Paediatric Surgery Flashcards
Blood volume in children
80mls/kg
Urine output in children
0.5-1ml/kg/hr
Insensible fluid loss in children
20ml/kg/day
Systolic BP in children
80 + (2 x age)
Weight in children
2 x (age + 4)
Differences in children vs adult
Communication Signs - children dont localise as well - get a lot of referred signs Disease processes - age related Physiological parameters Expectations Stress
What is calpol?
Infant paracetomal
WHO pain ladder
- paracetomal 20mg/kg 4-6 hourly
- Ibuprofen 10mg/kg 8 hourly
- weak opoid
- strong opiod
Under what age is codeine not recommended?
< 12 y / o
What is used in fluid resuscitation in children?
20ml/kg bolus 0.9% NaCl
Give as fast as you can
What is used in the maintenance of fluid management of children?
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
Why is it very difficult to pick out the sick child?
They dont deteriorate - they are well then very unwell suddenly
Sentinel signs (warning signs)
Feed refusal Bile vomits Colour Tone Temperature
What is an example of a reason a baby would refuse feed?
Too tired as feeding Is exhausting
What is vomit from a baby which is green indicate?
Bile
Fluid thats gone from the gallbladder into the small bowel, back into the stomach and vomited
What can cause green vomit?
A bowel obstruction
What is vomit from a baby which is yellow?
Gastric content
What colour are sick babies? Why?
Grey
Poorly perfused skin
What colour are well babies?
Pink
What colour are cyanotic babies?
Blue
What colour are hot babies?
Red
What is a bad tone sign of a baby?
Floppy
Which type of temperature is a red flag in a baby?
Low temperature
- bad perfusion
Babies 3 jobs
Eat
Sleep
Poo
If abdominal pain is closer to where, then this means there is less chance of pathology? Why?
Umbilicus
Midgut / small bowel which doesn’t have pain fibres and so will be referred pain to the umbilicus.
What does speed bump / car movement pain indicate with abdominal pain?
Peritoneal irritation / peritonitis = movement causes pain
Investigations for abdominal pain in children
Urine FBC (only if diagnostic doubt) Electrolytes (if sick / very dry) X rays (rarely) - bowel obstruction
Who usually gets appendicitis?
< 4 y/o
Presentation of appendicitis
Moderate temperature Vomiting Looks unwell Murphy's triad Tenderness over McBurneys point
What is Murphy’s Triad?
Pain
Vomiting
Fever
Treatment of appendicitis
Active observation
Appendectomy
Complications of appendicitis
Abscess
Mass
Peritonitis
What does NSAP stand for?
Non specific abdominal pain
Who gets NSAP?
G > B
What can NSAP mimic?
Early appendicitis
Features of NSAP
Short duration central not made worse by movement constant no GIT disturbance No temp site and severity of tenderness may vary
Causes of NSAP
Mesenteric adenitis Pneumonia Malrotation Intussecption umbilical hernia Epigastric hernia
Pathology of malrotation
Upper bowel twists and causes volvulus
Investigations of malrotation
Upper GI contrast study
Presentation of malrotation
NSAP
Fairy liquid green bile vomit
Treatment of malrotation
Laparotomy
What age of baby gets intussusception?
6 - 12 months
Presentation of intussesception
3 day history of viral illness then Intermittent colic and dying spells Bilious vomiting Bloody mucous PR Red current jelly stool (mucus and blood)
Investigations of intusseception
USS abdomen
“Target sign”
Management of intusscepstion
Pneumostatic reduction (air enema) Laparotomy
Increased risk of umbilical hernia in….
LBW
Trisomy 21
Hypothyroidism
Mucopolysaccharides
When should umbilical hernias have spontaneous closure by?
4 y / o
Repair umbilical hernia if…..
Complications
Persistence > 4 years
large defect
aesthetic
What is an epigastric hernia?
Defect in linear alba from xiphesternum to umbilicus with protrusion of peritoneal fat
Who gets pyloric stenosis?
4-16 weeks old
M > F 5;1
What is there often a feature of in pyloric stenosis?
FH
Presentation of pyloric stenosis
Weight loss Non bilious vomiting - "projectile" Alkalosis Hypocholoraemia Hypokalaemia
What is gastroschisis?
Abdominal wall defect where the babys gut is eviscerated and exposed on the outside of the body
Management of gastroschisis
Primary / delayed closure
TPN
What is exomphalos?
Umbilical defect with covered viscera
Associations of exomphalos
Cardiac Chromosomal - trisomy 13,18,21 Renal Neurological Beckwit-weiderman syndrome
Treatment of hirschprungs disease
Initially - rectal washouts
Anorectal ‘pull out procedure’
- removing section of affected bowel
- forming an anastomosis with healthy colon
Pathology of testicular torsion
The testis turns on the remnant of the processus vaginalis thereby restricting the blood flow
Presentation of testicular torsion
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
What often increases the pain in testicular torsion?
Elevation of testicle
What is the cremaster reflex?
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
Treatment of exomphalos
Gradual repair to prevent resp complications - starting immediately with completion at 6 - 12 months
Treatment of gastroschisis
Urgent correction
Inguinal hernia vs Umbilical hernia treatment
Inguinal hernias require urgent treatment whereas umbilical hernias spontaneously resolve
What is the 6, 2 rule for correcting inguinal hernias in children?
< 6 weeks old = correct in 2 days
< 6 months = correct within 2 weeks
< 6 y/o = correct within 2 months
