24. Peadiatric Surgery Flashcards
How do you calculate how much the weight of children?
(Kg)= 2x (Age+4)
How do you calculate the blood volume of children,
MLS=80mls per kilo
What is the urine output of children?
1ml/kg/hour, up until 20ml
If a child is sore what should you do?
Give them analgesia, don’t give anything is a silly thought process to have
Calpol is brilliant. IbopRuben is also good
What are the doses for paracetamol and ibuprofen for kids?
What is the pain ladder for kids
20ml/kg/4-6hours- paracetamol
10ml/kg 8 hourly- iboprufen
Weak opioid (not recommended in children under 12 as 1 in 5 can’t metabolise)
Strong opioids
What is resuscitation guideline for children?
20ml/kg bolus 0.9% Saline
Given quickly in children.
Give quickly and assess response in blood pressure. Give crystalloids over colloids
How do you give maintenance fluids in children’s
4 2 1 rule
Give 0.9% saline/ 5% dextrose +/- KCL
4mlml/kg/hr first 10KG
2 ml/kg/hr next 10kg
1ml/kg/hr every kg after that
What is the problem in 4th and 1/5th fluid?
Causes hyponutremia and cerebral oedema and death. Monitor nutrition levels if using it. Or just use 0.9% saline and 5% dextrose. Will only get moderate hyperchloreamia
What are the major red flags symptoms in children
Feed refusals
Bile vomits- sign of obstruction
Colour of child- grey baby means they’re not perfusimg
Tone- floppy baby is a sick baby
Temperature- hypothermia means not perfuming peripheries
How do you manage abdominal pain?
If it’s not simple it’s not surgical
How does pain help differentiate whether surgery is required?
Closer to umbilicus, less chance of pathology
Colic (functional) vs constant (peritonitis) pain
Movement (what was the car trip like)
How does vomiting affect surgical management
If they are vomiting, neeed surgery- yellow or green
What is tenesmus?
Sign of wanting to contstanly go to the toilet, accompanied with a loss of appetite this suggest appendicitis
What is key to know before examining a child
Relax them a lot
Young kids- peppa pig
Teenage girls- billie eilish
Teenage boys- football
Teenage girls- get them to examin themselves, get them to push in various bits
How do you test for rebound tenderness
DONT DO A PROPER REBOUND TEST
percussion, ask about speed bump history
What investigations do you do in kids in surgery?
Urine- all
FBC- If you’re not sure what the diagnosis is
Electrolytes- if very unwell
X-rays- bowel obstruction
What are your major diagnosis
Appendicitis- dangerous in young kids, present as septic and nonspecific unwell (20% admissions)
What is Murphy triad?
Classical appendicitis
Pain- tenderness of mcburneys point
Vomiting
Fever
What is non specific abdominal pain?
Short duration Central Constant Not made worse by movement No temp Site and severity of tenderness vary
What are your diagnosis for non specific abdominal pain
Appendicitis- 0.2% missed it yiu just watch and wait
Mesenteric adenitis- high temp, URTI often, not unwell
Pneumonia- clue is they’re sicker than abdominal signs, usually right lower lobe
What is malrotation?
3 day old baby presents with bile vomiting- classical presentation
Diagnosis malrotation and volvulus unless proven otherwise
10-12 weeks there isn’t rotation of the gut. Leads to unstable gut
Need an immediate x-ray
If there’s nothing you take from this lecture?
GREEN BILE VOMITING IS MALROTATION. DONT MISS IT
What is intussusception?
How is it treated?
3 day history of viral illness. Baby gets colic, crying, goes floppy and white. Child looks dead. Then comes back after 20s
May or may not have bilious comings
Has redcurrent jelly stool - dark red, blood and mucous in stool
One bit of bowel sliding into the other
Reduce using air and laparotomy
What gives you an increased risk of an umbilical hernia
Low birth weight, trisomy 21, hypothyroidism, mucopolusacharisdes
How do you distinguish for paraumbolical hernia?
Paraumbilical hernia- curly and points down
Important to identify and treat
If not then umbilical hernias will spontaneously close in 4 years
What is gastroschisis?
Gut eviscerated and exposed
10% associated atresia
Very obvious and scary (google in unsure)
