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Paediatrics > Paediatric Surgery > Flashcards

Paediatric Surgery Flashcards

1
Q

Calculate estimated weight of a child

A

Weight = 2 x (AGE +4)

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2
Q

Estimated blood volume of a child

A

80mls per kg

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3
Q

Urine output of a child

A

0.5-1ml/kg/hour

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4
Q

Insensible fluid loss of a child

A

20ml/kg/day

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5
Q

Systolic blood pressure of a child

A

80 + (2 x age)

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6
Q

Respiratory rate of a 3 year old

A

25-30

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7
Q

Heart rate of child less than 1

A

100-160

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8
Q

Systolic blood pressure of 4 year old

A

80-100

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9
Q

WHO recommended paracetamol dose for child

A

20 mg/kg 4-6 hrly

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10
Q

WHO recommended ibuprofen dose for child

A

10mg/kg 8 hourly

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11
Q

Resuscitation fluid for child

A

20 ml/kg bolus 0.9% NaCl

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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

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13
Q

Replacement fluid for child

A

0.9%NaCl, 10mmol KCl ml for ml (400ml bag)

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14
Q

Signs of deterioration

A 
Feed refusal
Colour 
Temperature
Change in tone
Bile vomits
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15
Q

Abdominal pain closer to the umbilicus is indicative of?

A

Funtional cause

Not surgical concern

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16
Q

Which dermatome relates to the umbilicus?

A

T10

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17
Q

Where are young children most likely to point referring to abdominal pain?

A

Umbilicus

Should be cautious

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18
Q

Two types of pain to distinguish in abdominal pain

A

Constant vs Colic

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19
Q

When assessing pain on movement what should be asked in abdominal pain history?

A

Pain worsening in car/speed bumps

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20
Q

What colour of vomit is important in surgical causes of abdominal pain?

A

Green bile

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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

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22
Q

4 investigations for abdominal pain

A

Urine
Electrolytes
Full blood count
X-ray

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23
Q

Murphy’s triad for appendicitis

A

Pain
Fever
Vomiting

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24
Q

Which point will be tender in appendicitis?

A

McBurney’s point

1/3 between ASIS and umbilicus

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25
Q

Complications of appendicitis

A

Abscess
Mass
Peritonitis

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26
Q

General presentation of child with appendicitis

A

Moderate temperature
Vomiting
Looks unwell

Unusual over 4 years old

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27
Q

Presentation of non-specific abdo pain

A 
Generalised, central
Constant
Not made worse by movement
No GI disturbance
No temperature
Site and severity can vary - functional
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28
Q

What condition can non-specific abdo pain mimic?

A

Early appendicitis

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29
Q

In which group of patients is non-specific abdo pain more common?

A

Young girls

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30
Q

Differential diagnoses for abdominal pain

A 
Mesenteric adenitis
Pneumonia
Pyloric stenosis
Malrotation
Intussusception
Gastroschisis
Exomphalos
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31
Q

Features of pain in appendicitis

A

Periumbilical pain radiating to right iliac fossa
Worse on coughing and over speed bumps
Children cannot hop on right foot

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32
Q

Why does the pain radiate to the right iliac fossa in appendicitis?

A

Localised Partietal peritoneal inflammation

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33
Q

Other common features of appendicitis

A

Mild pyrexia - not as high as mesenteric adenitis
May have loose stool
Anorexia - lose appetite

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34
Q

Which form of appendicitis has fewer signs?

A

Retrocaecal

35
Q

Examination of appendicitis

A

Abdo exam

Digital rectal - boogy sensation if pelvic abscess in case of pelvic appendix

36
Q

Diagnosis of appendicitis

A

Raised inflammatory markers
History and examination findings
Urine analysis to exclude UTI, renal colic and pregnancy
Ultrasound - presence of free fluid

37
Q

Management appendicitis

A

Appendectomy - laparoscopic
Prophylactic IV antibiotics
Broad spectrum antibiotics if mass present

Perforated appendicitis needs abdominal lavage

38
Q

Presenting features of mesenteric adenitis

A

High temperature
Abdominal pain
URTI
Not unwell

39
Q

Pneumonia can cause referred pain to which site>

A

Right iliac fossa

40
Q

Pyloric stenosis usually presents in which stage of life?

A

4-16 weeks of life

41
Q

Pyloric stenosis is more common amongst which group of patients?

A

Male babies

42
Q

What causes pyloric stenosis?

A

Hypertrophy of the circular muscles of the pylorus

43
Q

Presenting features of pyloric stenosis

A 
Non bilous projectile vomiting
Weight loss
Palpable mass upper abdomen possible
Dehydration and constipation possible
Alkalosis, hypochloraemia, hypokalaemia
44
Q

When does vomiting occur in pyloric stenosis?

