Paediatric Surgery Flashcards
1
Q
Calculate estimated weight of a child
A
Weight = 2 x (AGE +4)
2
Q
Estimated blood volume of a child
A
80mls per kg
3
Q
Urine output of a child
A
0.5-1ml/kg/hour
4
Q
Insensible fluid loss of a child
A
20ml/kg/day
5
Q
Systolic blood pressure of a child
A
80 + (2 x age)
6
Q
Respiratory rate of a 3 year old
A
25-30
7
Q
Heart rate of child less than 1
A
100-160
8
Q
Systolic blood pressure of 4 year old
A
80-100
9
Q
WHO recommended paracetamol dose for child
A
20 mg/kg 4-6 hrly
10
Q
WHO recommended ibuprofen dose for child
A
10mg/kg 8 hourly
11
Q
Resuscitation fluid for child
A
20 ml/kg bolus 0.9% NaCl
12
Q
Maintenance fluid for child
A
0.9% NaCl 5% Dextrose +/- 0.15%KCl
4/kg for first 10kg
2ml/kg for second 10kg
1 ml/kg for every kilo after
13
Q
Replacement fluid for child
A
0.9%NaCl, 10mmol KCl ml for ml (400ml bag)
14
Q
Signs of deterioration
A
Feed refusal Colour Temperature Change in tone Bile vomits
15
Q
Abdominal pain closer to the umbilicus is indicative of?
A
Funtional cause
Not surgical concern
16
Q
Which dermatome relates to the umbilicus?
A
T10
17
Q
Where are young children most likely to point referring to abdominal pain?
A
Umbilicus
Should be cautious
18
Q
Two types of pain to distinguish in abdominal pain
A
Constant vs Colic
19
Q
When assessing pain on movement what should be asked in abdominal pain history?
A
Pain worsening in car/speed bumps
20
Q
What colour of vomit is important in surgical causes of abdominal pain?
A
Green bile
21
Q
3 features to be noted in abdominal examination
A
General appearance of child
Temperature
Rebound tenderness (assess by asking to cough) and guarding
22
Q
4 investigations for abdominal pain
A
Urine
Electrolytes
Full blood count
X-ray
23
Q
Murphy’s triad for appendicitis
A
Pain
Fever
Vomiting
24
Q
Which point will be tender in appendicitis?
A
McBurney’s point
1/3 between ASIS and umbilicus
25
Complications of appendicitis
Abscess
Mass
Peritonitis
26
General presentation of child with appendicitis
Moderate temperature
Vomiting
Looks unwell
Unusual over 4 years old
27
Presentation of non-specific abdo pain
```
Generalised, central
Constant
Not made worse by movement
No GI disturbance
No temperature
Site and severity can vary - functional
```
28
What condition can non-specific abdo pain mimic?
Early appendicitis
29
In which group of patients is non-specific abdo pain more common?
Young girls
30
Differential diagnoses for abdominal pain
```
Mesenteric adenitis
Pneumonia
Pyloric stenosis
Malrotation
Intussusception
Gastroschisis
Exomphalos
```
31
Features of pain in appendicitis
Periumbilical pain radiating to right iliac fossa
Worse on coughing and over speed bumps
Children cannot hop on right foot
32
Why does the pain radiate to the right iliac fossa in appendicitis?
Localised Partietal peritoneal inflammation
33
Other common features of appendicitis
Mild pyrexia - not as high as mesenteric adenitis
May have loose stool
Anorexia - lose appetite
34
Which form of appendicitis has fewer signs?
Retrocaecal
35
Examination of appendicitis
Abdo exam
| Digital rectal - boogy sensation if pelvic abscess in case of pelvic appendix
36
Diagnosis of appendicitis
Raised inflammatory markers
History and examination findings
Urine analysis to exclude UTI, renal colic and pregnancy
Ultrasound - presence of free fluid
37
Management appendicitis
Appendectomy - laparoscopic
Prophylactic IV antibiotics
Broad spectrum antibiotics if mass present
Perforated appendicitis needs abdominal lavage
38
Presenting features of mesenteric adenitis
High temperature
Abdominal pain
URTI
Not unwell
39
Pneumonia can cause referred pain to which site>
Right iliac fossa
40
Pyloric stenosis usually presents in which stage of life?
4-16 weeks of life
41
Pyloric stenosis is more common amongst which group of patients?
Male babies
42
What causes pyloric stenosis?
Hypertrophy of the circular muscles of the pylorus
43
Presenting features of pyloric stenosis
```
Non bilous projectile vomiting
Weight loss
Palpable mass upper abdomen possible
Dehydration and constipation possible
Alkalosis, hypochloraemia, hypokalaemia
```
44
When does vomiting occur in pyloric stenosis?
30 mintues after feed
45
How is pyloric stenosis diagnosed?
