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1

What are common presentations requiring paediatric surgery?

Vomiting child

Acute abdomen

Acute scrotum

2

What factor influences the presentations you see in paediatrics?

Age

3

6 is an important number in paediatric surgery

4

6 weeks:

pyloric stenosis causes OBSTRUCTION and abdominal muscle contracts trying to push it into duodenum

> abdominal mass, vomiting after eating/drinking

5

abdominal muscle hypertrophies around pyloric stenosis and can be measured on ultrasound

stenosis itself caused by hypertrophied circular muscle layer of stomach

6

surgical treatment for pyloric stenosis = pyloromyotomy

7

6 months:

abdominal pain (pulling legs up) > limpness

pale (differentiates from colic, in which they're pink)

struggling to stool (which is bloody)

hard "sausage-shaped" mass in abdomen

> obstruction due to INTUSSUSCEPTION

8

Explanation of intussceception - bowel is "telescoping" on itself, swelling, then obstructing

Occurs around iliocaecal junction and travels along large bowel

"Target sign" (kidney bean laterally) on ultrasound - layers of bowel on top of one another

Treated by air enema

9

6 years:

young boy, hands on abdomen, bent over

history of pain on speed bumps???

can't jump  (and other general markers like dragging right leg)

low grade fever

> APPENDICITIS > PERITONITIS

10

viral infections - viruses tend to be swallowed and accumulate at appendix - right inguinal pain

they can jump tho :)

> mesenteric lymphadenitis

11

kids may describe their pain as abdominal and then have pneumonia - take history and examine / investigate properly

ask all children with abdominal pain if they can pass urine

12

bile is yellow when it's produced

green when it's vomited up (digestion by stomach acid)

13

newborn vomiting bile (green)

> assume MALROTATION

duodenum and caecum aren't fixed in normal places

allows rotation of large bowel around duodenum (where the bile duct enters)

so bile can enter the stomach and be vomited up

(also the blood supply is cut off and bowel starts to die off due to ischaemia)

14

green vomiter > malrotation > report immediately

15

acute scrotum:

testicular torsion - cannot miss it

epididymitis

mullerian duct remnants (i.e remnants from the female reproductive system) - MOST COMMON ; "blue dot", less pain than torsion

16

red, swollen, itchy scrotum, rash on groin and perineum

idiopathic scrotal oedema

 

17

closed foreskin is normal

18

- obliterans

requires circumcision

find out what this is

19

if swelling is ridiculous, squeeze it

20

most common congenital abnormality of male genitalia:

hydrospadias

urine exits below penis rather than through head - UG tracts are separate

21

bowel can herniate into scrotum

may be mistaken for a hydrocele using transillumination

22

undescended testicles

apply soap - "pop" - groin surgery to move it down

no pop - laparoscopic approach to rule out testicular tumour (testicle may be absent or malignant up in the abdomen)

23