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Paeds AM > Paediatric surgery > Flashcards

Paediatric surgery Flashcards

1
Q

What is the general calculation for the weight of children in kg?

A

2 x (age + 4)

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2
Q

What is the general rule for the blood volume of children?

A

80ml/kg

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3
Q

What is the general rule for urine output in children?

A

0.5-1ml/kg/hr

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4
Q

What is the general rule for insensible fluid loss in children?

A

20ml/kg/hr

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5
Q

What is the general calculation for systolic BP in children?

A

80 + (2 x age)

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6
Q

What are the general vital signs in children?

A

HR and RR start very high and decrease

BP starts low and incerases

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7
Q

What are the steps o pain management in children?

A

Paracetemol
Ibuprofen
(weak opioid)
strong opioid

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8
Q

What is the dosage of paracetamol in children?

A

20mg/kg every 4-6 hours

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9
Q

What is the dosage of ibuprofen in children?

A

10mg/kg every 8 hours

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10
Q

Why are weak opioids rarely used in children?

A

Codeine not indicated under 12

Codeine has to be metabolised to become active

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11
Q

What is resus fluid for children?

A

20ml/kg bolus 0.9% NaCl

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12
Q

What maintenance fluid is used for children?

A

0.9% NaCl and 5% dextrose +/- 0.15% KCl

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13
Q

How much maintenance fluid is used in children?

A

4ml/kg for first 10kg
2ml/kg for 10-20kg
1ml/kg thereafter

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14
Q

What are the sentinel signs of a very ill child?

A 
Feed refusals
Bile vomits
Colour
Tone 
Temperature
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15
Q

What must you ask about re pain in abdominal pain in a child?

A 
Colic vs constant
Onset
Previous episodes
Movement- ask about drive in
Vomiting- esp bile
Diarrhoea
Anorexia
Menstrual periods
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16
Q

What would increased abdominal pain on movement suggest?

A

peritonitis

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17
Q

What investigations are done in children with abdominal pain?

A

Urine dipstick always
FBC if diagnosis uncertain
U&E if very sick or dehydrated child
Rarely XR

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18
Q

Who is appendicitis seen in?

A

Usually school age

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19
Q

What are the clinical features of appendicitis?

A

Murphy’s triad- pain, vomiting, fever

Looks unwell

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20
Q

What is the management of appendicitis?

A

Analgesia

Surgery- laprascopic ideally

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21
Q

What are the possible complications of appendicitis?

A

Abscess
Mass
Peitonitis

22
Q

Who is non specific abdominal pain seen in?

A

Girls > boys

23
Q

What are the features of non specific abdominal pain?

A 
Short duration
Central, constant
Not made worse by movement
No GI disturbance or temperature
Site and severity varies
24
Q

What is mesenteric adenitis?

A

Inflammation of mesenteric lymph nodes causing pain

usually following/with viral infection

25
Q

What are the features of mesenteric adenitis?

A

Abdo pain
High temperature
Not unwell when fever not there
Usually gets better self

26
Q

How does pneumonia present with abdominal pain?

A

Referred pain, esp from right lower lobe, due to pleuritic infection, causing central abdominal pain
Very unwell and associated cough

27
Q

Who is pyloric stenosis seen in?

A

Males > females

28
Q

What are the features of pyloric stenosis?

A

Non bilious vomiting- projectile

Weight loss

29
Q

What investigation if done for pyloric stenosis?

A

US

30
Q

What is the treatment f pyloric stenosis?

A

Test feed
IV fluid
Periumbilical pyloromyotomy

31
Q

Who is malrotation seen in?

A

Generally babies

32
Q

What are the features of malrotation?

A

Fairy liquid green vomiting

33
Q

What is the investigation and management of malrotation?

A

Very urgent upper GI contract study

Urgent laparotomy

34
Q

Who is intussusception sen in?

A

Mainly 6-18 months

35
Q

What is intussusception?

A

Section of intestine invaginate into joining intestinal lumen

36
Q

What’re the features of intussusception?

A 
History of viral illness
Intermittent colic and dying spells
Bloody mucus PR- red currant jelly stool
Bilious vomiting
Prolonged cap refill, floppy
37
Q

What are “dying spells”?

A

Waves of colic cause a vagal response, causing a low BP, slow pulse, no breathing

38
Q

What investigation if done for intussusception?

A

US- taget sign

39
Q

What is the management of intussusception?

A

Pneumostatic reduction- air enema

Laparotomy

40
Q

What are some risk factors for an umbilical hernia?

A

Low birthweight
Trisomy 21
Hypothyroid

41
Q

What is done for umbilical hernias?

A

Nothing- spontaneous closure in 90%

Repair if there are complications or they are still there when starting school

42
Q

What is an epigastric hernia?

A

Defect in linea alba above umbilicus causing protrusion of pre peritoneal fat

43
Q

When to epigastric hernias normally present?

A

Age 2-3, only baby fat gone

44
Q

What is done for epigastric hernias?

A

Generally leave then, only cosmetic

45
Q

What is gastroschisis?

A

Abdo wall defect causing gut to be eviscerated and exposed

46
Q

What is the management of gastrochisis?

A

Primary/delayed closure

Total parenteral nutrition

47
Q

What is exomphalos?

A

Umbilical defect causing abode contents to protrude in covered viscera

48
Q

What is exomphalos associated with?

A

Cardiac anomalies
Chromosomal
Renal and neuro anomalies

49
Q

What is the management of exomphalos?

A

Primary/delayed closure

50
Q

What is the prognosis of exomphalous?

A

Very poor- if diagnosed antenatally, only 15% chance of taking baby home

Paeds AM (19 decks)

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