Test feed - observe for mass and visible peristalsis
| Ultrasound
46
Management of pyloric stenosis
```
IV fluid bolus for acute hypovolaemia
Feed by NG tube
Rehydration with crystalloid
Regular blood gases and U&Es
Periumbilical pyloromyotomy - Ramstedt's
Must have electrolytes corrected first
```
47
Presentation of malrotation
3 day old baby with bilious vomiting
| Fairy liquid green
48
What colour of vomit is associated with malrotation?
Fairy liquid green
49
Investigation for malrotation
Upper GI contrast study
50
Management of malrotation
Urgent laparotomy
51
When can babies resume feeding after pyloromyotomy?
6 hours
52
Why is vomiting common after pyloromyotomy?
Distension and dysmotility
53
Complications of pyloric stenosis
Hypovolaemia
Apnoea
```
Post operative
Infection
Bleeding
Perforation
Incomplete myotomy
Wound dehiscence
```
54
Intussusception most commonly occurs at what age?
3-9 month old babies
55
What is intussusception?
Invagination of one part of bowel into lumen of adjacent bowel
56
What area is intussusception most likely to occur?
Ileocaecal
57
Presentation of intussusception
```
3 day history of viral illness
(Paroxysmal) Intermittent colic
Dying spells
Bilious vomiting
Red currant jelly stools
4 second capillary refill
Sausage shaped mass RUQ
```
58
What sign will infant display during paroxysm in intussusception?
Draws knees up and turns pale
59
Investigation for intussusception
Ultrasound - Target sign
60
What sign on US indicates intussusception?
Target mass
61
Management of intussusception
```
Pneumatic reduction (air enema)
Laparotomy
```
62
Indication for laparotomy in intussusception
Pneumatic reduction fails or child has peritonitis
63
What is gastroschisis?
Congenital abdominal wall defect
Gut eviscerated and exposed
Atresia associated
64
Management of gastroschisis
May attempt vaginal delivery and newborn to theatre ASAP
Primary or delayed closure
Total Parenteral Nutrition
65
How does exomphalos (omphalocele) differ to gastroschisis?
Abdominal contents protrude through anterior abdominal wall but enclosed in amniotic sac
66
Anomalies associated with exomphalos
Beckwith Weideman
Cardiac and kidney malformations
Down's syndrome
67
Management of exomphalos
Primary/delayed closure
Casearean to keep amniotic sac intact
Staged repair where primary closure difficult- intraabdominal pressure
Sac is allowed to granuloate and epithelialise - forms a shell
As infant grows contents can fit in abdominal cavity and shell removed, abdomen closed
68
Hirschsprung's disease
Congenital Aganglionic megacolon
Ganglionic cells fail to develop in large intestine
Delayed or failed passage of meconium within 48 hours of birth
69
Triad for hirschsprung's disease
Abdominal distension
Bilious vomiting
Failure to pass meconium
70
Male to female ratio for hirschsprung's disease
4 to 1
71
Genetic associations with Hirschsprung's disease
Receptor Tyorisine Kinase Gene (RET)
Chromosome 10q11
and
Endothelin Type B receptor pathway
72
Conditions associated with Hirschsprung's
Trisomies -Down Syndrome
73
3 subtypes of hirschsprung's disease
Short segment
Long segment
Total colonic aganglionosis
74
Which subtype fo hirschsprung's disease is most common?
Short segment
75
Result of anganglionosis in Hirschsprung's disease
Failure of bowel movement and peristalsis
Accumulation of faeces will not trigger opening of sphincter
Proximal bowel dilatation leads to abdominal distension
Bacterial proliferation can lead to Hirschsprung's enterocolitis - complications of which can be sepsis and death
76
Risk factors for hirschsprungs
Male
Chromosomal Abnormalities
Family history
77
Clinical features of hirschrpung's
```
Abdominal distension
Bilious vomiting
Failure to pass meconium
Dilation of bowel - mass in left lower abdomen
Empty rectal vault
```
78
Differentials for hirschsprungs
```
Meconium plug syndrome
Meconium ileus
Intestinal atresia
Intestinal malrotation
Anorectal malformation
Constipation
```
79
Investigations for hirschsprungs
Contrast enema
Short transition zone between proximal and distal colon
Rectal suction biopsy- tested for acetylcholinesterase
80
NICE Rectal suction biopsy guidelines
Delayed passage of meconium
Constipation since first few weeks of life
Chronic abdominal distension and vomiting
FH of hirschsprung's
Faltering growth
81
Management of hirschsprungs
IV antibiotics
NG tube
Bowel decompression
Surgery - Swenson, Soave, Duhamel pull through : resect aganglionic bowel, connect unaffected to dentate
82
Complications of hirschsprungs
Hirschsprung associated Enterocolitiis (HEC)
Of surgery - constipation, enterocolitis, perianal abscess, faecal soiling and adhesions.
83
Which bacteria are associated with Hirschsprung Enterocolitis
C difficile
| Staph aureus
