stenosis in babies?

Answer 4

as the pylorus thickens in 6 weeks, it causes a physical obstruction that prevents the breastmilk from getting digested

Question 5

What surgery is done to treat pyloric stenosis?

Answer 5

Pyloromyotomy (cutting the pyloric muscle –> as far as the x, or else you will cut through the mucosa) open or laparoscopic

Question 6

Common features of pyloric stenosis

Answer 6

projectile vomiting 6 weeks rumbling bumps in the stomach usually in winter

Question 7

6 months, child vomits yellow, food, slightly floppy, , sausage-like mass in the abdomen (right or left), blood/ redcurrant jelly in the nappy

Answer 7

intussusception

Question 8

How serious is intusseption?

Answer 8

very serious kids can die due to dehydration

Question 9

What investigations will be helpful in intusseption?

Answer 9

US

Question 10

What are the features seen in intusseption US?

Answer 10

-bulls-eye sign - concentric - 6 months -pseudo-kidney shape -one part of the bowel folds into the other part like a telescope -causes a blockage

Question 11

How do you manage intusseption?

Answer 11

1. Resuscitation to prevent dehydration and shock
2. Barium/ Air enema: No laparoscopy or surgery usually - resuscitate them - take them to radiology, push a tube in and push the air into the bottom and push the folding out and stretch it -
3. if it doesn’t work use laparoscopy - dark colour circle - folded in part

Question 12

What does the fact that “jouney into the hospital with lumps and bumps on the roads feeling bad” indicate?

Answer 12

peritonitis - inflammation of the peritoneum

Question 13

Which condtition is common in 6 year olds?

Answer 13

peritonitis and appendicitis

Question 14

What is an important thing to do to find out more info in children with abdominal pain?

Answer 14

Observation ask them to jump (many can’t/ some can) if they can’t jump –. indicative

Question 15

What are the features of peitonitis?

Answer 15

mild fever apprehension to movement (jumping, bumps on roads)

Question 16

What investigations are done in peritonitis?

Answer 16

US

Question 17

What surgery is done

Answer 17

Laparoscopic open surgery - rare

Question 18

What is the important key to note if babies come in vomiting green at night?

Answer 18

DO NOT USE the word BILE

differentiate btw yellow or green!!!

green - dark like fairy liquid

exclude - Malrotation/ midgut volvulus ** IMPORTANT - ask for help

Question 19

What are the important of the two fixed points in the bowel?

Answer 19

the longest distance in the stomach and the blood supply to the mid-gut –> SMA stable - if the bowel is in the area What ahppens if the mi

Question 20

What happens if the 2 fixed points are changed?

Answer 20

the mid-gut area is not stable and likely to twist Mid-gut volvulus and Malrotation

Question 21

What does a baby vomiting green imply?

Answer 21

can be a malrotation, leading to mid-gut volvulus hence bile comes

Question 22

How do you investigate green vomit?

Answer 22

using Contrast Imaging (from pylorus to duodenum) like corkscrew

Question 23

What surgery do you do for malrotation?

Answer 23

Laparoscopic

Question 24

What happens if the mid-gut is black

Answer 24

the gut is necrotic, can’t save it

Question 25

What are some common clinical signs seen in scrotum?

Answer 25

-blue dots on the top of the testicle -red inflammation - torsion and twisitng of the testicle - black dot on the testicle (twisted and necrotic)

Question 26

What is a very serious condition of the scrotum in kids?

Answer 26

torsion of the testicle

Question 27

Which is the most common cause of an acute scrotum with a black dot?

Answer 27

testis hydatid/ Appendix of the testis

Question 28

What should be done if the scrotum is inflammed?

Answer 28

scrotal oedema usually just an allergy not serious

Question 29

What is a normal genitourinary condition in boys?

Answer 29

no scar slight shouldering, pink

Question 30

What is an abnormal but common genitourinary condition in boys?

Answer 30

scarred, fissured, small opening BXO (Balanitis xerotica obliterans/ Lichen sclerosus)

Question 31

Which system shows the most common genital abnormalities in kids?

Answer 31

Urinary

Question 32

How can you identify a Hydrocoel?

Answer 32

Transillumination ( clear fluid surrounding the testicle) but not always right -\> do US to rule out hernias or malignancies don't be reassured (can be just hydrocele or something else as well)

Question 33

Name the condition in which the testicle is not in the scrotum by 6 months of age?

Answer 33

Unilateral or bilateral cryptorchidism Surgery (orchidopexy) and put the testicle in a place where it can be examined -\> o (as it can lead to tumours in the future)

Question 34

How is fertility improved if the testicle is brought down from the groin?

Answer 34

not much if surgery has been done but if caught early before 6 months of age, better prognosis in the a young boy

Question 35

What do you do if the testicle hasn't come down into the scrotum?

Answer 35

Try feel it along the tract upwards and Do a Laparoscopy can't leave testicle on the inside

Question 36

what should be looked for in the laparoscopy

Answer 36

-blood supply to the testicle (testicular artery from aorta) - white tube (vas deferens)

Question 37

what should be looked for in the laparoscopy

Answer 37

-blood supply to the testicle (testicular artery from aorta) - white tube (vas deferens) - testicle at the end of the blood vessels

Question 38

Where do the testicular artery and vas deferens meet?

Answer 38

closed deep ring

Question 39

What happens if there are spider webs but blood supply to the testicle okay?

Answer 39

okay, reassure them, no tumour in the future

Question 40

What if the deep ring is open and what surgery is done?

Answer 40

chop the testicular artery from aorta, come back in 3-6 months (blood supply from below has become stronger has stronger) swing the testicle down to the scrotum

Question 41

What is testis hydatid/ hydatid of Morgnani/ appendix of the testis?

Answer 41

It is the vestigial remnants of the Mullerian duct in males, present on the upper pole of the testis, attached to the tunica vaginalis. Very common Significant if there is pain and can lead to one-sided testicular torsion palpable blue dot discolouration on the scrotum

Question 42

What test is done to investigate pyloric stenosis?

Answer 42

US