Common pediatric surgical conditions 3 Dr Hatem El Gohary
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Hirschsprung disease is a developmental disorder of the enteric nervous system characterized by the absence of ganglion cells in the distal colon, resulting in functional obstruction. It is caused by congenital aganglionosis of the distal bowel. Diagnosis involves symptoms of delayed meconium passage and chronic constipation, as well as barium enema and rectal biopsy showing aganglionosis. Treatment involves rehydration, colostomy, and resection of the aganglionic segment via procedures like Swenson or Duhamel. Imperforate anus is caused by defects in formation of the posterior urorectal septum. It can be low or high and is sometimes associated with VACTERL
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Common pediatric surgical conditions By Dr Hatem ElGohary
This document discusses several pediatric surgical topics including:
1. Thermoregulation issues in pediatric patients and the need to warm fluids, the operating theater, and insulate the child.
2. Gastroesophageal reflux and aspiration in children which can be addressed with a nasogastric tube.
3. Undescended testes including causes, investigations, risks related to fertility and malignancy, and treatment typically involving orchidopexy.
4. Hypertrophic pyloric stenosis in infants, presenting with non-billious vomiting and an olive-shaped tumor that can be treated with Ramstedt's pyloromyotomy.
Discuss intestinal obstruction
This document discusses intestinal obstruction and provides an overview of its classification, causes, pathophysiology, clinical presentation, management, and complications. It begins with definitions and outlines the various types of obstruction. Common causes are extramural factors like hernias or adhesions, intraluminal objects, and intramural issues like tumors or inflammatory lesions. The presentation depends on the site and severity of obstruction. Management involves supportive care as well as surgical intervention if needed to relieve the obstruction.
Gastric volvulus
A young infant presented with persistent vomiting and failure to thrive. Imaging showed malrotation of the gut with the superior mesenteric vein lying superior and lateral to the superior mesenteric artery. Further imaging found gastric volvulus, which was corrected surgically. Gastric volvulus can be primary due to laxity of ligaments, or secondary to anatomical abnormalities, and presents as epigastric pain, vomiting, and inability to pass a tube into the stomach.
Prune belly syndrome
Prune-belly syndrome is a rare condition characterized by three main findings: deficient abdominal wall muscles, undescended testes, and urinary tract anomalies. It is caused by abnormalities in the development of the urinary and genital systems. Affected individuals can have a wide range of urinary tract defects from mild hydronephrosis to severe kidney dysplasia. Treatment involves surgical reconstruction of the urinary tract and abdominal wall, with long-term outcomes dependent on the severity of renal anomalies.
Gastrci outlet obstruction
Gastric outlet obstruction has various causes including peptic ulcer disease, gastric cancer, and Crohn's disease. It leads to vomiting of partially digested food, dehydration, and metabolic abnormalities. Diagnosis involves imaging, endoscopy, and biopsy. Management focuses on correcting electrolyte abnormalities and removing the mechanical obstruction endoscopically or surgically via procedures like vagotomy and gastrojejunostomy. Gastric cancer is a common cause and may require total or subtotal gastrectomy depending on location, with postoperative risks of bleeding, leakage, and nutritional deficiencies. Palliative options for inoperable tumors include stenting or bypass procedures.
Sigmoid volvulus
Sigmoid volvulus is one of the commonest non malignant cause of colonic obstruction in elderly patients.Prompt diagnosis can be made by a plain x ray abdomen. the article gives a brief review of the presenting features, diagnosis and management of this dire emergency
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...
This document discusses various imaging modalities used to diagnose intestinal obstruction including radiography, computed tomography, magnetic resonance imaging, ultrasonography, nuclear imaging, and angiography. Plain X-rays can show dilated bowel loops and air-fluid levels. CT provides more detail of bowel wall abnormalities. MRI is useful for assessing strangulation. Ultrasound evaluates bowel peristalsis. Nuclear imaging detects inflammation. Angiography diagnoses internal hernias. Barium studies demonstrate characteristic signs of intussusception and volvulus. Imaging plays a key role in evaluating intestinal obstructions.
ACUTE ABDOMEN (SURGERY)
The document provides information on evaluating and diagnosing an acute abdomen. It describes how the causes of an acute abdomen vary by age and include appendicitis, biliary disease, bowel obstruction, and diverticulitis. A thorough history, physical exam, and lab tests are needed for diagnosis. The exam focuses on locating the pain and assessing for peritoneal irritation or inflammation. Common lab tests include complete blood count, electrolytes, and tests to check for conditions like pancreatitis or pregnancy. Imaging studies may also be used to diagnose the specific cause of the acute abdomen.
