1
Q
What is intestinal atresia?
A
Vascular accident in utero resulting in failure of segment to develop
Can be dependent on the level of vascular accident.
2
Q
What are the types of intestinal atresia?
A
- Type 1 - web between 2 segments
- Type 2 - fibrous chord
- Type 3a - v shaped defect
- Type 3b - Christmas tree or apple peel
- Type 4 - multiple defects
3
Q
What are common presentations of intestinal atresia?
A
- Vomiting
- Abdominal distension
- Excessive irritability
- Failure to pass meconium
4
Q
What is gastrochisis?
A
A midline defect to the right side of the upper abdomen as a result of obliteration of right umbilical vein in utero
Incidence is 1:3000.
5
Q
What characterizes the bowel condition in gastrochisis?
A
The bowel being completely outside with no protective covering
6
Q
What is the management for gastrochisis?
A
- NGT
- Urgent surgical repair or non-surgical (Dacron elastic)
- Admit
- Minor - surgical repair in 2 layers
- Major - conservative management with honey, formaldehyde, antibiotics
7
Q
What are potential complications of gastrochisis?
A
- Rupture
- Peritonitis
8
Q
What is exomphalos?
A
Umbilical defect occurring when the outpouching of the midgut fails to return during the 4th to 10th week of intrauterine life
9
Q
What covers the defect in exomphalos?
A
A thin membrane called Wharton gel, which forms the amnion and peritoneum
10
Q
What are the classifications of exomphalos based on size?
A
- Major (>5cm)
- Minor (<5cm)
11
Q
What is malrotation?
A
A physiological herniation of the primitive midgut around the 4th week of gestation into the umbilical sac, followed by a rotation of 270 degrees anti-clockwise
12
Q
What are the types of malrotation?
A
- Complete
- Incomplete
- Abnormal rotation
- Non-rotation
13
Q
What are symptoms of malrotation?
A
Can be asymptomatic or present with classical symptoms of obstruction
14
Q
What imaging is used to diagnose malrotation?
A
X-ray shows obstruction with gases in bowels; upper gastrointestinal series may be indicated
15
Q
What is the treatment for malrotation?
A
- Resuscitation
- Surgery
16
Q
What is the incidence of exomphalos or omphalocele?
A
1:6000
17
Q
What congenital anomalies are associated with exomphalos?
A
- Congenital heart disease
- Cleft palate or lip
- Club foot
- Intestinal atresia
- Extrophy of the bladder
- Undescended testes
- Hydrocephalus
18
Q
What is Hypertrophic Pyloric Stenosis?
A
The thickening of the pyloric antrum in the newborn resulting in impairment of the stomach to empty its content into the duodenum.
It is a common cause of gastric outlet obstruction in infants.
19
Q
What is the male to female ratio for Hypertrophic Pyloric Stenosis?
A
4:1
20
Q
What are the main functions of the stomach?
A
- Storage
- Mixing/churning
21
Q
What is the etiology of Hypertrophic Pyloric Stenosis?
A
Unknown, may include genetic factors and maternal usage of macrolides.
Genetic factors may involve extrinsic hormonal factors, smooth muscle cell growth factors, and neurotransmitters.
22
Q
What are the pathophysiological features of Hypertrophic Pyloric Stenosis?
A
- Stasis
- Muscular thickening/hypertrophy
- Stomach dilatation
- Electrolyte derangement
- Malnutrition
23
Q
What are the common clinical presentations of Hypertrophic Pyloric Stenosis?
A
- Non-bilious vomiting
- Projectile vomiting
- Poor weight gain
- Slight haematemesis
24
Q
What is a key diagnostic feature observed in physical examination for Hypertrophic Pyloric Stenosis?
A
Palpable pyloric antrum (Olive)
25
What age group is typically affected by Hypertrophic Pyloric Stenosis?
Typically 4-8 weeks of age.
26
What are the differential diagnoses for Hypertrophic Pyloric Stenosis?
* Duodenal atresia
* Gastroesophageal reflux
* Metabolic alkalosis
* Intestinal malrotation
* Bowel obstruction in the newborn
27
What is the standard imaging technique for diagnosing Hypertrophic Pyloric Stenosis?
