paediatric surgery

Question 1

physiological indices in children

Answer 1

weight related
mls/kg
blood volume
urine output
insensible fluid loss
systolic BP = 80+(2x age)

Question 2

pain management

Answer 2

paracetamol
ibuprofen
weak opiod (codeine)- not recommended <12 years metabolise to morphine
strong opiod

Question 3

fluid management

Answer 3

resuscitation
-20ml/kg bolus 0.9% saline

maintenance
0.9 saline/ 5% dextrose +/- KCL
4ml/kg 1st 10 kg
2ml/kg 2nd 10 kg
1mlkg every kg there after
crystalloid not colloid

Question 4

sentinel signs

Answer 4

feed refusal
bile vomits (obstruction)??
colour
tone
temperature

Question 5

pain

Answer 5

closer to umbilicius, less chance of pathology
colic vs constant( peritonitis)
Movement (car trip)\
going over speed bump pain- appendicitis
vomiting increases significance

diarhhoea
retro ileal/ retro colic
tenesmus (incomplete emptying) in pelvic appendix

diarrhoea
anorexia
previous episodes
menstrual history- blood goes back into peritoneum

appendicitis-low grade 38
viral 40

unclear presentation- appendicitis

murphy’striad
pain vomiting fever

complications

• abscess
• mass
• peritonitis

Question 6

mesenteteric adenitis

Answer 6

high temperature
URTI often
not unwell

Question 7

pneumonia

Answer 7

clue” sicker than abdominal signs

usually right ULL

Question 8

malrotation

Answer 8

3 day old baby presents with bile vomiting
fairy liquid green
diagnosis

Ix- upper GI contrast study ASAP
Mx- Laparotomy ASAP

Question 9

green bile vomiting

Answer 9

important!!!

Question 10

intussusception

Answer 10

nine month old baby
3 day history of viral illness then intermittent colic ad dying spells
bilious vomiting
4 seconds capillary refill
bloody mucous PR

investigations
USS abdomen
‘target sign’

management
pneumostatic reduction
laparotomy

Question 11

epigastric hernia

Answer 11

defect in linea alba above umbilicus

Question 12

Gastroschisis

Answer 12

abdominal wall defect