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Common pediatric surgical conditions By Dr Hatem ElGohary
This document discusses several pediatric surgical topics including:
1. Thermoregulation issues in pediatric patients and the need to warm fluids, the operating theater, and insulate the child.
2. Gastroesophageal reflux and aspiration in children which can be addressed with a nasogastric tube.
3. Undescended testes including causes, investigations, risks related to fertility and malignancy, and treatment typically involving orchidopexy.
4. Hypertrophic pyloric stenosis in infants, presenting with non-billious vomiting and an olive-shaped tumor that can be treated with Ramstedt's pyloromyotomy.
Discuss intestinal obstruction
This document discusses intestinal obstruction and provides an overview of its classification, causes, pathophysiology, clinical presentation, management, and complications. It begins with definitions and outlines the various types of obstruction. Common causes are extramural factors like hernias or adhesions, intraluminal objects, and intramural issues like tumors or inflammatory lesions. The presentation depends on the site and severity of obstruction. Management involves supportive care as well as surgical intervention if needed to relieve the obstruction.
Gastric volvulus
A young infant presented with persistent vomiting and failure to thrive. Imaging showed malrotation of the gut with the superior mesenteric vein lying superior and lateral to the superior mesenteric artery. Further imaging found gastric volvulus, which was corrected surgically. Gastric volvulus can be primary due to laxity of ligaments, or secondary to anatomical abnormalities, and presents as epigastric pain, vomiting, and inability to pass a tube into the stomach.
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Gastrci outlet obstruction
Gastric outlet obstruction has various causes including peptic ulcer disease, gastric cancer, and Crohn's disease. It leads to vomiting of partially digested food, dehydration, and metabolic abnormalities. Diagnosis involves imaging, endoscopy, and biopsy. Management focuses on correcting electrolyte abnormalities and removing the mechanical obstruction endoscopically or surgically via procedures like vagotomy and gastrojejunostomy. Gastric cancer is a common cause and may require total or subtotal gastrectomy depending on location, with postoperative risks of bleeding, leakage, and nutritional deficiencies. Palliative options for inoperable tumors include stenting or bypass procedures.
Sigmoid volvulus
Sigmoid volvulus is one of the commonest non malignant cause of colonic obstruction in elderly patients.Prompt diagnosis can be made by a plain x ray abdomen. the article gives a brief review of the presenting features, diagnosis and management of this dire emergency
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This document discusses various imaging modalities used to diagnose intestinal obstruction including radiography, computed tomography, magnetic resonance imaging, ultrasonography, nuclear imaging, and angiography. Plain X-rays can show dilated bowel loops and air-fluid levels. CT provides more detail of bowel wall abnormalities. MRI is useful for assessing strangulation. Ultrasound evaluates bowel peristalsis. Nuclear imaging detects inflammation. Angiography diagnoses internal hernias. Barium studies demonstrate characteristic signs of intussusception and volvulus. Imaging plays a key role in evaluating intestinal obstructions.
ACUTE ABDOMEN (SURGERY)
The document provides information on evaluating and diagnosing an acute abdomen. It describes how the causes of an acute abdomen vary by age and include appendicitis, biliary disease, bowel obstruction, and diverticulitis. A thorough history, physical exam, and lab tests are needed for diagnosis. The exam focuses on locating the pain and assessing for peritoneal irritation or inflammation. Common lab tests include complete blood count, electrolytes, and tests to check for conditions like pancreatitis or pregnancy. Imaging studies may also be used to diagnose the specific cause of the acute abdomen.
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The document discusses liver anatomy, injuries, and management approaches. It provides details on:
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Intestinal ( Bowel) strangulation
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2. Common signs of a surgical wound infection include fever, pain, pus or discharge, redness, swelling, and tenderness at the wound site. Infections are classified based on degree of contamination from clean to dirty.
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Mass in right hypochondrium.pptx
This document provides tips for using a PowerPoint presentation (PPT) for active learning sessions:
1. The PPT can be freely downloaded, edited, and modified.
2. Many slides are intentionally blank except for the title to facilitate discussion. The instructor should show blank slides, ask students what they know about the topic, and then show the content slide.
3. This process of blank slide + student input + content slide should be repeated for each topic across three revisions for optimal active learning. The PPT can also be used for self-study.
