402- Paediatrics > Surgery > Flashcards

Surgery Flashcards

(17 cards)

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1
Q

Inguinal canal anatomy

  • Location
  • Walls
  • Contains
A

Above, parallel and lower end of the inguinal ligament.

Starts at deep inguinal ring, extends to superficial

Walls:

  • Anterior = external oblique aponeurosis
  • Laterally= internal oblique
  • Posterior= transversalis fascia
  • Roof= transversalis abdominis and internal oblique
  • Floor= medial 1/2 of inguinal ligament

In both sexes, contains:

  • genitofemoral nerve
  • ilio-ingunal nerve (L1)

In men
- Spermatic cord

In women
- Round ligament of the uterys

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2
Q

Deep inguinal ring

  • Structure
  • Location
A

Opening of the transversalis fascia, forming the beginning of the evagination for the spermatic cord or round ligament.

Located halfway between the anterior superior iliac spine and the pubic tubercle.

Lateral to the inferior epigastric artery

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3
Q

Superficial inguinal ring

  • Structure
  • Location
A

End of the inguinal canal.
- Traingular opening in the aponeurosis of the external oblique muscle.

Location
- Superior to the pubic tubercle

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4
Q

Spermatic cord

  • Location
  • Contents
  • Fascia
A

Starts at deep inguinal ring, lateral to inferior epigastric vessels

Contains

  • Vans deferens
  • Branch of inferior epigastric artery (to ductus deferens)
  • Testicular artery
  • Pampiniform plexus of veins (testicular veins)
  • Genital branch of genitofemoral (to cremaster muscle)
  • Lymphatics
  • Sympathetic and visceral afferent nerves

Fascia

  • Deepest= internal spermatic fascia, from transversalis fascia. Attached to deep ring.
  • Middle layer= cremasteric fascia, from cremaster muscle originating from internal oblique
  • Covering= external spermatic fascia, from external oblique aponeurosis, attached to superficial inguinal ring
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5
Q

Inguinal hernia

  • Definition
  • Types
A

Passage of peritoneal tissue with/without abdominal contents, through the inguinal canal.

Indirect (congenital)

  • Through the deep inguinal ring
  • Due to processus vaginalis remaining patent (tunnel the testes migrate from)
  • Lateral to inferior epigastric vessels

Direct

  • Through posterior wall of inguinal canal
  • Due to weakened abdominal wall
  • medial to inferior epigastric vessels
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6
Q

Examination of inguinal hernia

A

Location
- Above the inguinal ligament

Feeling the upper edge of the lump= hernia

Reduction

  • Applying pressure and reducing the hernia into the deep ring.
  • This will remain reduced in indirect but reappear in direct.
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7
Q

Hesselbach’s triangle boundaries (RIP)

A

R- Rectus abdominis medially

I- Inferior epigastric, superior-laterally

P- Inguinal ligament, inferiorly

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8
Q

Presentation of inguinal hernia

A

Lump in the groin

Typically painless, reducible
- If painful, incarcerated (irreducible) or strangulated (obstruction/ blood supply compromised)

Intermittent
- Visible on straining or coughing

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9
Q

Management of inguinal hernia

A

Taxis

  • Manually
  • Analgesia

Surgery
- open or laparoscopic

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10
Q

Hydrocele

  • definition
  • Presentation
A

Passage of fluid through patent processus vaginalis

Presentation

  • asymptomatic
  • Lump in groin, may be blue
  • May present during viral illness
  • Larger in the evening/ when lying down
  • Can palpate above the hydrocoele
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11
Q

Hydrocele management

A

Typically, resolves spontaneously as the patent processus vaginalis closes within months

Surgery considered when it persists > 2 years.

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12
Q

Varicocele

  • definition
  • Presentation
  • Management
A

Swelling of the scrotal, testicular veins

Presentation

  • Scrotum resembling ‘bag of worms’
  • May present with dull ache,
  • 90% are on the left side, 10% bilaterally

Management

  • If <20% difference in size of testes, reassurance and observation
  • If >20%, surgery required.
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13
Q

First line investigation for pyloric stenosis

A

Abdominal ultrasound

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14
Q

The most ‘classic’ biochemical profile for pyloric stenosis is…

A

Hypochloraemic, hypokalaemic metabolic acidosis

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15
Q

First line surgical procedure of pyloric stenosis

A

Ramstedt’s pyloromyotomy

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16
Q

Pyloric stenosis typically presents …

Study These Flashcards
A

In first 3-6 weeks of life

17
Q

Pyloric stenosis typically affects (male/females) in a ration of ____

402- Paediatrics
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