Ultrasonography
28
What are the diagnostic features seen in ultrasound for Hypertrophic Pyloric Stenosis?
* Thickness of the pyloric muscle walls greater than 3mm
* Pyloric channel length ≥ 14mm
29
What is the treatment approach for Hypertrophic Pyloric Stenosis?
* Relief of the obstruction
* Surgical care: Pyloromyotomy
* Admission for IV fluid correction
30
What types of fluids may be necessary for IV correction in Hypertrophic Pyloric Stenosis?
* Ringer lactate
* 0.45% isotonic sodium chloride solution
* KCL correction
* 5% D/S
* 0.4% NaCl solution
31
What is the usual incision type for surgical care in Hypertrophic Pyloric Stenosis?
Upper transverse abdominal incision
32
What are the benefits of laparoscopic surgery for Hypertrophic Pyloric Stenosis?
* Shorter recovery
* Good cosmetic outcome
33
What is the management of postoperative care in pediatric patients after surgery for Hypertrophic Pyloric Stenosis?
Commencement of feeding following surgery
34
What is the indication for emergency surgery in the case of an incarcerated hernia?
If an incarcerated hernia cannot be reduced or signs suggest that the hernia is strangulated.
35
When should surgery be scheduled for full-term infants with no history of incarceration?
Surgery should be scheduled as soon as possible on an outpatient basis.
36
What is the risk of incarceration in frank hernias, particularly in premature children?
The risk of incarceration is significant, with as many as 60% of hernias in premature infants becoming incarcerated within the first 6 months after birth.
37
What is a hydrocoele?
A collection of peritoneal fluid in the tunica vaginalis around the testes due to patent processus vaginalis.
38
List the types of hydrocoele.
* Non-communicating
* Communicating
* Hydrocoele of the cord (male)
* Hydrocoele of canal of Nuck (female)
39
What are the common characteristics of unilateral or bilateral hydrocoeles in infants?
They are usually small to moderate in size, asymptomatic, and have a strong tendency to resolve spontaneously in the first year of life.
40
What are the features that differentiate a communicated hydrocele from an inguinal hernia?
* Cystic
* Irreducible
* Trans-illuminable
* No impulse on crying
* Difficult to separate from the testis
* Can get above its proximal limits
41
What is the typical management approach for hydrocoeles in infants?
Observation is often appropriate as many hydrocoeles resolve spontaneously.
42
What complications can arise from an inguinal hernia?
* Incarceration
* Intestinal obstruction
* Strangulation (ischemic necrotic bowel)
* Testicular atrophy due to compression of testicular blood vessels
43
What is the recommended timing for inguinal hernia repair to avoid complications?
Repair should be done soon after diagnosis, ideally within 1 month.
44
What are the signs and symptoms of an incarcerated hernia?
Crying, tense tender swelling in the groin, irreducible without impulse on crying, colicky abdominal pain, vomiting, abdominal distension.
45
What is the embryological origin of the processus vaginalis?
The processus vaginalis is a peritoneal diverticulum that extends through the internal inguinal ring and is dragged with the testis into the scrotum.
46
What is the gender ratio for inguinal hernias in children?
Male to female ratio is 6:1.
47
What is the incidence of indirect inguinal hernia in live births?
1-2 per 100 live births.
48
How can incarcerated hernias be manually reduced?
By administering sedation, elevating the child's buttocks, applying a padded ice pack, and using continuous pressure to compress the hernia.
49
What is the definition of undescended testis (UDT)?
A testis that stopped anywhere along the normal pathway of descent in retroperitoneum between kidney and scrotum.
50
What are the classifications of undescended testis?
* Palpable UDT
* Non-palpable UDT
* Intra-abdominal UDT
* Inguinal canal UDT
51
What is the risk associated with undescended testis?
* Infertility
* Malignancy
* Testicular torsion
* Testicular trauma
* Infection
* Psychosocial effect
52
What is the term for the absence of both testes?
Anorchia.
53
What are the differential diagnoses of groin masses?
