Surgical Problems in Children

Question 1

6 weeks old with abdominal swellings and severe vomiting?

Answer 1

pyloric stenosis

Question 2

why do babies vomit in pyloric stenosis?

Answer 2

stomach is peristalsing to push milk through the pylorus but due to a high up obstruction high up in the GI tract it is vomited back up

Question 3

what colour is the stomach on USS?

Answer 3

black

Question 4

what confirms pyloric stenosis on USS?

Answer 4

very thick muscle depth

Question 5

what is the procedure done in pyloric stenosis?

Answer 5

pyloromyotomy

Question 6

6 month old child with vomiting, no defecation, up at night with pain and then goes limp?

Answer 6

intussusception

Question 7

what is the classic appearance of stool in intussusception?

Answer 7

bloody like redcurrant jelly

Question 8

findings on abdo exam of a child with intussusception?

Answer 8

soft in some areas, hard in others

“sausage shaped mass”

Question 9

how could you differentiate intussusception and colic?

Answer 9

intussusception= pale child that goes limp
colic= red, angry child

Question 10

cause of intussusception?

Answer 10

telescoping and folding of the bowel in on itself causing swelling and obstruction in the terminal ileum and caecum

Question 11

why is the immune response so high in intussusception?

Answer 11

lots of lymph nodes in terminal ileal / caecal area

Question 12

what classic sign on USS demonstrates intussusception?

Answer 12

target (bullseye) appearance

Question 13

how is intussusception treated surgically?

Answer 13

blowing air via the anus to push it along the bowel

Question 14

6 year old with tummy pain and “hated the journey to the hospital as it was bumpy”

Answer 14

peritonitis

Question 15

what examination tests should be done to determine if a child needs surgery or not?

Answer 15

ask them to jump- GE kids will be able to, appendicitis kids wont
just try and find the sore area, dont do a full abdo unless necessary

Question 16

what kind of temperature to kids with a UTI get?

Answer 16

high grade

Question 17

what kind of temperature do kids with appendicitis get?

Answer 17

low grade

Question 18

why is it important to do a whole body examination?

Answer 18

a child may associate pain with the wrong area eg abdo pain that is actually chest pain

Question 19

why shouldnt you say “bile” when talking to patients with bile vomitus?

Answer 19

the colour of it varies so you are better to ask about the colour of the vomit

Question 20

what bile colour is the most severe?

Answer 20

green

Question 21

what does green bile indicate?

Answer 21

malrotation

Question 22

what is malrotation?

Answer 22

gut not sitting in correct orientation that can twist and decrease blood supply via the SMA

Question 23

where does the obstruction occur in malrotation?

Answer 23

high in the duodenum but below where pyloric stenosis happens

Question 24

most common cause of acute scrotum?

Answer 24

leftover malarian ducts (female embryological remnant) in boys

Question 25

how many hours to act on a testicular torsion?

Answer 25

4-6hrs

Question 26

what has the same presentation as testicular torsion?

Answer 26

epididymitis

Question 27

what presentation suggests leftover malarian ducts as the cause of an acute scrotum?

Answer 27

blue dot on testes

Question 28

acute, itchy scrotum with redness that radiates to the groin and perineum?

Answer 28

idiopathic scrotal oedema

Question 29

treatment for idiopathic scrotal oedema?

Answer 29

antihistamines and pain relief

Question 30

most common abnormality of the GU tract in boys?

Answer 30

hysospadus