A

30 mintues after feed

45
Q

How is pyloric stenosis diagnosed?

A

Test feed - observe for mass and visible peristalsis

Ultrasound

46
Q

Management of pyloric stenosis

A 
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
Q

Presentation of malrotation

A

3 day old baby with bilious vomiting

Fairy liquid green

48
Q

What colour of vomit is associated with malrotation?

A

Fairy liquid green

49
Q

Investigation for malrotation

A

Upper GI contrast study

50
Q

Management of malrotation

A

Urgent laparotomy

51
Q

When can babies resume feeding after pyloromyotomy?

A

6 hours

52
Q

Why is vomiting common after pyloromyotomy?

A

Distension and dysmotility

53
Q

Complications of pyloric stenosis

A

Hypovolaemia
Apnoea

Post operative
Infection
Bleeding
Perforation
Incomplete myotomy
Wound dehiscence
54
Q

Intussusception most commonly occurs at what age?

A

3-9 month old babies

55
Q

What is intussusception?

A

Invagination of one part of bowel into lumen of adjacent bowel

56
Q

What area is intussusception most likely to occur?

A

Ileocaecal

57
Q

Presentation of intussusception

A 
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
Q

What sign will infant display during paroxysm in intussusception?

A

Draws knees up and turns pale

59
Q

Investigation for intussusception

A

Ultrasound - Target sign

60
Q

What sign on US indicates intussusception?

A

Target mass

61
Q

Management of intussusception

A 
Pneumatic reduction (air enema)
Laparotomy
62
Q

Indication for laparotomy in intussusception

A

Pneumatic reduction fails or child has peritonitis

63
Q

What is gastroschisis?

A

Congenital abdominal wall defect
Gut eviscerated and exposed
Atresia associated

64
Q

Management of gastroschisis

A

May attempt vaginal delivery and newborn to theatre ASAP
Primary or delayed closure
Total Parenteral Nutrition

65
Q

How does exomphalos (omphalocele) differ to gastroschisis?

A

Abdominal contents protrude through anterior abdominal wall but enclosed in amniotic sac

66
Q

Anomalies associated with exomphalos

A

Beckwith Weideman
Cardiac and kidney malformations
Down’s syndrome

67
Q

Management of exomphalos

A

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
Q

Hirschsprung’s disease

A

Congenital Aganglionic megacolon
Ganglionic cells fail to develop in large intestine
Delayed or failed passage of meconium within 48 hours of birth

69
Q

Triad for hirschsprung’s disease

A

Abdominal distension
Bilious vomiting
Failure to pass meconium

70
Q

Male to female ratio for hirschsprung’s disease

A

4 to 1

71
Q

Genetic associations with Hirschsprung’s disease

A

Receptor Tyorisine Kinase Gene (RET)
Chromosome 10q11

and
Endothelin Type B receptor pathway

72
Q

Conditions associated with Hirschsprung’s

A

Trisomies -Down Syndrome

73
Q

3 subtypes of hirschsprung’s disease

A

Short segment
Long segment
Total colonic aganglionosis

74
Q

Which subtype fo hirschsprung’s disease is most common?

A

Short segment

75
Q

Result of anganglionosis in Hirschsprung’s disease

A

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
Q

Risk factors for hirschsprungs

A

Male
Chromosomal Abnormalities
Family history

77
Q

Clinical features of hirschrpung’s

A 
Abdominal distension
Bilious vomiting
Failure to pass meconium
Dilation of bowel - mass in left lower abdomen
Empty rectal vault
78
Q

Differentials for hirschsprungs

A 
Meconium plug syndrome
Meconium ileus
Intestinal atresia
Intestinal malrotation
Anorectal malformation
Constipation
79
Q

Investigations for hirschsprungs

A

Contrast enema
Short transition zone between proximal and distal colon
Rectal suction biopsy- tested for acetylcholinesterase

80
Q

NICE Rectal suction biopsy guidelines

A

Delayed passage of meconium
Constipation since first few weeks of life
Chronic abdominal distension and vomiting
FH of hirschsprung’s
Faltering growth

81
Q

Management of hirschsprungs

A

IV antibiotics
NG tube
Bowel decompression
Surgery - Swenson, Soave, Duhamel pull through : resect aganglionic bowel, connect unaffected to dentate

82
Q

Complications of hirschsprungs

A

Hirschsprung associated Enterocolitiis (HEC)

Of surgery - constipation, enterocolitis, perianal abscess, faecal soiling and adhesions.

83
Q

Which bacteria are associated with Hirschsprung Enterocolitis

A

C difficile

Staph aureus

Paediatrics (10 decks)

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