Paediatric surgery Flashcards
what is the equation to work out a childs weight?
2 x (age + 4)
how do you determine the normal value of a childs systolic BP?
80 + (2 x age)
what is the volume of insensible fluid loses in children?
20ml/kg/day
how do you determine a childs blood volume?
80ml/kg
what is the normal urine output in a child?
0.5-1ml/kg/day
what is the trend in heart rate from neonates to older children?
neonates have a HR about 110-160
decreases as you age
reaches 60-100bpm about 10 yrs old
what is the trend in systolic BP from neonates to older children?
neonates have a systolic BP from 70-90
increases as you age until it reaches about 100-120 at 10yrs old
what is the trend in respiratory rate from neonates to older children?
neonates have a high respiratory rate about 30-40
starts to decrease until it reaches 15-20 at about 10yrs old
what does of paracetamol do you give a child?
20mg/kg 4-6 hourly
what dose of ibuprofen do you give a child?
10mg/kg 8 hourly
at what age are weak opioids allowed in children?
> 12 years
what fluid type and volume is given for resuscitation in children?
20ml/kg bolus 0.9% NaCl
what volume of fluid do you give children for maintenance?
4ml/kg 1st 10kg
2ml/kg 2nd 10kg
1ml/kg every other kg thereafter
a 4 year old boy requires maintenance fluids.
what is his average weight?
what volume of maintenance fluids would you give?
approx 16kg
40+6= 48ml/hour
how do you assess a childs response to fluids you have just given?
assess heart rate and blood pressure
what are the red flag signs in paediatrics?
feed refusal bile vomiting grey colour decreased tone / floppy temperature (particularly hypothermia)
a child presents to the ED with abdominal pain.
what questions would you ask in the history to determine if the child required surgery?
site - closer to the umbilicus = less chance of pathology
colic vs constant
movement - sore when going over speed bumps? indicates ve+ rebound = appendicitis
vomiting green? (bile)
diarrhoea
menstrual history (menstrual pain?)
anorexia
previous episodes (less chance of surgical diagnosis)
a child presents to the ED with abdominal pain.
what investigations will you carry out?
urinalysis and dipstick FBC if not sure of diagnosis electrolytes if unwell/dehydrated CRP X-ray (rarely)
what is the presentation of appendicitis?
pain
vomiting
fever
what would you observe on clinical examination which would indicate appendicitis’s?
tenderness over mcburneys point
name 3 complications of appendicitis.
abscess
mass
peritonitis
what is the treatment for appendicitis?
analgesia
surgical opinion - laparoscopic removal
what are features of non-specific abdominal pain?
central constant not made worse by movement no GIT upset no temperature site and severity of tenderness varies
what are differential diagnoses of abdominal pain in children?
appendicitis
mesenteri adenitis
pneumonia
what is a clue to suspect pneumonia with a child who presents with abdominal pain?
they will be sicker than the abdominal signs show
what is mesentery adenitisand how does it present?
inflammation and swelling of the lymph nodes in the abdomen
presents with high temperature, abdominal pain and often a URTI
what features on a blood gas would you expect with pyloric stenosis?
hypochloraemia
hypokalaemia
alkalosis
a 3 day old baby presets with bile vomiting.
what is the most likely diagnosis?
malrotation and volvulus
age of the patient - only few days old makes malrotation most likely
a 9 month old baby presents with a 3 day history of viral illness then on and off abdominal pain and ‘fainting’.
he has also been vomiting which is green in colour.
what is the most likely diagnosis?
intussusception
most common in 6-9 month olds with bilious vomiting
what is the pathological location most commonly found in intussusception?
illiocaecal valve
in what age group is intersusception most common?
peak at 9 months
6-9 months
what is the presentation of intususception?
billious vomiting
bloody mucous stool
intermittent abdominal colic
dying spells
how is intussusception diagnosed?
USS to confirm diagnosis
‘target sign’
what is the management of intussusception?
pneumostatic reduction (air enema) laparotomy
what are risk factors for an umbilical hernia?
downs syndrome
low birth weight
mucopolyssacharidosis
hypothyroidism
what is the management for umbilical hernias?
conservative - usually close by year 4
if persistent > 4 years or complications then surgery
what is the defect that results in an epigastric hernia?
defect in linea alba above the umbilicus
protrusion of retroperitoneal fat
what’s the difference in the pathology with exomphalos and gastroschisis?
exomphalos = umbilical defect gastroschisis = abdominal wall defect
what anomalies are associated with exomphalos?
cardiac chromosomal i.e. trisomy 21, 13, 18 renal neurological beckwith-weideman syndrome
