Paediatric surgery Flashcards
What is the general calculation for the weight of children in kg?
2 x (age + 4)
What is the general rule for the blood volume of children?
80ml/kg
What is the general rule for urine output in children?
0.5-1ml/kg/hr
What is the general rule for insensible fluid loss in children?
20ml/kg/hr
What is the general calculation for systolic BP in children?
80 + (2 x age)
What are the general vital signs in children?
HR and RR start very high and decrease
BP starts low and incerases
What are the steps o pain management in children?
Paracetemol
Ibuprofen
(weak opioid)
strong opioid
What is the dosage of paracetamol in children?
20mg/kg every 4-6 hours
What is the dosage of ibuprofen in children?
10mg/kg every 8 hours
Why are weak opioids rarely used in children?
Codeine not indicated under 12
Codeine has to be metabolised to become active
What is resus fluid for children?
20ml/kg bolus 0.9% NaCl
What maintenance fluid is used for children?
0.9% NaCl and 5% dextrose +/- 0.15% KCl
How much maintenance fluid is used in children?
4ml/kg for first 10kg
2ml/kg for 10-20kg
1ml/kg thereafter
What are the sentinel signs of a very ill child?
Feed refusals Bile vomits Colour Tone Temperature
What must you ask about re pain in abdominal pain in a child?
Colic vs constant Onset Previous episodes Movement- ask about drive in Vomiting- esp bile Diarrhoea Anorexia Menstrual periods
What would increased abdominal pain on movement suggest?
peritonitis
What investigations are done in children with abdominal pain?
Urine dipstick always
FBC if diagnosis uncertain
U&E if very sick or dehydrated child
Rarely XR
Who is appendicitis seen in?
Usually school age
What are the clinical features of appendicitis?
Murphy’s triad- pain, vomiting, fever
Looks unwell
What is the management of appendicitis?
Analgesia
Surgery- laprascopic ideally
What are the possible complications of appendicitis?
Abscess
Mass
Peitonitis
Who is non specific abdominal pain seen in?
Girls > boys
What are the features of non specific abdominal pain?
Short duration Central, constant Not made worse by movement No GI disturbance or temperature Site and severity varies
What is mesenteric adenitis?
Inflammation of mesenteric lymph nodes causing pain
usually following/with viral infection
What are the features of mesenteric adenitis?
Abdo pain
High temperature
Not unwell when fever not there
Usually gets better self
How does pneumonia present with abdominal pain?
Referred pain, esp from right lower lobe, due to pleuritic infection, causing central abdominal pain
Very unwell and associated cough
Who is pyloric stenosis seen in?
Males > females
What are the features of pyloric stenosis?
Non bilious vomiting- projectile
Weight loss
What investigation if done for pyloric stenosis?
US
What is the treatment f pyloric stenosis?
Test feed
IV fluid
Periumbilical pyloromyotomy
Who is malrotation seen in?
Generally babies
What are the features of malrotation?
Fairy liquid green vomiting
What is the investigation and management of malrotation?
Very urgent upper GI contract study
Urgent laparotomy
Who is intussusception sen in?
Mainly 6-18 months
What is intussusception?
Section of intestine invaginate into joining intestinal lumen
What’re the features of intussusception?
History of viral illness Intermittent colic and dying spells Bloody mucus PR- red currant jelly stool Bilious vomiting Prolonged cap refill, floppy
What are “dying spells”?
Waves of colic cause a vagal response, causing a low BP, slow pulse, no breathing
What investigation if done for intussusception?
US- taget sign
What is the management of intussusception?
Pneumostatic reduction- air enema
Laparotomy
What are some risk factors for an umbilical hernia?
Low birthweight
Trisomy 21
Hypothyroid
What is done for umbilical hernias?
Nothing- spontaneous closure in 90%
Repair if there are complications or they are still there when starting school
What is an epigastric hernia?
Defect in linea alba above umbilicus causing protrusion of pre peritoneal fat
When to epigastric hernias normally present?
Age 2-3, only baby fat gone
What is done for epigastric hernias?
Generally leave then, only cosmetic
What is gastroschisis?
Abdo wall defect causing gut to be eviscerated and exposed
What is the management of gastrochisis?
Primary/delayed closure
Total parenteral nutrition
What is exomphalos?
Umbilical defect causing abode contents to protrude in covered viscera
What is exomphalos associated with?
Cardiac anomalies
Chromosomal
Renal and neuro anomalies
What is the management of exomphalos?
Primary/delayed closure
What is the prognosis of exomphalous?
Very poor- if diagnosed antenatally, only 15% chance of taking baby home