* Inguinal Hernia
* Hydrocoele
* Undescended testis
* Femoral hernia
* Reactive or malignant adenopathy
* Sebaceous cyst
* Epididymitis
* Lipoma
* Hidradenitis
* Varicocoele
54
What is the anatomy of the inguinal canal?
An oblique passage above the fold of the groin, extending from deep to superficial ring, approximately 4 cm long.
55
What is the significance of the cremasteric reflex in diagnosing undescended testis?
It is weak in the first 2 years of life, helping differentiate between retractile testis and UDT.
56
What are the indications for hydrocoele repair?
* Failure to resolve by age 2 years
* Continued discomfort
* Enlargement or waxing and waning in volume
* Unsightly appearance
* Secondary infection (very rare)
57
What are the three arteries associated with the testis?
* Aorta
* Differential (artery to ductus)
* Cremasteric (branch of inferior epigastric)
58
Which three nerves are associated with the testis?
* Genital branch of genitofemoral nerve
* Sympathetic nerves
* Ilioinguinal nerve
59
What are the three fascias associated with the testis?
* External spermatic fascia
* Cremasteric fascia
* Internal spermatic fascia
60
List three additional structures found with the testis.
* Ductus deferens
* Pampiniform plexus of veins
* Lymphatics
61
Where does the testis develop?
From the genital ridge in the posterior abdominal wall medial to the kidney
62
What is the gubernaculum testis?
A ligamentous structure that appears at the caudal end of the testis by the end of the 3rd month
63
What is the processus vaginalis?
A pouch of peritoneum pushed through the inguinal canal into the scrotum by the gubernaculum testis
64
When does the testis typically descend into the scrotum?
By the 9th month at birth
65
What is the length of the femoral canal?
1.25cm to 3cm long
66
What structures does the femoral canal contain?
* Lymph node of Cloquet
* Fat
67
What bounds the femoral ring posteriorly?
Pubic tubercle and pectineous ligament
68
What is Hasselbach’s Triangle?
A triangular area in the groin related to inguinal hernias
69
What are the contents of the femoral triangle?
* Femoral canal
* Femoral vein
* Femoral artery
* Femoral nerve
70
What forms the anterior wall of the femoral triangle?
* Skin
* Superficial fascia (containing superficial inguinal nodes and saphenous vein)
* Deep fascia (fascia lata) pierced by femoral vein
71
What bounds the femoral triangle superiorly?
Inguinal ligament
72
Fill in the blank: The floor of the femoral triangle is formed laterally by the _______ and medially by the _______.
[iliopsoas], [pectineus]
73
True or False: The right testis descends later and is responsible for greater anomalies on the left.
False
74
What is hypospadias?
A congenital condition where the opening of the urethra is located on the underside of the penis rather than at the tip of the glans.
75
What are the associated anatomical abnormalities with hypospadias?
* Chordee
* Hooded Prepuce
* Undescended Testes
* Micropenis
* Urethral Diverticula or Fistulas
76
What is chordee?
Ventral curvature of the penis due to fibrous tissue or abnormal skin tethering.
77
What are the clinical features of hypospadias?
* Abnormally placed urethral meatus
* Ventral curvature of the penis (chordee)
* Hooded dorsal foreskin
* Penile torsion or scarring
78
What functional issues can arise from hypospadias?
* Abnormal urine stream
* Risk of urinary tract infections (UTIs)
79
What psychosocial concerns may arise from hypospadias?
Body image concerns or social stigma, particularly in older children and adults.
80
How is hypospadias diagnosed?
Clinical diagnosis during newborn physical examination, noting the position of the meatus, presence of chordee, and appearance of the prepuce.
81
What additional evaluations may be needed in severe cases of hypospadias?
* Karyotyping and Endocrine Testing
* Ultrasound Imaging
82
What are the goals of treatment for hypospadias?
* Restore normal urinary function
* Achieve a straight, cosmetically acceptable penis
* Enable normal sexual function and reproduction in adulthood
83
What is the typical timing for surgical correction of hypospadias?
Usually performed between 6 to 18 months of age.
