Paediatric Surgery Flashcards
what does bilious vomiting suggest until proven otherwise?
bowel obstruction
outline the pain ladder management in children
- paracetamol
- 20mg/ kg 4-6hourly
- ibuprofen
- 10mg/kg 8 hourly
- weak opioids- codeine NOT to be used in <12y/o
- strong opioids
what are the sentinel signs of pathology in children? ie markers of disease
- abdominal pain
- bilious vomiting
- temperature
- tone
- colour
- reduced feeding
main investigations?
urine - always
FBC- only if diagnostic uncertainty
electrolytes- only if child dehydrated / very sick
X-Ray- rarely
features of classical appendicitis in children?
- murphy’s triad
- fever
- pain
- vomiting
- tenderness over McBurney’s point
- unusual >4years old
Features of Non-Specific Abdo Pain?
- central and constant
- short duration
- no temperature
- not worse on movement
main diagnoses linked to NSAP?
- mesenteric adenitis
- inflammation/swelling of lymph nodes in abdomen
- pneumonia
pathophysiology of Pyloric Stenosis?
hypertrophy of gastric pylorus causing upper GI obstruction
when does pyloric stenosis typically present?
3-6 weeks
in who is PS more likely?
boys > girls
presenting features of PS, including O/E?
- projectile milky non-bilious vomiting after every feed
- weight loss
- palpable olive mass in RUQ
investigations and findings of PS?
- Capillary Blood Gas
- hypochloraemic, hypokalaemic metabolic alkalosis
- Test feed first
- USS to confirm (thickened pylorus)
management of PS?
- NBM
- IV fluids
- surgical pyloromyotomy
at what age is malrotation more common?
what is the pathology?
- first few months of life
- failure of midgut to rotate during embryogenesis
presentation of malrotation?
bilious vomiting (green)
Ix of malrotation?
upper GI contrast study
Management of malrotation?
surgery
complication of malrotation?
volvulus
when does intussusception present?
6-12months
- often preceded by viral infection
how does intussusception present?
- bilious vomiting
- recurrent episodes of screaming & drawing up of the legs
- redcurrant jelly stools
examination findings in intussusception
- sausage shaped mass
- prolonged capillary refill
why do you get a prolonged capillary refill?
because of third space fluid loss, child is very dehydrated
investigation + management of intussusception
investigation: USS abdo
management: air enema, surgery only if failed reduction / suspected strangulation
what is gastroschisis + management
gastroschisis is a defect in the abdominal wall which leads to the herniation & expsoure of the gut contents
management: early / delayed closure & TPN
