Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Paediatric Surgery MCQ Revision ‘A game of 20 questions’Overview of the session 20 MCQ Questions Polls Learning Points • Taken from PassMedicine • Will show the question on • Once the correct answer is • Covers the major themes screen, along with a poll to shown, we’ll walk through put your answer why this is the case • As per normal exam conditions, you will have 80 seconds to answer the question • I won’t pick anyone out to answer any questions!1)1)1) Appendicitis - Can present as vague abdominal pain in children - However, he is E+D as normal - Temp is normal Constipation - ‘No change in bowel habit’ Gastroenteritis - ‘No change in bowel habit’ - No mention of vomiting Mesenteric Adenitis - It is inflamed mesenteric lymph nodes Abdominal migraine - Preceded by a recent viral illness - Very rare! - No history of migraines - It is his first presentation2)2)2) Appendicitis - There is RIF pain - Would not expect significant bleeding or haemodynamic instability however Intussusception - Normally more severe pain - Child often draws knees to chest to alleviate pain - Stool is ‘red-currant jelly’ like Peutz-Jeghers polyposis Meckel’s diverticulum - Autosomal dominant condition - Congenital outpouching of the small bowel - Pigmented freckles on the lips, palms and soles - Most common cause of painless massive PR bleeding in 1-2 year olds Cecal volvulus - Would also expect distension and a failure to pass flatus or stool3)3)3) Constipation - Does not explain fever Meckel’s diverticulum - He’s over 2 years old (rule of 2’s) - Absence of rectal bleeding Mesenteric Adenitis - Lack of previous viral infection Pyelonephritis Appendicitis - Explains fever, pain and leucocytes in - Central acute abdominal pain (moves later) urine - Fever - However, would expect loin→groin - Leukocytes in urine suggests infective cause pain + urinary tract symptoms such as dysuria or increased frequency - Urinalysis would also show nitrites4)4)3) Keep trying - Urgent clinical need School to consent - School cannot consent Consult safeguarding doctor - They cannot consent for patient Seek urgent court order Operate immediately - They can’t consent on their behalf - GMC 0-18 guidance states you can provide treatment to save the life or prevent serious deterioration of health - Not necessary for anyone’s consent (even if parent + patient refused)5)5)5) Endoscopic pyloric stenting - Used in gastric outlet obstruction - More common in gastric cancer cases Hydrostatic or air-contrast enema - Used for the management of intussusception Ramstedt pyloromyotomy Heller myotomy - This is the surgical management for pyloric stenosis - Can be used for management of - It divides the muscle to increase the achalasia diameter of the gastric outlet AP pull through with stoma - This can be used in the management of Hirschsprung's disease6)6)7)7)7)8)8)8) Meckel’s Diverticulum - Would expect PR bleeding Pyloric stenosis - Presents similarly - Also has target/donut sign on US - However, normally <6 months Duodenal atresia - Presents a few hours after birth Intussusception - AXR shows double-bubble sign - Abdominal pain with vomiting - Sausage shaped mass on X-ray Incarcerated hernia - Target/donut sign on US - No soft lump indicating hernia - ‘Red-currant jelly’ stool is late stage sign - Incarcerated hernias are typically painless9)9)10)10)11)11)11) Immediate referral for surgery - This is done if there are bilateral undescended testis Review at 12 months - Too late as it will increase your risk of certain conditions (next question) Arrange ultrasound - Will not change management Review at 3 months Refer to urology within 4 weeks - For unilateral undescended testis, wait till 3 - Only refer once you know they need months, then review (MCQ answer) surgery (ie. need to be assessed again - NICE guidance has recently changed however at 3 months) - See at 6-8 weeks - See again at 4-5 months - Referral for surgery by 6 months12)12)13)13)13) Condition Treatment Single undescended testis Review once child is 6-8 months old, then again at 4-5 months if still present, then surgical referral to be seen by 6 months Bilateral undescended testis Refer urgently Umbilical hernia Conservative management as it usually resolves by 3 years old Inguinal hernia if under 1 years old Urgent referral for surgery Inguinal hernia if older than 1 year old Routine referral for surgery14)14)15)15)15) IV antibiotics - Could be used postoperatively if needed Optimising feeds - Worth doing but not definitive - This forms part of the management of cystic fibrosis Ursodeoxycholic acid - This is often used after the operation Early surgical treatment - Attempts to restore bile flow Infusion of A1AT - Decreases hepatic damage, - A1AT levels are normal avoiding/delaying need for liver transplant16)16)16) Conservative management - Will not improve High dose steroids - Will not improve Laxatives - Would not be definitive Rectal washout - Definitive treatment is surgery - Regular washouts before surgery help to prevent enterocolitis Immediate surgery - Need to wash out undigested food/feces to prevent enterocolitis17)17)18)18)18)19)19)19)20)20)Thank you! Any questions → joshua.williams@student.manchester.ac.uk luqman.aizan@student.manchester.ac.uk Please fill out the feedback form! Next session is next tuesday on colorectal surgery, covering GI malignancies, diverticular conditions, anorectal conditions, haemorrhoids and more!