intro to paediatric Surgery

Question 1

important Numbers in Paediatric Surgery

Answer 1

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)

Question 2

Vital Signs for <1 yo

Answer 2

RR - 30-40
HR - 110 - 160
BP - 70-90

Question 3

Vital Signs for 2-5 olds

Answer 3

RR - 25-30
HR - 95 -140
BP - 80-100

Question 4

Vital Signs for 5-20 year olds

Answer 4

RR - 20 - 25
HR - 80 -120
BP - 90 - 110

Question 5

Vital Signs for >10 years old

Answer 5

RR - 15-20
HR - 60 - 100
BP - 100 -120

Question 6

paediatric Px management

Answer 6

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.

Question 7

paediatric Fluid management

Answer 7

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

Question 8

Sentinel Signs of required Sx

Answer 8

Refusing Feed
Bilious Vomit
Grey in colour
Tone 
Temperature

Question 9

what is significant about umbilical pain

Answer 9

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.

Question 10

What is Murhpey’s Triad?

Answer 10

Pain
Vomiting
Fever - Moderate (38.5)

3 three signs of classical appendicitis

Question 11

What else will you see in appendicitis?

Answer 11

Tender at McBurney’s point
and maybe a positive Rosvigs sign

Child will look unwell - End of Bed Dx

Question 12

MAnagement of Appendicitis

Answer 12

Analgesia should NOT be withheld
Oral Paracetamol is the best option

Sx Laparoscopic appendectomy ideally

Question 13

what are the features of non-specific Abdominal Pain (NSAP)

Answer 13

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

Question 14

Presentation of a child with Malrotation

Answer 14

3 day old baby (m/c in days to weeks old)

“fairy liquid green” vomit

Question 15

Ix of malrotation

Answer 15

Upper GI with Contrast ASAP

Question 16

Mx of malrotation

Answer 16

Laparotomy ASAP

Question 17

Presentation of a child with intussusception

Answer 17

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

Question 18

Ix of intussusception

Answer 18

USS abdomen - Target Sign

Question 19

Management of intussusception

Answer 19

Pneumostatic reduction (air enema) 
Laparotomy

Question 20

Presentation of pyloric Stenosis

Answer 20

4-16 wk Hx of Projectile NON-BILIOUS vomiting
Weight loss`
Alkalotic, Hypocholaemic and hypokalaemic (Cap Gas)

Question 21

Ix of pyloric Stenosis

Answer 21

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

Question 22

Mx of pyloric Stenosis

Answer 22

IV fluids
US
Periumbillical pyloromyotomy

Question 23

Paraumbilical Hernia

Answer 23

Defect in the linea Alba above the umbilicus –> protrusion of peritoneal fat

Operative repair - cosmetic only (mark skin prior to anaesthesia

Question 24

Define Gastroschisis

Answer 24

Abdominal Wal defect
Gut evisceration and exposure
10% assoc. With atresia

Question 25

Mx of Gastroschisis

Answer 25

Primary/Delayed Closure

TPN

Question 26

Define Exomphalos

Answer 26

umbilical Defect with covered viscera 
Assoc. with several anomalies 
   25% chromosomal - Trisomy 21, 13 and 18 
   25% cardiac
   15% Renal, neurological

Question 27

Mx of exopthalmos

Answer 27

Primary/delayed closure

Outcome - Post Natal Mortality of 25%