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Y3 paediatrics > paediatric surgery > Flashcards

paediatric surgery Flashcards

1
Q

physiological indices in children

A

weight (kg) = 2 x age (+4)

blood vol (mls) = 80ml/kg

UO = 1ml/kg/hr

insensible fluid loss = 20ml/kg/day

systolic BP (mmHg) = 80 + (2x age)

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2
Q

vital signs in children

A
  • babies = high RR, high HR, low BP
  • as you get older, trends reverse
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3
Q

pain barrier in children

A

much more difficult for a child to get analgesia straight away

  • children should get analgesia as soon as they are sore
  • follow WHO pain ladder
    • paracetamol 20mg/kg 4-6hrly
    • ibuprofen 10mg/kg 8hrly
    • weak opioid - codeine not recommended <12yrs (resp depression, rapid metabolises, may not be effective)
    • strong opioid
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4
Q

fluid management in children - resuscitation

A

20ml/kg bolus 0.9% sodium chloride

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5
Q

fluid management in children - maintenance

A

0.9% Nacl + 5% dextrose +/- KCl

4ml/kg 1st 10kg

2ml/kg 2nd 10kg

1ml/kg every kg thereafter

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6
Q

what are the sentinel signs in children

A

imply there is something significant going on

  • feed refusal
  • bile vomits (green) - implies obstruction
  • colour - grey = poor skin perfusion
  • tone - floppy/rigid
  • temp - pyrexia, hypothermia - inadequate peripheral circulation
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7
Q

basis of management of abdo pain

A

GP/ED decision - does this child need a surgical opinion

surgical decision - does the child need surgery

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8
Q

abdo pain in children - hx

A
  • closer to umbilicus - tends to be related to mid-gut pain → less likely to be pathological
  • colic vs constant - constant implies peritonitis
  • pain on movement - implies peritonitis
  • vomiting
    • increases significance - more likely to be an issue if pain + vomiting
    • bile is important
  • diarrhoea
    • retro-ileal/retro-colic appendix
    • tenesmus in pelvic appendix
  • anorexia
  • previous episodes - lessens chances of surgical diagnosis
  • menstrual hx
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9
Q

examining a child

A
  • distraction techniques
  • general appearance important
  • temp
  • guarding and rebound tenderness - avoid in children (very uncomfortable) - percussion is sufficient
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10
Q

investigations for abdo pain

A

urine - everyone

FBC - only if diagnostic doubt

electrolytes - only if sick/very dry

X-rays - rarely (unless obstruction), unlikely to alter management

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11
Q

when is it appendicitis in children

A

unusual <4y/o

can be difficult to diagnose

20% admissions

clues: moderate temp, vomiting, looks unwell

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12
Q

features of appendicitis

A

Murphy’s triad: pain, vomiting, fever

tenderness over McBurney’s point (⅓ of the way between umbilicus and iliac spine)

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13
Q

complications of appendicitis

A

abscess

mass

peritonitis

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14
Q

management of appendicits

A

analgesia - don’t withhold, oral paracetamol best option

surgery

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15
Q

features of non-specific abdo pain (NSAP)

A

short duration

central

constant

not made worse by movement

no GI disturbance

no temp

site and severity of tenderness vary

→ can mimic an early appendicitis (BUT risk of missing appendicitis 0.2%)

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16
Q

how common is NSAP

A

F > M

45% admissions

often recurrent

safe and usually not underlying pathology

17
Q

DDx for NSAP

A

mesenteric adenitis - high temp, often URTI, not unwell

pneumonia - sicker than abdo signs, usually R lower lobe, high WCC, high temp

18
Q

what does bile vomit indicate until proven otherwise

A

malrotation and volvulus

needs urgent diagnosis

19
Q

what is malrotation and volvulus

A

malrotation - abnormal arrangement of intestines

volvulus - intestines have twisted and lost blood supply

20
Q

management of malrotation and volvulus

A

laparotomy to salvage bowel before it dies

21
Q

what does this hx suggest a diagnosis of:

9mth old baby

3/7 hx of viral illness then intermittent colic and dying spells

bilious vomiting

bloody mucus PR

4s CRT

A

intusussception

22
Q

what are dying spells and what causes them

A

child is crying and then goes completely floppy and pale

don’t breathe for 10-15s then start crying again

  • wave of abdo colic → vagal response → breath holding and floppiness
23
Q

investigations for intusussception

A

USS abdo

  • target sign
24
Q

management of intusussception

A

requires urgent intervention to prevent ischaemia

pneumostatic reduction (air enema) - X-ray guided, generally successful

laparotomy

25
Q

what ages get intusussception

A

6-18mth old

26
Q

what diagnosis does this hx suggest:

  • 8mths old
  • umbilical swelling
  • present from 4 days old
  • worse w/ crying
  • easily reducible
A

umbilical hernia

27
Q

how common is umbilical hernia

A

1:6 children

spontaneous closure by 4yrs - almost always

more common in afro-caribbean children

complications rare

28
Q

when to repair an umbilical hernia

A

complications

relative - persistance >4yrs, large defect, aesthetic

29
Q

what is it important to distinguish and umbilical hernia from

A

paraumbilical hernia

  • hernia just above the umbilicus
  • paraumbilical tend to point down to the feet, umbilical point straight up
30
Q

what are 2 types of abdo wall defects

A

gastroschisis

exomphalos

31
Q

what is gastroschisis

A

abdo wall defect

  • gut eviscerated and exposed - comes out just to the side of the umbilicus
  • 10% associated atresia
32
Q

management of gastroschisis

A
  • delayed closure - create plastic chimney above defect and slowly ‘squeeze’ back into abdomen
  • TPN
33
Q

survival of gastroschisis

A

>90%

can be no long term implications

risk of short gut - catastrophic, happens if the defect is small and the gut gets cut off in utero (can lose entire midgut) - very poor outcomes and lifelong surgeries and management

34
Q

what is exomphalos

A

covered defect

large umbilical hernia with covered viscera

35
Q

associated anomalies with exomphalos

A

25% cardiac

25% chromosomal - trisomy 13, 18, 21

15% renal, neur

Beckwith Weideman syndrome

36
Q

management of exomphalos

A

1y/delayed closure

37
Q

outcome of exomphalos

A

post natal mortality 25%

  • due to associated lethal chromosomal and major cardiac problems

Y3 paediatrics (45 decks)

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