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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
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.
26
What does speed bump / car movement pain indicate with abdominal pain?
Peritoneal irritation / peritonitis = movement causes pain
27
Investigations for abdominal pain in children
``` Urine FBC (only if diagnostic doubt) Electrolytes (if sick / very dry) X rays (rarely) - bowel obstruction ```
28
Who usually gets appendicitis?
< 4 y/o
29
Presentation of appendicitis
``` Moderate temperature Vomiting Looks unwell Murphy's triad Tenderness over McBurneys point ```
30
What is Murphy's Triad?
Pain Vomiting Fever
31
Treatment of appendicitis
Active observation | Appendectomy
32
Complications of appendicitis
Abscess Mass Peritonitis
33
What does NSAP stand for?
Non specific abdominal pain
34
Who gets NSAP?
G > B
35
What can NSAP mimic?
Early appendicitis
36
Features of NSAP
``` Short duration central not made worse by movement constant no GIT disturbance No temp site and severity of tenderness may vary ```
37
Causes of NSAP
``` Mesenteric adenitis Pneumonia Malrotation Intussecption umbilical hernia Epigastric hernia ```
38
Pathology of malrotation
Upper bowel twists and causes volvulus
39
Investigations of malrotation
Upper GI contrast study
40
Presentation of malrotation
NSAP | Fairy liquid green bile vomit
41
Treatment of malrotation
Laparotomy
42
What age of baby gets intussusception?
6 - 12 months
43
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) ```
44
Investigations of intusseception
USS abdomen | "Target sign"
45
Management of intusscepstion
``` Pneumostatic reduction (air enema) Laparotomy ```
46
Increased risk of umbilical hernia in....
LBW Trisomy 21 Hypothyroidism Mucopolysaccharides
47
When should umbilical hernias have spontaneous closure by?
4 y / o
48
Repair umbilical hernia if.....
Complications Persistence > 4 years large defect aesthetic
49
What is an epigastric hernia?
Defect in linear alba from xiphesternum to umbilicus with protrusion of peritoneal fat
50
Who gets pyloric stenosis?
4-16 weeks old | M > F 5;1
51
What is there often a feature of in pyloric stenosis?
FH
52
Presentation of pyloric stenosis
``` Weight loss Non bilious vomiting - "projectile" Alkalosis Hypocholoraemia Hypokalaemia ```
53
What is gastroschisis?
Abdominal wall defect where the babys gut is eviscerated and exposed on the outside of the body
54
Management of gastroschisis
Primary / delayed closure | TPN
55
What is exomphalos?
Umbilical defect with covered viscera
56
Associations of exomphalos
``` Cardiac Chromosomal - trisomy 13,18,21 Renal Neurological Beckwit-weiderman syndrome ```
57
Treatment of hirschprungs disease
Initially - rectal washouts Anorectal 'pull out procedure' - removing section of affected bowel - forming an anastomosis with healthy colon
58
Pathology of testicular torsion
The testis turns on the remnant of the processus vaginalis thereby restricting the blood flow
59
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
60
What often increases the pain in testicular torsion?
Elevation of testicle
61
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
62
Treatment of exomphalos
Gradual repair to prevent resp complications - starting immediately with completion at 6 - 12 months
63
Treatment of gastroschisis
Urgent correction
64
Inguinal hernia vs Umbilical hernia treatment
Inguinal hernias require urgent treatment whereas umbilical hernias spontaneously resolve
65
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

Paeds (28 decks)

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