intro to paediatric Surgery Flashcards
important Numbers in Paediatric Surgery
Weight = 2 x (age + 4) Blood volume = 80mls/kg U/O = 1mls/kg/hour (drops to 0.5mls as we get older) Insensible Fluid loss = 20ml/kg/day Systolic BP = 80 + (2 x age)
Vital Signs for <1 yo
RR - 30-40
HR - 110 - 160
BP - 70-90
Vital Signs for 2-5 olds
RR - 25-30
HR - 95 -140
BP - 80-100
Vital Signs for 5-20 year olds
RR - 20 - 25
HR - 80 -120
BP - 90 - 110
Vital Signs for >10 years old
RR - 15-20
HR - 60 - 100
BP - 100 -120
paediatric Px management
WHO pain Ladder
Paracetamol 20mg/kg 4-6 hrly
Ibuprofen 10mg/kg 8 hrly
Weak Opiod*
Strong Opiod
*Codeine, not recommended for <12 as the matebolism to morphine can potentially not work delaying proper analgesia, or work a little too well and cause extremely high doses.
paediatric Fluid management
Resus - 20ml/kg Bolus 0.9% NaCl
Maintenance - 0.9% NaCl/ 5% dextrose +/- 0.15% KCl
4ml/kg 1st 10kg
2ml/kg 2nd 10 kg
1ml/kg thereafter
Sentinel Signs of required Sx
Refusing Feed Bilious Vomit Grey in colour Tone Temperature
what is significant about umbilical pain
the closer the pain is to the umbilicus the less likely there is to be a pathology.
This is because the pain is most likely referred from the mid gut where there is very few acute peritonitic episodes occurring.
What is Murhpey’s Triad?
Pain
Vomiting
Fever - Moderate (38.5)
3 three signs of classical appendicitis
What else will you see in appendicitis?
Tender at McBurney’s point
and maybe a positive Rosvigs sign
Child will look unwell - End of Bed Dx
MAnagement of Appendicitis
Analgesia should NOT be withheld
Oral Paracetamol is the best option
Sx Laparoscopic appendectomy ideally
what are the features of non-specific Abdominal Pain (NSAP)
Short duration - 24-48hrs Central - peri-umbilical Constant - no variation Not made worse by movement No GIT disturbance - Bowel habits unchanged etc. No Temperature Site and severity of tenderness vary
What out - this may mimic appendicitis but tits not - it will only get better, not worse
Presentation of a child with Malrotation
3 day old baby (m/c in days to weeks old)
“fairy liquid green” vomit
Ix of malrotation
Upper GI with Contrast ASAP
Mx of malrotation
Laparotomy ASAP
Presentation of a child with intussusception
Nine month old baby (6-12 months most commonly)
3 day Hx of Viral illness then intermittent COLIC and DYING SPELLS - baby goes white and floppy due to a wave of colic causing a massive vagal response
Bilious vomiting
On admission - prolonged cap refill
RED CURRENT JELLY STOOL
mucus and blood mixes together
Ix of intussusception
USS abdomen - Target Sign
Management of intussusception
Pneumostatic reduction (air enema) Laparotomy
Presentation of pyloric Stenosis
4-16 wk Hx of Projectile NON-BILIOUS vomiting
Weight loss`
Alkalotic, Hypocholaemic and hypokalaemic (Cap Gas)
Ix of pyloric Stenosis
Capillary Blood gas
Test Feed - will see stomach start to fill and round - after time the mass will shift to the babies right as it slowly passes through the pyloris
Mx of pyloric Stenosis
IV fluids
US
Periumbillical pyloromyotomy
Paraumbilical Hernia
Defect in the linea Alba above the umbilicus –> protrusion of peritoneal fat
Operative repair - cosmetic only (mark skin prior to anaesthesia
Define Gastroschisis
Abdominal Wal defect
Gut evisceration and exposure
10% assoc. With atresia
Mx of Gastroschisis
Primary/Delayed Closure
TPN
Define Exomphalos
umbilical Defect with covered viscera Assoc. with several anomalies 25% chromosomal - Trisomy 21, 13 and 18 25% cardiac 15% Renal, neurological
Mx of exopthalmos
Primary/delayed closure
Outcome - Post Natal Mortality of 25%