84
What is the most common surgical technique for distal hypospadias?
Snodgrass (TIP) Repair: Tubularized incised plate urethroplasty.
85
What are the immediate postoperative complications of hypospadias surgery?
* Bleeding
* Infection
* Edema
* Hematoma formation
86
What are the long-term complications associated with hypospadias surgery?
* Urethrocutaneous fistula (10–20% of cases)
* Meatal stenosis
* Urethral stricture
* Residual chordee or penile torsion
* Cosmetic dissatisfaction
87
What factors contribute to the etiology of hypospadias?
* Genetic factors
* Environmental factors
* Ethnicity
* Prematurity
* Multifactorial causes
88
What is the incidence of hypospadias?
Approximately 1 in 200–300 live male births.
89
What embryological development occurs during the 8th to 14th week of gestation related to hypospadias?
The urethral groove forms and fuses along the ventral aspect of the penis.
90
How is hypospadias classified?
* Anterior (Distal) Hypospadias
* Middle Hypospadias
* Posterior (Proximal) Hypospadias
91
Fill in the blank: Hypospadias is classified into four main types based on its location on the penis: Anterior, Middle, and _______.
Posterior (Proximal) Hypospadias
92
What percentage of hypospadias cases are classified as Anterior (Distal) Hypospadias?
70% of cases.
93
True or False: Hypospadias is more common in African populations than in Caucasian populations.
False
94
What is the definition of neonates?
Infants who are within the first 28 days of life.
95
According to Olivia Nelson et al, how are neonates defined for purposes of surgery?
Infants less than 44 weeks postmenstrual age for full term or 60 weeks postmenstrual age for preterm.
96
Why is the neonatal period critical in a baby's life cycle?
It is the period of transition from intrauterine to extrauterine life.
97
What are neonates particularly vulnerable to?
Infections, congenital conditions, birth complications.
98
What type of care do neonatal surgical patients require?
Specialised perioperative care due to anatomical, physiological, and metabolic immaturity.
99
What can predispose neonates to neurodevelopmental disorders?
Lack of timely medical or surgical intervention.
100
What anatomical feature of neonates makes them prone to respiratory distress?
Highly flexible and easily deformable chest walls.
101
What causes a compliant chest wall in neonates?
Cartilaginous rib cage, weak intercostal muscles.
102
What are the risks associated with high airway resistance and low functional residual capacity in neonates?
Increased risk of atelectasis and hypoxia.
103
What condition predisposes preterm neonates to respiratory distress?
Immature surfactant production.
104
In the cardiovascular system, what is cardiac output dependent on in neonates?
Heart rate due to limited myocardial contractility.
105
What circulatory condition can affect perioperative hemodynamics in neonates?
Persistent fetal circulation.
106
What makes neonates prone to bradycardia?
Immature autonomic regulation.
107
What is a key risk factor for hypothermia in neonates?
High surface area-to-body mass ratio.
108
What contributes to poor thermoregulation in neonates?
Immature hypothalamic function and limited brown fat reserves.
109
What results from immature renal function in neonates?
Poor urine concentration, sodium retention, and delayed drug clearance.
110
What gastrointestinal issue is common in neonates due to immature gut motility?
Feeding intolerance and necrotizing enterocolitis (NEC).
111
What increases the risk of aspiration during anesthesia in neonates?
Delayed gastric emptying.
112
What hematological condition can increase bleeding risks in neonates?
Reduced clotting factor synthesis.
113
What may require blood transfusion during major surgeries in neonates?
Physiological anemia of infancy.
114
What is a common surgical condition in neonates involving the diaphragm?
Congenital diaphragmatic hernia (CDH).
115
What is a challenge during anesthesia in neonates?
Difficult airway due to anatomical features.
116
What is a significant risk for postoperative apnea in neonates?
Prematurity.
117
What type of monitoring is essential in postoperative care for neonates?
Close monitoring in neonatal intensive care units (NICU).
118
What approaches are used for pain management in neonatal surgery?
Multimodal approaches including opioids, local anesthetics, non-opioids.
119
What is crucial for parental consent and counseling in neonatal surgery?
