Paed Surgery Flashcards
How would you determine the avg weight of a child if you don’t have time to weigh them?
2 x (age +4)
E.g. 10yr old:
2 x (10 + 4) = 28 kg
How do you determine blood volume, urine output and insensible fluid loss in kids?
Blood volume = 80ml/kg
UO = 1ml/kg/hr
Insensible fluid loss = 20ml/kg/day
How do we determine the systolic BP of kids?
80 + (2 x age)
E.g. 9yr old:
80 + (2 x 9) = 98
How do we manage pain in kids?
Follow the WHO pain ladder:
1) PM
2) Ibuprofen
3) Weak opiod (but codeine can’t be used <12yrs)
4) Strong opioid e.g. morphine
What would we give kids as resuscitation fluids?
20ml/Kg bolus of 0.9% NaCl (saline)
What do we give kids as maintenance fluids?
4ml/Kg (1st 10Kgs)
2ml/Kg (2nd 10kgs)
1ml/Kg (thereafter)
Of 0.9% NaCL & 5% dextrose +/- KCl
E.g. 10yr old = 28kgs
(4 x 10) + (2x10) + (1 x 8 ) = 68ml/hr
List 5 red flag signs of a surgical problem in kids?
- Feed Refusal
- Bile vomits (green)
- Colour (worse grey)- Tone (floppy)
- Temp (hypothermia is more advanced than hyperthermia)
What other symptoms should you ask about in abdo pain?
- Vomiting (& colour)
- Diarrhoea (& tenesmus)
- Anorexia
- Previous episodes
- Menstrual history
What is the speedbump pain?
Kid’s abdo pain gets way worse on sudden movement e.g. going over speedbumps (indicates peritonitis)
What tests can be used to determine the source of a child’s abdo pain?
Urinalysis (For all of them)
FBC (only if you’re unsure)
U&E (if very sick or dry)
X-ray (only necessary if you suspect bowel obstruction)
How does appendicitis present?
Murphy’s triad of pain, vomiting & fever
Along with tenderness over McBurney’s point
(Not likely if <4yrs)
How do we manage someone with appendicitis?
Analgesia & Laparoscopic appendectomy
Non-specific Abdo Pain (NSAP) is a +Ve diagnosis for when we can’t find a pathological reason for abdo pain. What are it’s features?
Short
Central
Constant
Not affected by movement
No GIT disturbance
No temp
Site/severity changes
It’s more common in girls and is often recurrent
What is Mesenteric Adenitis
Lymphadenopathy in abdomen –> Abdo pain, tenderness & high fever
It’s caused by a precedeing viral illness e.g. URTI
How can pneumonia present with abdo pain?
Now and then a Right LL pneumonia comes with abdo pain
The clue is they’re very sick but have no abdo signs
What is a malrotation?
Bowel fails to undergo the 270* rotation during pregnancy so it can become twisted/obstructed very easily (aka volvulus)
How would a malrotation present?
Fine until they have a volvulus then:
- Bile vomiting
Newborn with bile vomiting is this until proven otherwise
Most occur before 1month, almost all by 1 yr
How do we manage a malrotation with volvulus?
Get an UGI contrast study asap to confirm and do a laparotomy or they die
What is an intussusception?
On big part of bowel has slid further inside another (mostly terminal ileum into colon)
Leads to waves of colic which triggers vagal responses leading to dying spells
How does an intussusception present?
Usually a short history of viral illness followed by:
- Intermittent colic
- Dying spells (white, floppy & not breathing)
- Bilious vomiting
- Slow cap refill
- Bloody mucous PR
How do we confirm and treat an intussusception?
Abdo US - target sign
Pneumostatic reduction (Aka air enema), if that fails a laparotomy
What are Gastroschisis and exomphalos
Gastroschisis = Gut never goes back into abdo from amniotic sac
Exomphalos = Like gastroschisis but covered with viscera
What’s worse gastroshisis or exomphalos?
Gastroschisis has a good prognosis
Exomphalos has a bad one but not directly, it’s because of ass abnormalities e.g. cardiac, chromosomal, renal & neuro
How do we treat Gastroschisis & exomphalos?
Surgical closure (primary or delayed)
And TPN
