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Paediatric Surgery, Bilious vomiting is bad - Coggle Diagram

- - - - Free air - perf
      - Intramural air / gas - pathognomic
- - - - 5%
    - - 1st week/ month of life
      - Cadinal symptos is Bilious vomiting
      - Neonate + Bilious vomiting - Malrotation+ volvulus until proven otherwise
    - - 6hour window to dx and tx
    - - Contrast study
    - - Black bowel
  - - - Defect in anterior abdominal wall lateral to umbilicus
    - - Small bowel atresia
      - Not associated with cardiac defect
    - - Tx with silo if bowel is too big
    - - Covered by membrane
      - Graded on size of lesion - 5cm
        Minor -> Major
      - Multiple associated abnormalitites in 50%
  - - - Cannot swallow saliva
      - Bubbly/frothy after birth
      - Risk of aspiration
    - - Antenatal
      - Polyhydramnios
    - - CXR
      - Unable to pass NG tube
  - - - Bowel obstruction
      - Bilious vomiting
      - Abdominal distention
    - - Presentation
        
        Double bubble on X ray
        
        Bilious vomiting
      - Associations
        
        Prematurity
        
        COngenital heart defects
        
        Trisomy 21
      - D for Down's D for Duoudenal atresia
    - - Presentation
        
        Imperforate anus
        
        Abdominal distention
        
        Bilious vomiting
      - 25% missed
      - Coplications
        
        Perforation
  - - - Lack of peristalsis causes colonic obstruction
      - Failure to pass meconium
      - Fever
      - Diarrhoea
      - Toxic megacolon - enterocolitis
      - Abdominal distention
    - - NEC
    - - Histological
  - - - 15% of CF cases
    - - Thick meconium impacts in ileum
    - - Abdominal distention at birth
      - Bilious vomiting
    - - Volvulus
      - Perforation
- - - - Assess tightness of spermatic cord
      - Does testical stay in scrotum
- - - - Possible to get above
  - - - Prematurity
    - - 2% in females
      - 7-30% in males
      - Risk of incarceration in more than 60%
      - Incidence: 1-5%
      - 60% on the right side
      - M:F, 9:1
      - 99% indirect hernias
      - 15% present with incarceration
    - - Intestinal necrosis
      - Perforation
      - Intestinal obstruction
      - Intestinal stricure
      - Testicular / ovarian necrosis
      - Testicular/ ovarian atrophy
      - Tubal stricture
    - - Incarcerated
        
        Immediate attempt at manual reduction
        
        Taxis - manual reduction successful in >90%
        
        Surgery: Herniotomy
        
        ? Explore opposite side?
  - - - Operate at 4yrs
      - High chance of spontaneous resolution
- - - - ↑WCC
      - ↑CRP
- - - - Avulsion
      - Wedge resection
      - Willetts procedure
      - Zadicks procedure
      - High failure rate