24. Peadiatric Surgery

Question 1

How do you calculate how much the weight of children?

Answer 1

(Kg)= 2x (Age+4)

Question 2

How do you calculate the blood volume of children,

Answer 2

MLS=80mls per kilo

Question 3

What is the urine output of children?

Answer 3

1ml/kg/hour, up until 20ml

Question 4

If a child is sore what should you do?

Answer 4

Give them analgesia, don’t give anything is a silly thought process to have

Calpol is brilliant. IbopRuben is also good

Question 5

What are the doses for paracetamol and ibuprofen for kids?

What is the pain ladder for kids

Answer 5

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

Question 6

What is resuscitation guideline for children?

Answer 6

20ml/kg bolus 0.9% Saline

Given quickly in children.

Give quickly and assess response in blood pressure. Give crystalloids over colloids

Question 7

How do you give maintenance fluids in children’s

Answer 7

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

Question 8

What is the problem in 4th and 1/5th fluid?

Answer 8

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

Question 9

What are the major red flags symptoms in children

Answer 9

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

Question 10

How do you manage abdominal pain?

Answer 10

If it’s not simple it’s not surgical

Question 11

How does pain help differentiate whether surgery is required?

Answer 11

Closer to umbilicus, less chance of pathology
Colic (functional) vs constant (peritonitis) pain
Movement (what was the car trip like)

Question 12

How does vomiting affect surgical management

Answer 12

If they are vomiting, neeed surgery- yellow or green

Question 13

What is tenesmus?

Answer 13

Sign of wanting to contstanly go to the toilet, accompanied with a loss of appetite this suggest appendicitis

Question 14

What is key to know before examining a child

Answer 14

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

Question 15

How do you test for rebound tenderness

Answer 15

DONT DO A PROPER REBOUND TEST

percussion, ask about speed bump history

Question 16

What investigations do you do in kids in surgery?

Answer 16

Urine- all

FBC- If you’re not sure what the diagnosis is

Electrolytes- if very unwell

X-rays- bowel obstruction

Question 17

What are your major diagnosis

Answer 17

Appendicitis- dangerous in young kids, present as septic and nonspecific unwell (20% admissions)

Question 18

What is Murphy triad?

Answer 18

Classical appendicitis

Pain- tenderness of mcburneys point
Vomiting
Fever

Question 19

What is non specific abdominal pain?

Answer 19

Short duration
Central
Constant
Not made worse by movement
No temp
Site and severity of tenderness vary

Question 20

What are your diagnosis for non specific abdominal pain

Answer 20

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

Question 21

What is malrotation?

Answer 21

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

Question 22

If there’s nothing you take from this lecture?

Answer 22

GREEN BILE VOMITING IS MALROTATION. DONT MISS IT

Question 23

What is intussusception?

How is it treated?

Answer 23

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

Question 24

What gives you an increased risk of an umbilical hernia

Answer 24

Low birth weight, trisomy 21, hypothyroidism, mucopolusacharisdes

Question 25

How do you distinguish for paraumbolical hernia?

Answer 25

Paraumbilical hernia- curly and points down

Important to identify and treat

If not then umbilical hernias will spontaneously close in 4 years

Question 26

What is gastroschisis?

Answer 26

Gut eviscerated and exposed
10% associated atresia
Very obvious and scary (google in unsure)