Surgical Conditions

Question 1

What is Balanitis Xerotica Obliterans?

Answer 1

Keratinisation of the Foreskin leads to scarring and a non-retractile prepuce.

Question 2

What are some features of Balanitis Xerotica Obliterans?

Answer 2

Ballooning of Foreskin with Micturition

Urethral Scarring - Irritation, Dysuria, Haematuria, Local infection

Question 3

What is seen on examination of BXO?

Answer 3

White, Fibrotic Foreskin

Question 4

What is the management of BXO?

Answer 4

Circumcision and Histopathology

Question 5

What are some potential complications of BXO treatment?

Answer 5

Surgical complications - Bleeding, infection, post-op swelling
Meatal stenosis
Phimosis
Glans/prepuce erosions

Question 6

What is Hypospadias?

Answer 6

Congenital defect leaving the urethral meatus located elsewhere than the end of the penis

Question 7

What are some features of Hypospadias?

Answer 7

Ventral opening for Urethral Meatus
Ventral Curvature of the Penis
Dorsal Hooded Foreskin

Question 8

What could Hypospadias also be suggestive of, and how should this be managed?

Answer 8

Disorder of Sex development if also combined with Cryptorchidism. Investigate through Karyotype and Pelvic USS

Question 9

How is Hypospadias treated?

Answer 9

Urethroplasty

Question 10

What are some short-term complications of Hypospadias treatment?

Answer 10

Blockage of catheter
Pain and Bladder Spasms
Bleeding
Infection

Question 11

What are some long-term complications associated with treatment of Hypospadias?

Answer 11

Urethral fistula

Meatal/Urethral Stenosis

Question 12

What is Cryptorchidism?

Answer 12

Absence of 1/both testicles in the scrotum due to failure to descend

Question 13

In Cryptorchidism, where can the missing testicle be found?

Answer 13

True Undescended - Lies along the line of descent
Ectopic - Found elsewhere within the abdomen
Ascending - Found initially within scrotum, then ascends

Question 14

What are some risk factors for Cryptorchidism?

Answer 14

Prematurity
Low birth weight
Other genital abnormalities
FHx in a first degree relative

Question 15

At what age does Cryptorchidism warrant investigation/management?

Answer 15

3m - Refer to surgeons for open orchidopexy or laparoscopy

Question 16

What are some complications associated with Cryptorchidism?

Answer 16

Impaired fertility
Testicular cancer
Testicular torsion

Question 17

What is Hirschprung’s Disease?

Answer 17

A congenital disease where ganglionic cells don’t develop in large intestine

Question 18

Which types of Hirschprung’s disease are there?

Answer 18

Short Segment
Long Segment
Total

Question 19

What are some risk factors for Hirschprung’s disease?

Answer 19

Male
Chromosomal Abnormalities - T21
FHx

Question 20

What are some symptoms suggestive of Hirschprung’s disease?

Answer 20

Failure to pass Meconium in 48h
Abdominal distension
Bilious Vomiting
Palpable mass
Empty Rectum

Question 21

Which investigations are appropriate for suspected Hirschprung’s disease?

Answer 21

AXR
Contrast Enema
Rectal Suction biopsy

Question 22

How should confirmed Hirschprung’s disease be managed?

Answer 22

IV Abx
NG Bowel Decompression
Surgical resection of the affected area

Question 23

What are possible complications of Hirschprung’s disease?

Answer 23

Hirschprung Associated Enterocolitis - Due to bacterial overgrowth
Surgical complications - Bleeding, infection, wound dehiscence.

Question 24

What is Intusussception?

Answer 24

Telescoping of one aspect of bowel into another

Question 25

What are some causes of Intusussception?

Answer 25

``` Idiopathic Meckel Diverticulum Polyps Henoch-Schoenline Purpura Lymphoma Post-operative ```

Question 26

What are some symptoms of Intusussception?

Answer 26

Uncontrollable Crying Pallor Knees drawn to chest Red Current Stools - Pathognonomic

Question 27

Which investigation is recommended for suspected Intusussception, and what will it demonstrate?

Answer 27

Abdominal USS - Doughnut on transverse plane

Question 28

What are potential management options for intusussception?

Answer 28

Non-surgical reduction via air enema | Surgical reduction

Question 29

If untreated, what are some complications of intusussception?

Answer 29

Obstruction Perforation Dehydration Shock

Question 30

What is Pyloric Stenosis?

Answer 30

Progressive hypertrophy of pyloric muscle leading to gastric outlet obstruction

Question 31

What are some risk factors for Pyloric Stenosis?

Answer 31

Male | FHx

Question 32

How does Pyloric Stenosis present?

Answer 32

4-6w history of Forceful Non-Bilious Projectile Vomiting after every feed Still hungry after feeds W/loss and dehydration

Question 33

What may be apparent on examination of Pyloric Stenosis?

Answer 33

Visible waves of peristalsis | Olive-sized pyloric mass when feeding

Question 34

What investigations are appropriate for suspected Pyloric Stenosis?

Answer 34

Test Feed with NGT USS - Pyloric Muscle Hypertrophy ABG - Hypokalaemic Hypochloraemic Metabolic Alkalosis

Question 35

What is the recommended management for confirmed Pyloric Stenosis?

Answer 35

NG Feed, Hydrate at 150ml/kg/day

Question 36

Which surgical procedure is the definitive management of Pyloric Stenosis?

Answer 36

Ramsteadt's Pyloromyotomy

Question 37

When after surgical correction of Pyloric Stenosis can the baby feed, and which advice should be given to the relatives?

Answer 37

6h, post-operative vomiting is common

Question 38

What are some pre-operative complications of Pyloric Stenosis?

Answer 38

Hypovolaemia | Apnoea

Question 39

What are some post-operative complications of Pyloric Stenosis?

Answer 39

Bleeding | Infection