General Surgery Flashcards by Alexa Geddes

Findings for malrotation with volvulus on AXR, US, and UGI?

AXR = double bubble sign
US = whirlpool sign
UGI = dilated duodenum, corkscrew sign

How well did you know this?

Not at all

Perfectly

Intussception - age range, etiology, presentation, imaging findings, and management

Age = 3 months to 3 years
Etiology = idiopathic (peyer's patches) or leadpoints (polyps, Meckel's, CF, IBD, lymphoma)
Presentation = acute colicky abdo pain, currant jelly stools, bilious emesis, sausage mass
Imaging = AXR (obstructive), US (target lesion)
Management = enema reduction (if stable), surgical

How well did you know this?

Not at all

Perfectly

Definition, management, + most common associated abnormality for hypospadias

= congenital defect where urethral opening is located on the ventral side of the penis

Mgmt: Surgical correction 6-12 months of age, avoid circumcision until then (as may use the tissue)
Chordee: fibrous band of tissue on ventral side causing curvature

How well did you know this?

Not at all

Perfectly

Clinical presentation of intussception

Classic triad (only 20%) = colicky pain, emesis, red currant bloody stool
Other = toxic, shock, dehydration, RLQ mass, distention

How well did you know this?

Not at all

Perfectly

Umbilical hernias: (a) approximate size when unlikely to spontaneously close and (b) what age to intervene if not closed?

(a) >1.5-2.0cm

(b) 5 years of age

How well did you know this?

Not at all

Perfectly

Phimosis - definition + possible treatment

=narrowing of distal foreskin that prevents retraction over the glans penis

Normal adhesions in the newborn
May require circumcision

How well did you know this?

Not at all

Perfectly

Paraphimosis - definition, complication, management steps

=incarceration of retracted foreskin behind the glans

Progressive edema –> ischemia
Ice, anesthesia, manual reduction –> surgical

How well did you know this?

Not at all

Perfectly

Most common associated abnormality to gastroschisis?

intestinal atresia

How well did you know this?

Not at all

Perfectly

Important initial steps in management of a neonate born with gastroschisis

Wrap bowel in sterile/saline dressings + plastic wrap
Maintain normothermic
Fluids
IV Abx
OG for decompression
Surgical intervention

How well did you know this?

Not at all

Perfectly

What is the most common congenital anomaly of the GI tract?

Meckel’s Diverticulum

How well did you know this?

Not at all

Perfectly

Rule of 2’s for Meckel’s Diverticulum

2% of the population
2:1 of M:F
2-6% symptomatic, complicated
50-75% symptomatic by age 2
Within 2 feet of ileocecal valve
2 inches long
2 types of heterotropic mucosa - gastric, pancreatic

How well did you know this?

Not at all

Perfectly

x3 main complications/presentations of Meckel’s Diverticulum

Bleeding = most common, painless
Diverticulitis
Obstruction

How well did you know this?

Not at all

Perfectly

What is the investigation (+what does it detect) for Meckel’s Diverticulum?

99Tc Meckel’s scan = gastric mucosa

How well did you know this?

Not at all

Perfectly

US findings for pyloric stenosis

Length >14mm + thickness >4mm

- Shouldering

How well did you know this?

Not at all

Perfectly

Metabolic derangement in pyloric stenosis

HypoCl metabolic alkalosis

- Paradoxical aciduria

How well did you know this?

Not at all

Perfectly

x3 cardinal features of Hirschsprung’s disease

Failure to pass meconium within 24 hours of birth
Abdo distention
Bilious emesis

How well did you know this?

Not at all

Perfectly

Infectious complication of Hirschsprung disease, including symptoms

Hirschsprung-associated enterocolitis

-acute diarrhea, explosive stools, abdo distention

How well did you know this?

Not at all

Perfectly

Important management steps for Malrotation

Surgical center
NG to LIS
IVF resus
IV Abx
Surgical Ladd’s procedure

How well did you know this?

Not at all

Perfectly

Top x5 diagnoses for bilious emesis

Malrotation with midgut volvulus
Duodenal or other atresia
Annular pancreas
Hirschsprung’s disease
Ileus

How well did you know this?

