Paedatric Surgery Flashcards
How can you calculate a child’s average weight from their age?
2 x (4 + age)
How do you calculate a child’s blood volume norm?
80mls/kg
How do you calculate a child’s urine output norm?
0.5-1ml/kg/hr (little less as you age)
How do you measure insensible loss norms of a child?
20ml/kg/day
How do you work out systolic BP norms for a child?
80 + (2 x age)
What are the vital signs of a <1yo and how do these age with age?
RR 30-40
HR 110-160
BP 70-90
BP increases with age and HR and RR decrease
What is the concept of pain barriers?
The hurdles to a child receiving analgesia
E.g. telling mum/teacher they are sore, going to GP, going to hospital etc.
Don’t delay giving analgesia to kids - makes them easier to examine
What is the WHO pain ladder for children?
Paracetamol - 20mg/kg 4-6hrly
Ibuprofen - 10mg/kg 8hrly
Weak opioid
Strong opioid
What age is codeine licensed for?
> 12
What are the issues with codeine?
20% people don’t have the enzyme that coverts it into morphine (which supplies pain relief)
A small handful of people have too many enzymes –> respiratory depression & death
What are the two types of fluid manage?
Resuscitation - acute fluid depletion
Maintenance
What do you give as resuscitation fluids?
0.9% NaCl saline 20ml/kg bolus
What do you give as maintenance fluids?
0.9% NaCl 0.5% dextrose, 0.15%KCl
4ml/kg for first 10kg, 2ml/kg for next 10kg, 1ml/kg after that
What are the sentinel signs?
Reduced feeding (too tired to fed = v. unwell)
Green bilious vomit (bowel obstruction)
Colour - grey baby
Tone - floppy baby
Temperature - low temp more useful for diagnosing sepsis
What things do you want to clarify in your history of abdominal pain?
Colic vs constant pain Vomiting (?green) = sicker Diarrhoea Loss of appetite = sicker Movement - pain going over speed bumps? more likely to be peritonitis Menstrual pain
What is colic pain more likely to be?
Dysfunctional gut
What is constant pain more likely to be?
Peritoneal irritation/peritonitis
What kind of menstrual pain can you get?
Mittleshmzer and dysmenorrhoea
What are you looking for in examination of a child with abdominal pain?
General appearance
Guarding
Temperature
What is guarding?
Involuntary contraction of abdominal muscles
What investigations should you do in abdominal pain?
Urine dipstick
FBC if diagnostic uncertainty
Electrolytes if v sick/dehydrated
X-ray rarely
What is murphy’s triad?
Classical symptoms of appendicitis: fever, pain (McBurney’s point), vomiting
Where is McBurney’s point?
2/3rds along the line from the umbilicus to ASIS on the right side
What are the clues that would make you think appendicitis?
Periumbilical pain, followed by localised pain in McBurney’s point
Moderate temp <40, vomiting, looks unwell
Unusual <4y
What are complications of appendicitis?
Abscesses, masses (missed appendicitis that has walled off into appendix), perionitis
How do you Rx appendicitis?
Laparoscopic appendectomy + paracetamol
What is NSAP?
Abdominal pain of a short duration (24-48h), that is central, constant, unaffected by movement, no GIT disturbance, temperature and site/severity vary
In which gender is NSAP more common?
Girls
What is mesenteric adenitis?
Inflammation of the mesenteric lymph nodes after a viral illness etc. –> pain
What are the symptoms of mesenteric adenitis?
High temperature (>40), following URT often, not that unwell
Pneumonia can sometimes present with abdominal pain - how can you pick this up?
Child sicker than abdominal signs (completely soft abdomen)
Look for cough, SoB, tachycardia etc.
What kind of pneumonia tends to present with abdominal pain?
Right LL
What is malrotation and what does it lead to?
Abnormal coiling/fixation of the intestines
Leads to volvulus - abnormal twisting of a loop of bowel on its mesentery –> ischaemia, gangrene
What is a typical hx for malrotation & volvulus?
3 day old baby, w. green bile vomiting = MALROTATION until proven otherwise
How do you investigate volvulus & malrotation?
Upper GI contrast study ASAP
How do you manage malrotation and malrotation?
Laparotomy ASAP
What is intrussuception?
Loop of proximal bowel slides into distal bowel
What is a typical hx for intrussception?
9m (6-12m) baby hx of viral illness (D/V/cold) + intermittent colic and dying spells + bilious vomiting
Prolonged cap refill & redcurrant jelly stool
What causes dying spells in intrussception?
Go white, floppy and stop breathing as they get colic waves, then starting breathing etc. 10s later after it passes
Vagal response
How do you investigate intrussception?
USS abdomen, target sign
How do you manage intrussception?
Pneumostatic reduction (air enema), laparotomy
What is gastroschisis?
Paraumbilical herniation of intestines through abdominal wall without sac formation
In which direction does a paraumbilical hernia point?
Towards the feet
In which direction do umbilical hernias point?
Towards the ceiling
What condition is gastroschisis assoc with?
Atresia
What is the management for gastroschisis?
Primary/delayed closure + TPN
What is the prognosis for gastroschisis?
90%
Short gut is the biggest killer (constriction of mesenteric arteries –> ischaemia and reduced bowel length)
What is exomphalos?
Umbilical defect where by abdominal viscera herniate through the abdominal wall with covering viscera
What is exomphalos associated with?
Cardiac abnormalities, chromosomal abnormalities (trisomy 13, 18, 21), renal & neurological abnormalities
Beckwith-Weideman syndrome
What are the three things in Beckwith-Weideman syndrome?
Macroglossia, exomphalos, hyperinsulinaemia
How do you treat exomphalos?
Primary/delayed closure
What is the post-natal mortality of exomphalos?
25%
What is umbilical hernia?
Protrusion of a sac (with/without intestines) through umbilicus
How do you Mx umbilical hernia?
Closure only if not closed itself by 4/5
What is umbilical hernia assoc with?
Down’s, hypothyroidism, mucopollysaccharidosis
What leads to epigastric hernia?
Defect in linea alba
What is an epigastric hernia?
Protrusion of preperitoneal fat
How you Mx epigastric hernia?
Laparoscopic repair only for cosmetic reasons - must mark before you give anaesthesia as relaxing abdominal wall –> disappearance
