Paediatric Surgery Flashcards
formula for child weight
kg = 2(age + 4)
child blood volume
80ml/kg
child urine output
0.5-1ml/kg/hr
child insensible fluid loss
20ml/kg/day
child systolic BP
80 + (2 x age)
big differences between children and adults
- Communication
- Signs
- Disease processes
- Physiological parameters
- Expectations
- Stress
WHO pain ladder in children
• Paracetamol o 20mg/kg 4-6 hourly • Ibuprofen o 10mg/kg 8 hourly (• Weak opioid o Codeine not recommended in <12 years) • Strong opioid
fluid management in children: resus
20ml/kg bolus 0.9% NaCl
fluid management in children: maintenance
o 0.9% NaCl / 5% Dextrose +/- 0.15% KCl
o 4ml/kg 1st 10kg
o 2ml/kg 2nd 10kg
o 1ml/kg every kg thereafter
sentinel signs in children
- Feed refusal
- Bile vomits
- Colour
- Tone
- Temperature
abdominal pain in children: Hx pain
closer to umbilicus = less chance of pathology
colic vs constant
movement - cars
abdominal pain in children: Hx vomiting
increases sig
bile
abdominal pain in children: exam
distraction
general appearance
temperature
guarding
abdominal pain in children: investigations
urine - all
FBC - only if diagnostic douby
electrolytes - only if sick/very dry
xrays - rarely
abdominal pain in children: basis of management
• GP/A+E decision
o Does this child need a surgical opinion?
• Surgical decision
o Does this child need an operation?
Murphy’s triad for appendicitis
pain
vomiting
fever
what is McBurney’s pont?
one-third of the distance from the anterior superior iliac spine to the umbilicus
complications of appendicitis
abscess
mass
peritonitis
in what age is appendicitis ratre?
<4
features of non-specific abdominal pain
- Short duration
- Central
- Constant
- Not made worse by movement
- No GIT disturbance
- No temperature
- Site and severity of tenderness vary
- Girls > boys
- 45% of admissions
- Often recurrent
- Can mimic an early appendicitis
- Risk of missing appendicitis is 0.2%
features of mesenteric adentitis
o High temperature
o URTI often
o Not “unwell”
pneumonia with abdominal pain in children
o Clue “sicker than abdominal signs”
o Usually right lower lobe
pyloric stenosis: age and M:F
4-16 wks
5:1
pyloric stenosis: features
• Non bilious vomiting “projectile” • Weight loss • Capillary gas o Alkalosis, hypochloraemia, hypokalaemia • Test feed • IV fluid o 0.45% N saline / 5% dextrose + KCL o 0.9% saline for NG loss
pyloric stenosis: investigation and treatment
US
• Periumbilical pyloromyotomy
malrotation: features
3 day old with bile vomiting
malrotation: diagnosis + treatmenet
malrotation and volvulus
• Upper GI contrast study ASAP
• Laparotomy ASAP
intussusception: age
nine month - 6-23 months
intussusception: features
3 day Hx of viral illness then intermittent colic and dying spells
bilious vomiting
on admission - 4sec cap refill
redcurrent jelly stool
intussusception: inbestigations
USS
target sign
intussusception: management
pneumostatic reduction - air enema
laparotomy
gastroschisis: what
abdo wall defect
gut eviscerated and exposed
gastroschisis: 10% is associated with
atressia
gastroschisis: management
primary/delayed closure
TPN
gastroschisis: survival
90% +
gastroschisis:why may some not survive?
short gut
exomphaos: what
umbilical defect with covered viscera
exomphaos: associated anomalies
o 25% cardiac
o 25% chromosomal - Trisomy13, 18, 21
o 15% renal, neurological
o Beckwith-Weideman syndrome
exomphaos: management
primary/delated closure
exomphaos: outcome
post natal mortality 25%