Not at all

Perfectly

Where is the level of obstruction if (a) no abdo distention vs (b) abdo distention?

(a) proximal

(b) distal

How well did you know this?

Not at all

Perfectly

Reasons to repair an umbilical hernia early (x2)

Bowel incarceration

- Hernia size = controversial

How well did you know this?

Not at all

Perfectly

x3 risk factors for an inguinal hernia in children

Prematurity
VP shunt
Peritoneal dialysis

How well did you know this?

Not at all

Perfectly

Incarcerated inguinal hernia - rate of incidence (+ inc if prem)

Study These Flashcards

~8%

-x2 greater if prem

If no clear reason for a hydrocele, what must you think about?

Study These Flashcards

Secondary hydrocele - think of testicular pathology

When do most hydroceles resolve?

>2/3 will resolve by 18-24 months

Timeline for hydrocele repair

-Typically a 2 year cut off

Best modality to differentiate hernia from hydrocele?

Transillumination

DDx for acute scrotum

- Testicular torsion - Appendiceal torsion - Epididymitis/orchitis - Inguinal hernia - first presentation and/or complicated - Acute hydrocele - primary or secondary - Trauma - HSP - Tumors

x2 peaks in incidence during pediatrics for testicular torsion

- Infantile | - Post-pubertal

How to make dx of testicular torsion in adolescents?

Clinical

Clinical sign of appendiceal torsion

Blue dot sign

Tx for appendiceal torsion

NSAIDs + excision

Tx for testicular torsion

- Infantile: controversial, testicular salvage is rare because of ++delay in presentation - Post-pubertal: manual detorsion < surgical consultation for testicular salvage

When should you refer a hydrocele to surgery?

One year of age

What bug in addition to STIs cause epididymitis?

E coli

At what age can you consider doxy over amox for lyme disease?

8 years old

When do you start Abx right away and when to test first for lyme disease that is symptomatic?

Tx right away if early and test before for late

Next step in evaluation to differentiate CDH vs eventration

Diaphragm fluoroscopy after CXR

What investigations should be done if epididymitis/orchitis?

- UA - UCx - Urethral swab for sexually active adolescents - US

If bacterial epididymitis/orchitis then what Ix and referral are your next steps?

- Urology consultation | - VCUG

If there is bilateral cryptorchidism what must you think about?

Syndromic or DSD = requires immediate work-up

Main reasons for treating cryptorchidism?

- Malignancy - Fertility - Trauma - Torsion - Hernia

When to treat cryptorchidism?

Orchidopexy between 6-12 months of age

Role of US in cryptorchidism?

- Determine presence or size of testicle | - NOT helpful for position or to differentiate between undescended vs retractile

What x3 investigations should occur prior to OR repair of TEF?

- Rectal exam - Echo - given association with VACTERL - Abdo US (if no urination)

Location of defect for (a) gastroschisis vs (b) omphalocele

(a) right of umbilicus | (b) through umbilicus

What abdo wall defect is larger: (a) gastroschisis vs (b) omphalocele?

Best test to differentiate between CDH and eventruation?

Diaphragm fluoroscopy

Most common associated anomaly with gastrochisis?

Intestinal atresia

What is the primary mode of treatment for a perianal abscess in an infant or young child?

I+D

x2 most common complications from a ruptured appendicitis management (in order of prevalence)?

Wound infection > intra-abdo abscess

What are your first investigations if child with bilious emesis? - As per Tito

- XR = determine if gas in abdo - If yes = LGI - If no = UGI

Alvarado score

``` =Out of 10 § Anorexia § N/V § Migration of pain to RLQ § Fever § RLQ tenderness = 2 points § Rebound pain § WBC > 10 = 2 points (CRP no advantage) PMNs > 75% ```

When is an intussception most likely to recur?

Within 6 hours

What does a thoracotomy as an infant put you at risk of later on from an MSK perspective?

Scoliosis

General Surgery Flashcards

(55 cards)