Paediatric Surgery

Question 1

How do work out the average weight of a child using age?

Answer 1

Wt (kg ) = 2 x (Age +4)

Question 2

What is the blood volume in children per kilogram?

Answer 2

80mls/kg

Question 3

other physical indices

Answer 3

.

Question 4

Generally outline the RR, HR and BP changes throughout childhood.

Answer 4

Breathing gets slower

HR gets slower

BP goes up

Question 5

What are the major differences in dealing with children rather than adults?

Answer 5

• communication
• signs
• disease processes
• physiological parameters
• expectations

Question 6

What are the main painkiller/ananlgesia options for children?

Answer 6

• Paracetamol - 20mg/kg 4-6 hly
• Ibuprofen - 10mg/kg 8 hly
• (weak opioid)* (codeine)
• Strong opioid

Question 7

What is fluid management for children?

Answer 7

• Resusitation:
  
  • 20ml/kg bolus 0.9% NaCl
• Maintenance
  
  • 0.9% NaCl / 5% Dextrose +/- 0.15% KCl
  • 4ml/kg 1st 10kg
  • 2ml/kg 2nd 10 kg
  • 1ml/kg every kg thereafter
  • 10 yrs = 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr

Question 8

What are Sentinel Signs?

Answer 8

Warnings signs for unwell children.

• FEED REFUSAL
• BILE VOMITS - ( green ) - into small bowel and back, implies bowel obstruction.
• COLOUR - sick babies look grey.
• TONE - floppy babies are bad.
• TEMPERATURE - low temp. not perfusing skin (peripheral shut down)

Question 9

When there is abdominal pain in a child what are important history aspects?

Answer 9

Pain

• colic (dysfunction) vs constant (peritonitis)
• movement (car trip / speed bumps)
  
  • speed bump pain - rebound & peritonitis

Vomiting

• increases significance
• bile important (bile is green not yellow!)

Diarrhoea

• retroileal/retocolic
• tenesmus (if pus in pelvis)

Anorexia

Previous Episodes w/o surgery - decreases chance of periods.

Menstrual history - esp. if signs of development

Question 10

How do you examine children?

Answer 10

• Be oppourtunistic
• Distraction techniques are essential
• General appearance is important
• Temperature
• “guarding and rebound” - this is not needed, just causes pain in children

Question 11

What are the investigations required in surgical assessment?

Answer 11

• Urine
  
  • all
• FBC
  
  • only if diagnostic doubt
• Electrolytes
  
  • only if sick / very dry
• X-rays
  
  • Rarely done (bowel obstruction - very unusual)

Question 12

What is the classical Appendicitiis features?

Answer 12

Murphy’s Triad

• Pain
• Vomiting
• Fever

Tenderness over McBurney’s point

Question 13

What are the complications of appendicitiis?

Answer 13

• Abscess
• mass
• peritonitis

Question 14

Management of appendicitisi

Answer 14

Analgesia

Laparoscopic Surgery

Question 15

What are the common features of Non- Specific Abdominal Pain?

Answer 15

• short duration
• central
• constant
• not made worse by movement
• no GIT disturbance
• no temperature
• site & severity of tenderness vary

Question 16

Who is NSAP (Non-Specific Abdominal Pain)?

Answer 16

• Girls more than boys

Question 17

Pyloric Stenosis

What is it?

How does it present?

Changes on cap gas?

Answer 17

Condition where the passage (pylorus) between the stomach and small bowel (duodenum) becomes narrower.

• males 5:1 female, FH often
• non bilious vomiting - “projectile”
• weight loss
• cap gas
  
  • alkalosis, hypochloraemia, hypokalaemia

Question 18

How would pyloric stenosis appear on capillary gas?

Answer 18

Hypokalaemic hypochloraemia metabolic alkalosis

Question 19

Rx for pyloric stenosis?

Answer 19

• test feed
• IV fluid
  
  • 0.45 N Saline/ 5% Dextrose + KCl
  • 0.9% Saline for NG loss
• US
• periumbilical pyloromyotomy

Question 20

What is mesenteric adenitiis?

Common features?

Answer 20

Mesenteric lymphadenitis is an inflammation of lymph nodes .

Very high temperature

URTI often too

not “unwell”

Question 21

How does pneumonia in abdominal pain usually present in children?

Answer 21

Referred from nerve irritation to abdomen.

Look very unwell.

Soft abdomen.

Question 22

What is malrotation?

Presentation?

Investigation

Manangement?

Answer 22

• 3-day old baby presents with bile vomiting
• “fairy liquid” green
• Diagnosis
  
  • Malrotation and volvulus
• Investigation
  
  • Upper GI contrast study ASAP
• Management
  
  • Laparotomy

Question 23

What is Intussusception?

Presentation

Answer 23

Presentation

• 3-day history of viral illness then intermittent COLIC and DYING SPELLS (white and floppy, don’t breathe, due to enlarged bowel colic)
• Bilious vomiting
• 4-second cap. refill
• Bloody mucous PR

Question 24

What are the investigations and management in Intussusception?

Answer 24

Investigations

• USS abdomen
• Shows “target sign”

Management

• Pneumostatic reduction (air enema)
• Laparotomy

Question 25

What is an umbililcal hernia?

RFs

Manangement?

Answer 25

Increased risk in LBW, t21, Hy

Spontaneous closure by 4 years is rule

Complicatiosn are rare

Repair if complications or persisitence

Question 26

What is an epigastirc hernia?

Answer 26

Defect in linea alba aboce umbillicus

Protrusion of preperitoneal fat

Operative repair - cosmetic reasons only.

Question 27

What is Gastroschisis?

Management and survival?

Answer 27

• abdominal wall defect
  
  • gut eviscerated and exposed
  • 10% associated atresia
• management
  
  • primary/delayed closure
  • TPN - total parenteral nutrition
• survival
• 90%+
• short gut can cause death

Question 28

What is Exomphalos?

Managment and outcome?

Answer 28

• umbilical defect with covered viscera
• associated anomalies
  
  • 25% cardiac
  • 25% chromosomal - Trisomy13, 18, 21
  • 15% renal, neurological
  • Beckwith-Weideman syndrome
• management
  
  • primary / delayed closure
• outcome
  
  • post natal mortality - 25%