Paediatric Surgery

Question 1

What are some important indices in children?

Answer 1

Weight (kg) - 2 x (age + 4)
Blood volume (mls) - 80ml/kg
Urine output - 1ml/kg/hr
Insensible fluid loss - 20ml/kg/day
Systolic BP - 80 + (age + 2)

Question 2

What is the pain management for children?

Answer 2

Paracetamol 20mg/kg 4-6 hourly
Ibuprofen 10mg/kg 8 hourly
Weak opioids - codeine is not recommended under 12 yrs for resp. distress
Strong opioid - morphine

Question 3

What is the fluid management for children?

Answer 3

Resus - 20ml/kg bolus 0.9% sodium chloride
Maintenance -0.9% NaCl/ 5% dextrose and KCl
Volume depends on weight

Question 4

What are sentinel signs?

Answer 4

Feed refusal, bile vomits, colour, tone and temperature

Question 5

What are important part of the history?

Answer 5

Pain, vomiting, diarrhoea, anorexia, previous episodes and menstrual history

Question 6

What is Murphy’s triad?

Answer 6

Pain, vomiting and fever
Tenderness over McBurney’s point

Question 7

What is the management of appendicitis in children?

Answer 7

Analgesia should be given - oral paracetamol is the best option
Surgical

Question 8

What are the features of non-specific abdominal pain?

Answer 8

Short duration, central, constant, not made worse by movement, no GI disturbance and no temperature
Varying site and severity

Question 9

What is the presentation of mesenteric adenitis?

Answer 9

High temp., URTI often and not unwell

Question 10

What is the investigation and diagnosis of bile vomiting until proven otherwise?

Answer 10

Upper GI contrast study
Malrotation and volvulus
Management is laparotomy ASAP

Question 11

What are the symptoms and signs of intussusception?

Answer 11

3 day history of viral illness than intermittent colic and dying spells
Bilious vomiting
Bloody mucous PR
4 seconds capillary refill time

Question 12

What are the investigations of intussusception?

Answer 12

USS abdomen
Target sign - bowel slide into another part of the bowel

Question 13

What is the management of intussusception?

Answer 13

Pneumostatic reduction - air enema
Laparotomy

Question 14

What is the presentation of an umbilical hernia?

Answer 14

Umbilical swelling and worse when crying

Question 15

When should umbilical hernia’s be repaired?

Answer 15

If complications and relative (persistence past 4 years)
Important to distinguish from para-umblical hernia - points to feet

Question 16

What is gastroschisis?

Answer 16

Abdominal wall defect
Gut eviscerated and exposed
Management is delayed closure and TPN
Survival is 90%+ and risk is short gut

Question 17

What is exomphalos?

Answer 17

Umbilical defect with covered viscera
Associated anomalies - cardiac, chromosomal, renal, neuro and Beckwith-Weideman syndrome
Management is primary or delayed closure
Mortality is 25%