Abdominal Common Cases

Nephrectomy

Signs to look out for:

Scar on the loin area

Indications: Conditions that may require nephrectomy as part of the management include:

-Multicystic dysplastic kidney (MCDK) -Polycystic kidney disease -Wilms’tumour -Vesico-ureteric reflux (VUR) -Pelvi-ureteric junction (PUJ) obstruction – severe trauma to the kidney -chronic infection – renal disease resulting in severe hypertension

 

 

Kidney transplant

Signs to look out for:

Palpable mass on iliac fossa

Indications:

Chronic renal insufficiency (CRI) and end-stage renal disease (ESRD) with

1) symptoms of uremia not responsive to standard therapy;

2) failure to thrive due to limitations in total caloric intake;

3) delayed psychomotor development;

4) hypervolemia;

5) hyperkalemia; and

6) metabolic bone disease due to renal osteodystrophy

Contraindications:

Children with acute or chronic active infection

Children with malignancy

Child or family with a history or high likelihood of noncompliance with a prescribed medication regimen.

Active systemic lupus erythematosus and Goodpasture disease (as this processes can damage an allograft).

 

 

Liver transplant

Signs:

Large scar on upper abdomen

Palpable liver mass on upper abdomen which may extend to epigastric region beneath the scar

Conditions that may require liver transplantation as part of the management:

1. Biliary atresia

2. Metabolic disorders (Wilson disease, alpha 1-antitrypsin deficiency, tyrosinemia, hemochromatosis, Crigler-Najjar syndrome, Glycogenosis, Hyperoxaluria, Metabolic respiratory chain deficiencies, Familial hypercholesterolemia, Methylmalonyl aciduria)

3. Progressive intrahepatic cholestasis

4. Acute liver failure

 

 

Splenectomy

Signs:

Scar on left subcostal margin

Indications:

-Sickle Cell Disease (Recurrent acute splenic sequestration crisis, hypersplenism, splenic abscess ,splenic infarction)

- Hereditary spherocytosis

- Chronic idiopathic thrombocytopenic purpura,

- Hypersplenism,

- Hodgkin’s disease

 

Necrotising Enterocolitis

What is it?

- Necrosis of portions of bowel, affecting mainly premature babies

- Medically managed most of the time. Surgical input required for perforation or severe necrotising enterocolitis

Signs:

Scars on abdomen

Ex-premature baby, may have features of cerebral palsy

 

Short gut

What is it?

Inadequate absorptive capacity of bowel to support nutrient and fluid requirements due to decreased length and/or decreased functional bowel.

Signs:

-Scars on abdomen

-Central line for parenteral nutrition

Causes of Short Gut

- Necrotizing Enterocolitis (NEC)

- Intestinal atresia

– Volvulus

– Hernia

– Intussusception

-Congenital short bowel syndrome

–Trauma

- Gastroschisis

- Crohn’s disease

-Abdominal tumors

- Radiation enteritis

- Hirschsprung’s disease

 

 

Biliary atresia

What is it?

Surgically treatable cause of cholestasis encountered during the newborn period in which there is obliteration or discontinuity of the extrahepatic biliary system, resulting in obstruction to bile flow

Treatment:

Procedure : Kasai Procedure

Liver Transplant if failed Kasai

 

 

 

 

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