4. The notes section includes bibliographic references.
Congenital hernia & hydrocoele
This document discusses congenital inguinal hernia and hydrocele. It notes that congenital inguinal hernia is caused by the continued patency of the processus vaginalis after birth, which allows intra-abdominal structures to descend into the scrotum. Congenital hydrocele involves a narrow sac within the processus vaginalis that contains fluid but no structures. The document provides details on the causes, clinical presentation, management including surgical repair, and complications of each condition.
Gastric outlet obstruction
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The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
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Intestinal ( Bowel) strangulation
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Intussusception
Intussusception is a condition where one part of the bowel slides into the next, blocking fluid and food passage and cutting off blood supply. It most commonly affects children under 2 years old. Symptoms include abdominal pain, vomiting, and bloody stools. Diagnosis is usually via ultrasound or enema x-ray. Treatment involves nonsurgical reduction via air or liquid enema or surgical reduction if complications are present. With treatment, prognosis is excellent though recurrence or complications can sometimes occur.
Mekelsdiverticulum.
The document summarizes Meckel's diverticulum, which is the most common congenital abnormality of the gastrointestinal tract. It arises from incomplete obliteration of the vitelline duct during fetal development. Key points include:
- Meckel's diverticulum contains all three layers of the bowel and can contain ectopic gastric or pancreatic tissue.
- It is usually found within 2 feet of the ileocecal valve and is symptomatic in only about 2% of adults but more commonly in children under 2 years old.
- Common presentations include bleeding, intestinal obstruction, diverticulitis, and intussusception. Bleeding can be caused by ulceration from acidic secretions of
Acute Pancreatitis
1. Acute pancreatitis is inflammation of the pancreas that presents with abdominal pain and elevated pancreatic enzymes. Gallstones and alcohol are the most common causes.
2. The pathogenesis involves premature activation of digestive enzymes within the pancreas due to obstruction of pancreatic ducts or direct injury to acinar cells. This leads to autodigestion of the pancreas.
3. Management involves hydration, pain control, treating complications, and considering surgery for gallstone pancreatitis to prevent recurrence.
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This document discusses the diagnosis and management of acute abdominal pain. It defines acute abdomen as sudden abdominal pain lasting less than 24 hours. Common causes are appendicitis, cholecystitis, intestinal obstruction, and perforated viscus. A thorough history, physical exam, and lab/imaging workup is needed to diagnose the specific cause as treatment depends on the etiology. Laparoscopy can help diagnose unclear cases or distinguish surgical from non-surgical conditions. The goal is to determine if the patient requires immediate surgery, surgical observation, medical management, or further diagnostics.
Benign anorectal disorders
This document provides an overview of the surgical anatomy of the anal canal and rectum. It describes the rectum as a fixed portion of the large intestine located between the sigmoid colon and anal canal. Key details include the relations of the rectum to surrounding structures, its blood supply, innervation, and support. The anal canal is described as the terminal portion of the gastrointestinal tract, surrounded by striated sphincter muscles that maintain fecal continence.
PENETRATING ABDOMINAL INJURY.pdf
A presentation that will help clinicians attain the basic diagnostic skills required to effectively manage patients.
Testicular torsion/ Torsion of testes
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
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3. Proper preventative measures include preoperative antibiotic prophylaxis, hygienic practices in the operating room, and careful postoperative wound management. Established infections require identification of causative organisms and targeted antibiotic treatment.
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This document discusses two common pediatric surgical conditions: intussusception and acute appendicitis. Intussusception occurs when one portion of the intestine invaginates into an adjacent segment, causing obstruction. It is usually ileocolic and can progress to gangrene. Acute appendicitis is inflammation of the appendix due to obstruction, and risks include poor localization and early perforation in pediatrics. Both conditions present with abdominal pain and require resuscitation, antibiotics, and sometimes surgery. Other causes of abdominal pain discussed include intestinal obstruction, constipation, urinary issues, and gastroenteritis.
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Urgences chirurgicales pédiatriques du nourrisson et grand enfant
urgences chirurgicales pédiatriques dans la pratique courante
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Psoriasis
Psoriasis is a chronic inflammatory skin condition characterized by erythematous scaly plaques. It has genetic and environmental causes, and can be triggered by certain drugs, infections, and trauma. The most common type is psoriasis vulgaris, which presents as erythematous scaly plaques on the elbows and knees, and can affect the nails. Other types include guttate psoriasis, inverse psoriasis, erythrodermic psoriasis, and pustular psoriasis. A diagnostic test called the Auspitz sign involves scraping a lesion to observe increased scaling, a glistening membrane, and punctate bleeding spots.
