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Common Paediatric Surgical Problems Philip Morreau Starship www.kidzhealth.co.nz.

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Presentation on theme: "Common Paediatric Surgical Problems Philip Morreau Starship www.kidzhealth.co.nz."— Presentation transcript:

1 Common Paediatric Surgical Problems Philip Morreau Starship www.kidzhealth.co.nz

2 What is Paediatric Surgery?

3 Small bowel atresia

4 Reality = rare & common problems

5 ConditionType of referral Abdominal pain-AcuteNeeding admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate. Vascular anomaliesDiagnostic uncertainty, airway, vision, hearingArea of special concern Epigastric herniaWhen notedFax 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 scarredFax or letter Recurrent infectionFax or letter Fused labiaAs soon as diagnosedFax or letter Hydrocele If persistent after 2 years of ageFax or letter At any age if diagnostic uncertaintyFax or letter HypospadiasAs soon as diagnosedFax or letter Inguinal hernia Reducible - < 6 months of agePhone /urgent fax Reducible - > 6 months of ageFax or letter Irreducible or if symptomatic or difficult to reduce (including female) Phone/immediate referral & attention ParaphimosisAs soon as diagnosedPhone/immediate referral & attention Testicular torsionSuspected – i.e. Acute scrotal painImmediate phone call Umbilical hernia After 3 years of ageFax or letter Acutely in rare event of irreducibilityPhone/immediate referral & attention Undescended testis If both not fully descended by 3 months post term Fax or letter

6 Normal penis

7 Phimosis

8 Glanular adhesions (and meatal cyst)

9 BXO

10 Hypospadias

11 Smegma

12 paraphimosis

13 Hernia Vs Hydrocele

14 Bilateral hydroceles Painless Scrotal Can not reduce

15 Bilateral Inguinoscrotal Hernia

16 Inguinal hernia

17 N.B. IRREDUCIBLE GROIN LUMP Inguinal hernia Encysted hydrocele of the cord undescended testis lymphangioma HYDOCELE Scrotal Can’t reduce Painless (trans illumination)

18 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

19 ? UDT

20

21 Testicular Torsion

22

23 Hydatid of Morgagni

24 Testicular Torsion

25 Neonatal Torsion

26 Traps! Epididymo-orchitis HSP ultrasound RIF pain trauma tumour

27 Umbilical hernia

28 Haemangioma

29 Haemangioma- treat with β blocker ??

30 ConditionType of referral Abdominal pain-AcuteNeeding admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate. Vascular anomaliesDiagnostic uncertainty, airway, vision, hearingArea of special concern Epigastric herniaWhen notedFax 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 scarredFax or letter Recurrent infectionFax or letter Fused labiaAs soon as diagnosedFax or letter Hydrocele If persistent after 2 years of ageFax or letter At any age if diagnostic uncertaintyFax or letter HypospadiasAs soon as diagnosedFax or letter Inguinal hernia Reducible - < 6 months of agePhone /urgent fax Reducible - > 6 months of ageFax or letter Irreducible or if symptomatic or difficult to reduce (including female) Phone/immediate referral & attention ParaphimosisAs soon as diagnosedPhone/immediate referral & attention Testicular torsionSuspected – i.e. Acute scrotal painImmediate phone call Umbilical hernia After 3 years of ageFax or letter Acutely in rare event of irreducibilityPhone/immediate referral & attention Undescended testis If both not fully descended by 3 months post term Fax or letter


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