Intro to Paeds Surgery Flashcards
Equation for working out weight from age
2 x (age + 4)
Equation for working out blood volume of kid per kg
80mls/kg
Urine output = …../kg/hour
0.5-1ml/kg/hour
Insensible fluid loss = …/kg/hour
20ml/kg/day
Systolic BP (mm Hg) =
80 + (2x Age)
Paeds range of Respiratory rate
infants - 30-40
above ten - 15-20
Paeds range of heart rate
infants - 110-160
above ten - 60-100
Paeds range of BP
infants - 70-90
above ten - 100-120
What is the pain barrier in paeds?
kids dont get analgesia as teacher wants to ask parent who wants to ask doctor who wants to ask hospital and all are scared calpol will mask signs
Pain ladder is
paracetamol
ibuprofen
weak opiod
strong opiod (morphine)
which weak opiod should not be given to kids?
codeine
what rule is used to calculate maintenance fluids in paeds?
421 rule
4ml/kg 1st 10kg
2ml/kg 2nd 10 kg
1ml/kg every kg thereafter
10 yrs = 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr
what fluid would you use for maintenance fluid in paeds?
0.9% NaCl / 5% Dextrose +/- 0.15% KCl
what fluid would you use for resus in paeds
0.9% NaCl
20ml/kg bolus
5 sentinel signs in paeds?
feed refusal bile vomits colour tone temperature
clues - signs of appendicitis
moderate temperature, vomiting
looks unwell
Murphys triad (appendicitis) is
pain
vomiting
fever
in appendicitis where do you get tenderness?
McBurney’s point
complications of appendicitis
abscess
mass
peritonitis
management of appendicitis
laparoscopic / open appendicectomy
NSAP - non specific abdomen pain FEATURES
short duration central constant not made worse by movement no GIT disturbance no temperature site and severity of tenderness vary
mesenteric adenitis is
great big swollen glands in abdomen
high temperature
URTI often
not “unwell”
Malrotation presentation
3 day old baby
with bile vomiting
“fairy liquid” green
3 day old baby
with bile vomiting
“fairy liquid free” whats the diagnosis?
MALROTATION and VOLVULUS
what is malrotation?
failure of midgut to rotate during embryogenesis. Mobile midgut with short mesentery and propensity to twist?
what is volvulus?
where the malrotation twists
investigation of malrotation
URGENT upper GI contrast study
management of malrotation
URGENT surgery (laparotomy)
What is Intussusception?
Telescoping f one portion of bowel into an immediately adjacent segment.
Subsequent restriction of blood supply and oedema of bowel wall rapidly leads to obstruction and potentially gangrene/ perforation
(one bit of bowel sliding into another bit)
incidence of intussusception
most common in those aged 3 - 12 months
symptoms of intussusception
3 day history of viral illness then intermittent COLIC and DYING SPELLS
bilious vomiting
Whats a DYING SPELL?
baby goes floppy and white - parents think they have died- vagal response- crying 20 mins later
Signs of intussusception
palpable sausage shaped mass, redcurrant jelly stools (PR)
investigations of intussusception
USS - target sign
Management of intussusception
reduction with air enema
if this fails - reduction at laparotomy
incidence of umbilical hernia
1:6 kids
increased risk in LBW, trisomy 21, hypothyroidism
Rx of umbilical hernia
spontaneous closure by 4 years
What is an epigastric hernia?
defect in linea alba above the umbilicus
protrusion of peritoneal fat
Rx of epigastric hernia
leave alone
operative role is cosmetic but leaves big scar instead
What is Pyloric Stenosis?
Hypertrophy of the gastric pylorius causing upper GI obstruction
incidence of pyloric stenosis
males 5:1 female, FH often
2-8 weeks
Symptoms of pyloric stenosis
non bilious - milky - vomiting - “projectile” after every feed, constantly hungry baby, acute weight loss
Signs of pyloric stenosis
dehydration, palpable olive mass in right upper abdomen,
investigations of pyloric stenosis -
cap gas
hyperchloraemic, hypokalaemia metabolic alkalosis
Abdo USS
Rx of Pyloric stenosis
mild by mouth, correct electrolyte abnormalities with iv fluids, NG tube and replace NG losses
surgical pyloromyotomy
Gastroschisis is
herniation through abdominal wall defect to right of umbilicus. bowel not covered with membrane
bowel comes out in utero and just doesn’t go back in
Management of gastroschisis
primary surgical closure or delayed if bigger
Exomphalos
herniation through umbilicus. bowel and viscera covered with membranous sac
associated with other congenital abnormalities
Management of Exomphalus
primary/ delayed surgical closure
