Intro to Paediatric Surgery

Question 1

What are the stages on the WHO pain ladder for children?

Answer 1

• Paracetamol 20mg/kg 4-6 hourly
• Ibuprofen 10mg/kg 8 hourly
• (weak opiod) - codeine not suitable < 12yrs
• Strong opiod

Question 2

Which fluid and how much should be used for paediatric resus?

Answer 2

20ml/kg bolus of 0.9% NaCl

Question 3

Which fluids can be used for paediatric maintenance fluids and how much should be used?

Answer 3

• 0.9% NaCl/ 5% dextrose +/- 0.15% KCl
• 4ml/kg 1st 10kg
• 2ml/kg 2nd 10kg
• 1ml/kg every kg thereafter

Question 4

What are the red flag signs?

Answer 4

• Feed refusal
• Bile vomits
• Colour
• Tone (floppy baby)
• Temperature

Question 5

Which features of a history might be present in a child presenting with abdominal pain and what do they mean?

Answer 5

Pain

• Closer to umbilicus less chance of pathology
• Colic vs constant
• Movement

Vomiting
-Is there bile

Diarrhoea
Anorexia
Previous episodes - lessens chance of surgical diagnosis
Menstrual history

Question 6

Which investigations might you do in a patient presenting with abdo pain?

Answer 6

• Urine (everything)
• FBC (if diagnostic doubt)
• Electrolytes (if sick/ very dry)
• XR

Question 7

What is the classical presentation of appendicitis?

Answer 7

• Pain (tenderness over McBurney’s point)
• Vomiting
• Fever
• Looks unwell

Question 8

What are the complications of appendicitis?

Answer 8

• Abscess
• Mass
• Peritonitis

Question 9

What are the features of non specific abdominal pain?

Answer 9

• Short duration
• Central
• Constant
• Not made worse by movement
• No GIT disturbance
• No temperature
• Site and severity vary

Question 10

How does mesenteric adenitis present?

Answer 10

• Abdo pain
• High temp
• URTI often
• Not unwell

Question 11

How does pneumonia present?

Answer 11

• Can have abdo pain
• Sicker than abdo symptos
• Usually Right LL

Question 12

How does pyloric stenosis present?

Answer 12

• Males>females
• 1-4 months of life
• Non bilious vomiting
• Weight loss
• Alkalosis, hypochloraemia and hypokalaemia

Question 13

How can pyloric stenosis be investigated and managed?

Answer 13

• Test feed
• IV fluid
• USS
• Periumbilical pyloromyotomy

Question 14

How does malrotation present?

Answer 14

• 3 day old baby

- Bile vomiting: fairy liquid green

Question 15

How is suspected malrotation managed?

Answer 15

• Urgent upper GI contrast study

- Laparotamy asap

Question 16

How does intussusception present?

Answer 16

• Nine month baby
• 3 day history of viral illness
• Intermittent colic and dying spells
• Bilious vomiting
• 4s capillary refill
• Bloody mucous on PR (redcurrant jelly stool)

Question 17

How is intussusception investigated and how is it managed?

Answer 17

• USS abdo (target sign)
• Pneumostatic reduction (air enema)
• Laparotomy

Question 18

What is gastroschisis and how is it managed?

Answer 18

• Abdo wall defect: gut eviscerated and exposed
• Primary/delayed closure
• TPN

Question 19

What is an exomphalos?

Answer 19

An umbilical defect with covered viscera

Question 20

Which abnormalities are associated with exomphalos?

Answer 20

• Cardiac
• Chromosomal: Trisomy 13, 18 and 21
• Renal
• Neurological
• Beckwith-Weideman Syndrome

Question 21

How can exomphalos be managed?

Answer 21

Primary/delayed closure