Paediatric Surgery Flashcards
What are the physiolical indices in children?
- Wt(kg ) = 2 x (Age +4)
- Blood Volume (mls) = 80ml/kg
- Urine output = 1ml/kg/hour
- Insensible fluid loss = 20ml/kg/day
- Systolic BP (mm Hg) = 80 + (2 x Age )
What are the normal vital signs in children?
What are some of the main differences in treating children compared to adults?
Communication
Signs
Disease processes
Physiological parameters
Expectations
STRESS
What is the “pain barrier”?
What stops children getting anagesia
What are the doses of paracetamol and ibuprofen for children?
Paracetamol 20mg/kg 4-6 hly
Ibuprofen 10mg/kg 8 hly
Both weak and strong opioids can be given to children but which weak opioid cannot?
Codeine not recommened in <12 years
What is the type/volume of fluid given for child resus?
20ml/kg bolus 0.9% Sodium Chloride
What types of fluid are used for child maintenance?
- 0.9%NaCl/ 5% Dextrose +/- KCl
- 4ml/kg 1st 10kg
- 2ml/kg 2nd 10 kg
- 1ml/kg every kg thereafter
- 10yrs= 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr
What are the sentinel signs?
FEED REFUSAL
BILE VOMITS
COLOUR
TONE
TEMPERATURE
What are the types of abdonimal pain?
“closer to umbilicus, less chance of pathology”
Colic vs constant
Movement (car trip)
Why is vomiting important?
Increases significance
Bile important (bile is green notyellow!)
What is the relevance of diarrhoea?
Retro-ileal/retro-colic
Tenesmus in pelvic appendix
What is the relevance of anorexia in surgical?
What do previoud episodes tell you?
Lessens chances of surgical diagnosis
What else is relevant in abdominal presentation?
Menstrual history
What is important when doing an abdominal examination?
Distraction techniques essential
General appearance important
Temperature
“Guarding and rebound”
What investigations can be carried out for abdominal presentation?
- Urine
- all…
- FBC
- only if diagnostic doubt
- Electrolytes
- only if sick / very dry
- X-rays
- rarely
What indicates appendicitis?
- Unusual <4 years
- Can be difficult diagnosis
- 20% admissions
- Clues:
- moderate temperature
- vomiting
- looks unwell
- Murphy’s triad
- Tenderness over Mc Burney’s point
What is Murphy’s Triad?
Indicators of appendictis:
pain
vomiting
fever
What are the complications of appendicitis?
Abscess
Mass
Peritonitis
What is the manegment of appendicitis?
- Analgesia
- not a problem
- shouldn’t be with held
- oral paracetamol best option
- Surgery
What are the features of non-specific abdominal pain (NSAP)?
short duration
central
constant
not made worse by movement
no GI disturbance
no temperature
site & severity of tenderness vary
How common is NSAP?
girls > boys
45% admissions
often recurrent
can mimic an early appendicitis
What are differentials for NSAP?
- Mesenteric adenitis
- high temperature
- URTI often
- not “unwell”
- Pneumonia
- clue “sicker than abdominal signs”
- usually Right Lower Lobe
When a child presents with bile vomiting taht is “fairy liquid” green, what investigation should you do?
Upper GI contrast study ASAP
A cause of bile vomit in a child is malrotation and subsequent volvulus. What are these and how are they managed?
Malrotation is an abnormality of the bowel, which happens while the baby is developing in the womb
Volvulus is a complication of malrotation and occurs when the bowel twists so the blood supply to that part of the bowel is cut off
LAPAROTOMY ASAP
What is intussusception?
A serious condition in which part of the intestine slides into an adjacent part of the intestine
How might intussusception present?
- 3 day history of viral illness then intermittent COLIC and DYING SPELLS
- Biliousvomiting
- Bloody mucous PR (redcurrant jelly stool)
- On admission – 4 seconds capillary refill
What investigations can be carried out for intussusception?
USS abdomen
“target sign” appearance
What is the management of intussusception?
Pneumostaticreduction (air enema)
Laparotomy
How may an umbilical hernia present?
8 month baby
Umbilical swelling
Present from about 4 days old
Worse with crying
Easily reducible
How is an umbilical hernia managed?
- 1 : 6 children
- Spontaneous closure by 4 years is rule
- Complications rare
- Repair if:
- complications
- relative
- persistance>4yrs, large defect, aesthetic)
- Important to distinguish from paraumbilical hernia
What are 2 types of abdominal wall defects?
Gastroschisis
Exomphalos
What is gastroschisis?
Gut eviscerated and exposed
10% associated atresia
What is the management and prognosis of gastroschisis?
- Management
- delayed closure
- TPN - total parenteral feeding
- Survival
- 90%+
- short gut
What is exomphalos and what are its associated anomalies?
- Umbilical defect with covered viscera
- Associated anomalies
- 25% cardiac
- 25% chromosomal - Trisomy 13, 18, 21
- 15% renal, neurological
- Beckwith-Weideman syndrome
What is the managemnet of exomphalos?
- Management
- primary/delayed closure
- Outcome
- post natal mortality - 25%
