Introduction to Paediatric Surgery Flashcards
How is fluid given to children?
Crystalloid fluid is used for resuscitation and is given as a 20ml/kg bolus of 0.9% NaCl. Maintenance fluid can be given as 0.9% NaCl or 5% dextrose and is given as follows:
•4ml/kg for first 10kg of child’s weight
•2ml/kg for second 10kg of child’s weight
•1ml/kg for every kg thereafter
What are the non-specific red flags of an ill child?
Feed refusal (especially in babies) Bile vomits (green) Paleness Tone (a floppy baby is a sick baby) Temperature
What are the symptoms of appendicitis?
Classically, appendicitis is associated with Murphy’s triad of pain, vomiting and fever.
Tenderness over McBurney’s point
Pain exacerbated by rebound- which is elicited by a car going over speed bumps so it is more appropriate to ask if this happens than to elicit the rebound pain on examination.
Appendicitis is unusual >4 years of age and clues to diagnosis include a moderate temperature, vomiting and a child who looks unwell
What are the common complications of appendicitis?
Abscess
Mass formation
Peritonitis
Where is McBurney’s point?
1/3 of the way from the umbilicus to the anterior superior iliac spine
What are the features of non-specific abdominal pain?
Short duration Central Constant Not exacerbated by movement No GIT disturbance No temperature Girls > boys
What other diagnoses can be made in paediatric abdominal pain?
Mesenteric adenitis- high temperature, URTI common, not unwell
Pneumonia- right middle lobe can have referred pain to right iliac fossa, generally appear less well than abdominal signs indicate
In what populations is pyloric stenosis most common?
Weeks 4-16 of life
Boys > girls 5:1
What are the symptoms of pyloric stenosis?
Non-bilious projectile vomiting
Weight loss
Hypochloraemia, hypokalaemia and alkalosis
How is pyloric stenosis managed?
Test feed
IV fluid
Ultrasound
Periumbilical pyloromyotomy
What is the classical history associated with malrotation?
The classic history is of a three day old baby presenting with bilious vomiting- reported as “fairy liquid” green in appearance. Diagnosis is malrotation and volvulus until proved otherwise
How is malrotation investigated and treated?
Investigation- urgent GI contrast study
Management- urgent laparotomy
What is intussusception?
Intussusception is when one part of the bowel slides inside another bit
At what age is intussusception most common?
6-12 months
What are the symptoms of intussusception?
Three day history of viral illness Intermittent colic Dying spells Bilious vomiting Prolonged capillary refill time
How is intussusception investigated and managed?
Investigated with a ultrasound of the abdomen
Treated with pneumostatic reduction (air enema) or laparotomy
What is the incidence of umbilical hernias?
1:6 babies
What are the risk factors for umbilical hernias?
Low body weight
Trisomy 21
Hypothyroidism
Mucopolysaccharidosis
How do umbilical hernias close?
Usually close spontaneously by 4
Can be closed surgically if there are complications
What is gastroschisis?
An abdominal wall defect that leaves the gut eviscerated and exposed through the umbilicus. 10% of cases have an associated atresia
How is gastroschisis managed?
Management is with delayed closure- can be surgical if large defect
What are the survival rates of gastroschisis and when does it become fatal?
Survival rates are 90%+, with the condition only becoming fatal if short gut occurs- when the umbilicus causes ischaemia of a large portion of bowel and the baby is only left with a small part of the bowel
What is exomphalos?
An umbilical defect where the herniating mass is covered in the three layers of the umbilical cord. It is a marker of poor embryological development and so has a number of associated anomalies
What anomalies can be associated with exomphalos?
Cardiac anomalies Chromosomal- trisomy 13, 18 (both lethal) and 21 Renal Neurological Beckwith-Weideman syndrome
