Paed Surgery

Question 1

How would you determine the avg weight of a child if you don’t have time to weigh them?

Answer 1

2 x (age +4)

E.g. 10yr old:
2 x (10 + 4) = 28 kg

Question 2

How do you determine blood volume, urine output and insensible fluid loss in kids?

Answer 2

Blood volume = 80ml/kg
UO = 1ml/kg/hr
Insensible fluid loss = 20ml/kg/day

Question 3

How do we determine the systolic BP of kids?

Answer 3

80 + (2 x age)

E.g. 9yr old:
80 + (2 x 9) = 98

Question 4

How do we manage pain in kids?

Answer 4

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

Question 5

What would we give kids as resuscitation fluids?

Answer 5

20ml/Kg bolus of 0.9% NaCl (saline)

Question 6

What do we give kids as maintenance fluids?

Answer 6

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

Question 7

List 5 red flag signs of a surgical problem in kids?

Answer 7

• Feed Refusal
• Bile vomits (green)
• Colour (worse grey)- Tone (floppy)
• Temp (hypothermia is more advanced than hyperthermia)

Question 8

What other symptoms should you ask about in abdo pain?

Answer 8

• Vomiting (& colour)
• Diarrhoea (& tenesmus)
• Anorexia
• Previous episodes
• Menstrual history

Question 9

What is the speedbump pain?

Answer 9

Kid’s abdo pain gets way worse on sudden movement e.g. going over speedbumps (indicates peritonitis)

Question 10

What tests can be used to determine the source of a child’s abdo pain?

Answer 10

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)

Question 11

How does appendicitis present?

Answer 11

Murphy’s triad of pain, vomiting & fever
Along with tenderness over McBurney’s point
(Not likely if <4yrs)

Question 12

How do we manage someone with appendicitis?

Answer 12

Analgesia & Laparoscopic appendectomy

Question 13

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?

Answer 13

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

Question 14

What is Mesenteric Adenitis

Answer 14

Lymphadenopathy in abdomen –> Abdo pain, tenderness & high fever

It’s caused by a precedeing viral illness e.g. URTI

Question 15

How can pneumonia present with abdo pain?

Answer 15

Now and then a Right LL pneumonia comes with abdo pain
The clue is they’re very sick but have no abdo signs

Question 16

What is a malrotation?

Answer 16

Bowel fails to undergo the 270* rotation during pregnancy so it can become twisted/obstructed very easily (aka volvulus)

Question 17

How would a malrotation present?

Answer 17

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

Question 18

How do we manage a malrotation with volvulus?

Answer 18

Get an UGI contrast study asap to confirm and do a laparotomy or they die

Question 19

What is an intussusception?

Answer 19

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

Question 20

How does an intussusception present?

Answer 20

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

Question 21

How do we confirm and treat an intussusception?

Answer 21

Abdo US - target sign

Pneumostatic reduction (Aka air enema), if that fails a laparotomy

Question 22

What are Gastroschisis and exomphalos

Answer 22

Gastroschisis = Gut never goes back into abdo from amniotic sac

Exomphalos = Like gastroschisis but covered with viscera

Question 23

What’s worse gastroshisis or exomphalos?

Answer 23

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

Question 24

How do we treat Gastroschisis & exomphalos?

Answer 24

Surgical closure (primary or delayed)

And TPN

Question 25

What makes an umbilical hernia more likely?

Answer 25

LBW
Trisomy 21
Hypothyroid
Mucopolysaccharidoses

Question 26

What is an epigastric hernia?

Answer 26

Defect in linea alba sup to umbilicus –> protrusion of peritoneal fat

Question 27

When would we repair an umbilical or epigastric hernia?

Answer 27

Umbilical if >4 (most resolve spontaneously before that)

Epigastric we tend not to, it’s largely hidden by natural fat as you age and preferable to a large scar

They are both largely harmless