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Common Paediatric Surgical Problems
Philip Morreau Starship
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What is Paediatric Surgery?
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Small bowel atresia
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Reality = rare & common problems
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Condition Type of referral
Abdominal pain-Acute Needing admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate. Vascular anomalies Diagnostic uncertainty, airway, vision, hearing Area of special concern Epigastric hernia When noted Fax or letter Foreskin Asymptomatic non-retractile foreskin does not usually need assessment. Starship does not perform Circumcision for cultural nor religious reasons If prepuce looks scarred Recurrent infection Fused labia As soon as diagnosed Hydrocele If persistent after 2 years of age At any age if diagnostic uncertainty Hypospadias Inguinal hernia Reducible - < 6 months of age Phone /urgent fax Reducible - > 6 months of age Irreducible or if symptomatic or difficult to reduce (including female) Phone/immediate referral & attention Paraphimosis Testicular torsion Suspected – i.e. Acute scrotal pain Immediate phone call Umbilical hernia After 3 years of age Acutely in rare event of irreducibility Undescended testis If both not fully descended by 3 months post term
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Normal penis
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Phimosis
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Glanular adhesions (and meatal cyst)
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BXO
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Hypospadias
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Smegma
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paraphimosis
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Hernia Vs Hydrocele
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Bilateral hydroceles Painless Scrotal Can not reduce
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Bilateral Inguinoscrotal Hernia
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Inguinal hernia
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N.B. IRREDUCIBLE GROIN LUMP Inguinal hernia
Encysted hydrocele of the cord undescended testis lymphangioma HYDOCELE Scrotal Can’t reduce Painless (trans illumination)
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UDT Vs Retractile? testes in the scrotum at birth normal size testis
manipulated to bottom scrotum does not retract immediately cord not tight, nor painful resides in scrotum some of time
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? UDT
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Testicular Torsion
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Testicular Torsion
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Hydatid of Morgagni
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Testicular Torsion
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Neonatal Torsion
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Traps! Epididymo-orchitis HSP ultrasound RIF pain trauma tumour
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Umbilical hernia
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Haemangioma
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Haemangioma- treat with β blocker ??
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Condition Type of referral
Abdominal pain-Acute Needing admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate. Vascular anomalies Diagnostic uncertainty, airway, vision, hearing Area of special concern Epigastric hernia When noted Fax or letter Foreskin Asymptomatic non-retractile foreskin does not usually need assessment. Starship does not perform Circumcision for cultural nor religious reasons If prepuce looks scarred Recurrent infection Fused labia As soon as diagnosed Hydrocele If persistent after 2 years of age At any age if diagnostic uncertainty Hypospadias Inguinal hernia Reducible - < 6 months of age Phone /urgent fax Reducible - > 6 months of age Irreducible or if symptomatic or difficult to reduce (including female) Phone/immediate referral & attention Paraphimosis Testicular torsion Suspected – i.e. Acute scrotal pain Immediate phone call Umbilical hernia After 3 years of age Acutely in rare event of irreducibility Undescended testis If both not fully descended by 3 months post term
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