Common Surgical Conditions Quiz

Common Surgical Conditions

• Pylorus, appendix, and bowel conditions are covered.

Pylorus

• Hypertrophic Pyloric Stenosis:
  • A condition where the pyloric muscle thickens and narrows the pyloric canal, leading to obstruction.
  • This is a common condition in male infants (4:1 ratio)
  • Typically occurs between 3 and 12 weeks of age, often peaking at 4 weeks.
  • Bile-free vomiting is the most frequent symptom.
  • Vomiting gets progressively more frequent and projectile as the pyloric muscle thickens.
  • Dehydration and weight loss can result.
  • Examination preparation typically involves fasting (NPO) for at least a couple of hours prior to scanning.
  • Sonographic examination is important
  • The pyloric muscle thickness greater than or equal to 3mm is a diagnostic indicator.
  • Channel length measurement greater than 15-16mm is a reliable indicator.

Appendix

• Appendicitis:

  • The most common cause of emergent surgical abdominal pain in children (ages 5-15).
  • Appendicitis occurs when the appendiceal lumen becomes obstructed and infected.
  • Infants and young children experience a more rapid progression to perforation.
  • Common symptoms include RLQ pain and vomiting with pain usually starting in the umbilicus, migrating to McBurney's Point.
  • McBurney's point is located one-third the distance between the right anterior superior iliac spine and umbilicus.
  • A curvilinear array transducer is used in a supine position.
  • The patient should be instructed on the compression portion of the examination.

• Normal Appendix Ultrasounds:

  • A blind-ending, long tubular structure in a longitudinal view.
  • A bullseye appearance in a transverse view.
  • Appearance is compressible, with no peristalsis.

• Acutely Inflamed Appendix Ultrasound:

  • Non-compressible
  • Measured outer wall to outer wall thickness is greater than 7mm.
  • Increased "hyperemic" flow (look at textbook).
  • Appendicolith shows acoustic shadowing, can be single or multiple.
  • Enlarged retroperitoneal lymph nodes might also be present.

Intussusception

• Definition:
  • A condition in early childhood where one part of the bowel telescopes into another part causing obstruction.
  • Typically the ileum telescopes into the cecum, but can also occur further down.
  • Characterized by a telescoping pattern in the intestines.
• Symptoms:
  • Colicky abdominal pain.
  • Vomiting.
  • Bloody (currant-jelly) stools.
• Diagnosis with Ultrasound:
  • The bowel displays alternating hypoechoic and hyperechoic rings around an echogenic center (target or cinnamon bun sign).
  • Pathologically measures greater than 3 cm in diameter.
  • Other signs like Pseudo-Kidney or Sandwich sign are relevant.