Paed Surgery Flashcards

1
Q

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

A

2 x (age +4)

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

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

A

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

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3
Q

How do we determine the systolic BP of kids?

A

80 + (2 x age)

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

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4
Q

How do we manage pain in kids?

A

Follow the WHO pain ladder:

1) PM 20mg/kg 4-6hly
2) Ibuprofen 10mg/kg 8hly
3) Weak opiod (but codeine can’t be used <12yrs)
4) Strong opioid e.g. morphine

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5
Q

What would we give kids as resuscitation fluids?

A

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

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6
Q

What do we give kids as maintenance fluids?

A

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

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7
Q

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

A
  • Feed Refusal
  • Bile vomits (green)
  • Colour (worse grey)- Tone (floppy)
  • Temp (hypothermia is more advanced than hyperthermia)
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8
Q

What other symptoms should you ask about in abdo pain?

A
  • Vomiting (& colour)
  • Diarrhoea (& tenesmus)
  • Anorexia
  • Previous episodes
  • Menstrual history
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9
Q

What is the speedbump pain?

A

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

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10
Q

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

A

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)

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11
Q

How does appendicitis present?

A

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

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12
Q

How do we manage someone with appendicitis?

A

Analgesia & Laparoscopic appendectomy

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13
Q

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?

A
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

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14
Q

What is Mesenteric Adenitis

A

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

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

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15
Q

How can pneumonia present with abdo pain?

A

Now and then a Right LL pneumonia comes with abdo pain

The clue is they’re very sick but have no abdo signs

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16
Q

What is a malrotation?

A

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

17
Q

How would a malrotation present?

A

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

18
Q

How do we manage a malrotation with volvulus?

A

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

19
Q

What is an intussusception?

A

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

20
Q

How does an intussusception present?

A

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
21
Q

How do we confirm and treat an intussusception?

A

Abdo US - target sign

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

22
Q

What are Gastroschisis and exomphalos

A

Gastroschisis = Gut never goes back into abdo from amniotic sac- it is umbilical cord defect

Exomphalos = Like gastroschisis but covered with viscera- it is umbilical cord defect

23
Q

What’s worse gastroshisis or exomphalos?

A

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

24
Q

How do we treat Gastroschisis & exomphalos?

A

Surgical closure (primary or delayed)

And TPN

25
Q

What makes an umbilical hernia more likely?

A

LTHM

LBW
Trisomy 21
Hypothyroid
Mucopolysaccharidoses

26
Q

What is an epigastric hernia?

A

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

27
Q

When would we repair an umbilical or epigastric hernia?

A

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