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Paeds > Paediatric Surgery > Flashcards

Paediatric Surgery Flashcards

1
Q

Blood volume in children

A

80mls/kg

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2
Q

Urine output in children

A

0.5-1ml/kg/hr

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3
Q

Insensible fluid loss in children

A

20ml/kg/day

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4
Q

Systolic BP in children

A

80 + (2 x age)

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5
Q

Weight in children

A

2 x (age + 4)

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6
Q

Differences in children vs adult

A 
Communication 
Signs
- children dont localise as well
- get a lot of referred signs
Disease processes
- age related
Physiological parameters
Expectations
Stress
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7
Q

What is calpol?

A

Infant paracetomal

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8
Q

WHO pain ladder

A
  1. paracetomal 20mg/kg 4-6 hourly
  2. Ibuprofen 10mg/kg 8 hourly
  3. weak opoid
  4. strong opiod
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9
Q

Under what age is codeine not recommended?

A

< 12 y / o

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10
Q

What is used in fluid resuscitation in children?

A

20ml/kg bolus 0.9% NaCl

Give as fast as you can

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11
Q

What is used in the maintenance of fluid management of children?

A 
0.9% NaCl / 5% Dextrose +/- 0.15% KCL
Volume given is based on the weight
- 4ml/kg 1st 10kg
- 2ml/kg 2nd 10kg 
- 1ml/kg every kg therafter
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12
Q

Why is it very difficult to pick out the sick child?

A

They dont deteriorate - they are well then very unwell suddenly

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13
Q

Sentinel signs (warning signs)

A 
Feed refusal 
Bile vomits
Colour
Tone
Temperature
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14
Q

What is an example of a reason a baby would refuse feed?

A

Too tired as feeding Is exhausting

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15
Q

What is vomit from a baby which is green indicate?

A

Bile

Fluid thats gone from the gallbladder into the small bowel, back into the stomach and vomited

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16
Q

What can cause green vomit?

A

A bowel obstruction

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17
Q

What is vomit from a baby which is yellow?

A

Gastric content

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18
Q

What colour are sick babies? Why?

A

Grey

Poorly perfused skin

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19
Q

What colour are well babies?

A

Pink

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20
Q

What colour are cyanotic babies?

A

Blue

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21
Q

What colour are hot babies?

A

Red

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22
Q

What is a bad tone sign of a baby?

A

Floppy

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23
Q

Which type of temperature is a red flag in a baby?

A

Low temperature

- bad perfusion

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24
Q

Babies 3 jobs

A

Eat
Sleep
Poo

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25
Q

If abdominal pain is closer to where, then this means there is less chance of pathology? Why?

A

Umbilicus

Midgut / small bowel which doesn’t have pain fibres and so will be referred pain to the umbilicus.

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26
Q

What does speed bump / car movement pain indicate with abdominal pain?

A

Peritoneal irritation / peritonitis = movement causes pain

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27
Q

Investigations for abdominal pain in children

A 
Urine
FBC (only if diagnostic doubt)
Electrolytes (if sick / very dry) 
X rays (rarely)
- bowel obstruction
28
Q

Who usually gets appendicitis?

A

< 4 y/o

29
Q

Presentation of appendicitis

A 
Moderate temperature
Vomiting
Looks unwell 
Murphy's triad
Tenderness over McBurneys point
30
Q

What is Murphy’s Triad?

A

Pain
Vomiting
Fever

31
Q

Treatment of appendicitis

A

Active observation

Appendectomy

32
Q

Complications of appendicitis

A

Abscess
Mass
Peritonitis

33
Q

What does NSAP stand for?

A

Non specific abdominal pain

34
Q

Who gets NSAP?

A

G > B

35
Q

What can NSAP mimic?

A

Early appendicitis

36
Q

Features of NSAP

A 
Short duration 
central 
not made worse by movement
constant 
no GIT disturbance
No temp 
site and severity of tenderness may vary
37
Q

Causes of NSAP

A 
Mesenteric adenitis 
Pneumonia
Malrotation 
Intussecption 
umbilical hernia 
Epigastric hernia
38
Q

Pathology of malrotation

A

Upper bowel twists and causes volvulus

39
Q

Investigations of malrotation

A

Upper GI contrast study

40
Q

Presentation of malrotation

A

NSAP

Fairy liquid green bile vomit

41
Q

Treatment of malrotation

A

Laparotomy

42
Q

What age of baby gets intussusception?

A

6 - 12 months

43
Q

Presentation of intussesception

A 
3 day history of viral illness then 
Intermittent colic and dying spells 
Bilious vomiting 
Bloody mucous PR
Red current jelly stool (mucus and blood)
44
Q

Investigations of intusseception

A

USS abdomen

“Target sign”

45
Q

Management of intusscepstion

A 
Pneumostatic reduction (air enema)
Laparotomy
46
Q

Increased risk of umbilical hernia in….

A

LBW
Trisomy 21
Hypothyroidism
Mucopolysaccharides

47
Q

When should umbilical hernias have spontaneous closure by?

A

4 y / o

48
Q

Repair umbilical hernia if…..

A

Complications
Persistence > 4 years
large defect
aesthetic

49
Q

What is an epigastric hernia?

A

Defect in linear alba from xiphesternum to umbilicus with protrusion of peritoneal fat

50
Q

Who gets pyloric stenosis?

A

4-16 weeks old

M > F 5;1

51
Q

What is there often a feature of in pyloric stenosis?

A

FH

52
Q

Presentation of pyloric stenosis

A 
Weight loss
Non  bilious vomiting - "projectile"
Alkalosis
Hypocholoraemia
Hypokalaemia
53
Q

What is gastroschisis?

A

Abdominal wall defect where the babys gut is eviscerated and exposed on the outside of the body

54
Q

Management of gastroschisis

A

Primary / delayed closure

TPN

55
Q

What is exomphalos?

A

Umbilical defect with covered viscera

56
Q

Associations of exomphalos

A 
Cardiac
Chromosomal 
- trisomy 13,18,21
Renal 
Neurological 
Beckwit-weiderman syndrome
57
Q

Treatment of hirschprungs disease

A

Initially - rectal washouts
Anorectal ‘pull out procedure’
- removing section of affected bowel
- forming an anastomosis with healthy colon

58
Q

Pathology of testicular torsion

A

The testis turns on the remnant of the processus vaginalis thereby restricting the blood flow

59
Q

Presentation of testicular torsion

A

Acutely severe testicular pain
Often associated with N and V
May be swelling of testis with overlying erythema
Cremaster reflex may be absent on affected side

60
Q

What often increases the pain in testicular torsion?

A

Elevation of testicle

61
Q

What is the cremaster reflex?

A

This reflex is elicited by lightly stroking or poking the superior and medial part of the thigh—regardless of the direction of stroke. The normal response is an immediate contraction of the cremaster muscle that pulls up the testis ipsilaterally

62
Q

Treatment of exomphalos

A

Gradual repair to prevent resp complications - starting immediately with completion at 6 - 12 months

63
Q

Treatment of gastroschisis

A

Urgent correction

64
Q

Inguinal hernia vs Umbilical hernia treatment

A

Inguinal hernias require urgent treatment whereas umbilical hernias spontaneously resolve

65
Q

What is the 6, 2 rule for correcting inguinal hernias in children?

A

< 6 weeks old = correct in 2 days
< 6 months = correct within 2 weeks
< 6 y/o = correct within 2 months

Paeds (28 decks)

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