High-risk procedures.
120
What must be discussed in decision-making for life-threatening anomalies?
Multidisciplinary discussions.
121
What are the implications of neonatal surgical care in resource-limited settings?
Cost implications and accessibility.
122
True or False: Neonatal age is associated with increased risk of infant mortality.
True.
123
Fill in the blank: A detailed understanding of complications is essential to prevent or reduce _______.
infant mortality.
124
What is Hirschsprung’s disease?
A disorder of the gut caused due to congenital absence of the Meissner & Auerbach autonomic plexus (aganglionosis) in the sub-mucosal and myenteric plexus of the intestine
## Footnote
Also known as Megacolon or congenital aganglionic Megacolon
125
What is the incidence of Hirschsprung’s disease?
Occurs in 1 in 5000 live births
## Footnote
More common in males than females
126
What are the risk factors associated with Hirschsprung’s disease?
* Family history
* Male gender
* Associated syndromes (e.g., Down syndrome, Mowat-Wilson syndrome)
* Certain genes (e.g., EDNRB, EDN3)
## Footnote
The etiology is thought to be the failure of migration of neural progenitors from the neural crest.
127
What are the clinical features of Hirschsprung’s disease in neonates and infants?
* Failure to pass meconium within 24-48 hours
* Abdominal distension within 1-2 days after birth
* Bile stained vomiting
* Enterocolitis due to fecal stagnation
## Footnote
Enterocolitis may lead to dehydration and sepsis.
128
What are the clinical features of Hirschsprung’s disease in older children?
* Constipation with abdominal distension due to mass of feces and gas
* Foul smelling stools
* Ribbon-like stools
* Protruding abdomen
129
What diagnostic evaluations are used for Hirschsprung’s disease?
* Barium enema
* Rectal suction or surgical biopsy
* Rectal manometry
## Footnote
Diagnosis should be made as soon as possible to avoid complications.
130
What are the key findings of a barium enema in Hirschsprung’s disease?
May show a transition in diameter between the dilated, normally innervated colon proximal to the narrowed distal segment which lacks normal innervation
131
Why should a barium enema not be done in patients suspected of having Hirschsprung enterocolitis?
Due to the risk of perforation
132
What does a rectal suction biopsy reveal in Hirschsprung’s disease?
The absence of ganglion cells
133
What does rectal manometry reveal in Hirschsprung’s disease?
A lack of relaxation of the internal anal sphincter upon balloon insufflation of the rectum
134
What is the aim of surgical management in Hirschsprung’s disease?
To remove the aganglionic bowel followed by anastomosis of the remaining portion
135
What is Stage 1 of surgical management in Hirschsprung’s disease?
Creation of a temporary colostomy to divert stool away from the affected bowel segment
## Footnote
This allows the bowel to decompress before definitive surgery.
136
What is Stage 2 of surgical management in Hirschsprung’s disease?
Definitive surgery involving excision of the aganglionic segment and anastomosis between ganglionic colon and anus
137
What are common definitive surgeries for Hirschsprung’s disease?
* Swenson procedure
* Soave's procedure
* Duhamel procedure
138
What is a colostomy?
A surgical procedure that creates an opening in the abdomen for the large intestine to drain stool
139
What are the potential complications after definitive repair of Hirschsprung’s disease?
* Chronic dysmotility
* Constipation
* Obstructive problems
140
True or False: The prognosis after definitive repair of Hirschsprung’s disease is poor.
False
## Footnote
The prognosis is good, although some infants may experience chronic issues.
MBBS Revision
flashcards
Decks in class (13)
# Cards
-
SURGERY - General900
-
SURGERY - Pediatrics140
-
SURGERY - Urology251
-
SURGERY - NEURO177
-
SURGERY - Trauma149
-
SURGERY - Cardiothoracic298
-
COBES - Epidemiology & Biostatistics129
-
COBES - Communicable & Non-Communicable Dx210
-
MEDICINE - Cardiology407
-
MEDICINE - Nephrology643
-
MEDICINE - Gastroenterology16
-
MEDICINE - Rheumatology403
-
MEDICINE - Neurology706