Apoptosis
1. Apoptosis is programmed cell death marked by cell fragmentation, chromatin condensation, and elimination of apoptotic bodies by phagocytosis. 2. Apoptosis can occur physiologically during development and homeostasis or pathologically due to DNA damage, protein misfolding, and viral infections. 3. Apoptosis is initiated through the intrinsic mitochondrial pathway or extrinsic death receptor pathway and executed via caspase activation, resulting in cytoskeletal and DNA breakdown into apoptotic bodies for phagocytic removal.
Body Systems: Homeostasis, blood, cardio and respiratory
- The cell membrane is a phospholipid bilayer that separates the intracellular and extracellular fluids and controls the movement of substances into and out of cells. Transport proteins allow selective uptake of nutrients and removal of waste.
- Water movement across the membrane is determined by osmosis, moving from low to high solute concentration areas. Osmotic pressure and tonicity regulate water distribution and fluid balance in the body.
- The glycocalyx layer contains carbohydrates that protect the cell membrane and aid processes like cell adhesion and immune response.
Surgical anatomy of nerve and vascular injuries in the upper limb
After completion of this session, students should be able to discuss, identify, and describe:
Nerve injuries:
The anatomical factors predisposing to nerve injuries.
The anatomy of deformity, weakness and sensory loss following the nerve injury.
The applied anatomy of clinical examination for specific nerves.
Surgical anatomy of treating nerve injuries.
The following nerve injuries are discussed:
Upper limb: upper brachial plexus; lower brachial plexus; long thoracic nerve; axillary nerve; median nerve; ulnar nerve; radial nerve.
Vascular injuries:
Collateral circulation and its significance in maintaining the arterial supply after occlusion of a major artery.
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Scapular anastomosis in relation to axillary and subclavian artery obstruction.
Anastomosis around the elbow in relation to brachial artery obstruction.
1. tce web
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Common pediatric surgical conditions 2 By Dr Hatem El Gohary
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Common pediatric surgical conditions 3 Dr Hatem El Gohary
- 1. Common Pediatric Surgical Conditions Dr. Hatem El Gohary Lecturer of General Surgery MD, MRCS
- 3. Definition Developmental disorder of the enteric nervous system and is characterized by an absence of ganglion cells in the distal colon resulting in a functional obstruction.[
- 5. Aetiology Innervation of the colon: • Extrinsic: Mainly lead to Increase in smooth muscle tone. • Interinsic: Relaxation of the colon. • Congenital aganglionosis of the distal bowel • Both the myenteric (Auerbach) plexus and the submucosal (Meissner) plexus are absent, resulting in reduced bowel peristalsis and function.
- 6. Diagnosis Symptoms: • Newborn with delayed passage of meconium. • Chronic constipation • Vomiting, Distention, poor feeding, and failure to thrive. Signs: • Distended abdomen. • Spasm of the anus.
- 8. Investigations 1- Barium enema Narrowed distal colon Proximal dilation Transition zone 2- Full Thickness rectal biopsy Aganglionosis
- 9. TREATMENT • Rehydration and Nasogastric tube. • Diverting colostomy at the time of diagnosis. Then • Swenson procedure : Resection of the aganglionic segment and oblique anastomosis of the colon. • Duhamel procedure Resection of the aganglionic segment and end to side anastomosis of the colon.
- 10. IMPERFORATE ANUS
- 11. Embryology
- 12. • The rectum and anus are believed to develop from the dorsal potion of cloacal cavity, • Downgrowth of the urorectal septum is believed to close this duct by 7 weeks' gestation. • This septum separates the rectum and anal canal dorsally from the bladder and urethra.
- 13. Aetiology Defects in the formation or shape of the posterior urorectal septum.
- 14. Types • A low lesion, in which the colon remains close to the skin. • A high lesion, in which the colon is higher up in the pelvis. • A persistent cloaca , in which the rectum, vagina and urinary tract are joined into a single channel.
- 15. Diagnosis • Identified upon the first physical examination. • Failure to pass meconium within 24 hours.
- 16. • X-Ray Lateral view Upside down. < 1cm …low > 1cm …high
- 17. Common Association VACTERL Vertebral anomalies Anorectal (e.g.imperforate anus) Cardiac Tracheal (e.g.fistula) Eosophegeal Renal Limb
- 18. Treatment < 1 cm Primary neonatal pull-through. > 1 cm Colostomy Then Pull - through.