4: Common surgical problems in children (notes)

Question 1

What are common presentations requiring paediatric surgery?

Answer 1

Vomiting child

Acute abdomen

Acute scrotum

Question 2

What factor influences the presentations you see in paediatrics?

Answer 2

Age

Question 3

6 is an important number in paediatric surgery

Question 4

6 weeks:

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

> abdominal mass, vomiting after eating/drinking

Question 5

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

stenosis itself caused by hypertrophied circular muscle layer of stomach

Question 6

surgical treatment for pyloric stenosis = pyloromyotomy

Question 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

Question 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

Question 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

Question 10

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

they can jump tho :)

> mesenteric lymphadenitis

Question 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

Question 12

bile is yellow when it’s produced

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

Question 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)

Question 14

green vomiter > malrotation > report immediately

Question 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

Question 16

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

> idiopathic scrotal oedema

Question 17

closed foreskin is normal

Question 18

• obliterans

requires circumcision

find out what this is

Question 19

if swelling is ridiculous, squeeze it

Question 20

most common congenital abnormality of male genitalia:

hydrospadias

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

Question 21

bowel can herniate into scrotum

may be mistaken for a hydrocele using transillumination

Question 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)