paediatric surgery Flashcards
average weight (kg) =
2 x (age + 4)
average blood volume (mls) =
80mls/kg
average urine output =
1ml/kg/hr
insensible fluid loss =
20ml/kg/day
avg systolic BP (mmHg) =
80 + (2 x age)
the pain barrier
if child has pain they must rely on someone to give them it - teacher waits for mum, mum waits for dr etc.
pain management in children
WHO pain ladder
paracetamol
ibuprofen
weak opioid (not codeine in <12yrs)
strong opioid
fluid management in children: resuscitation
20ml/kg bolus 0.9% sodium chloride
fluid management in children: maintenance
0.9% NaCl or 5% dextrose +/- KCl
4ml/kg 1st 10kg
2ml/kg 2nd 10kg
1ml/kg every kg thereafter
sentinel signs
feed refusal bile vomits - green colour - grey is bad tone - floppy/hyperrigidity temperature - warm or cold
appendicitis presenting features
pain - mid abdo then localises RLQ vomiting diarrhoea anorexia fever raised neutrophils
appendicitis investigations
FBC
CRP
USS
CT
apendicitis complications
abscess
mass
peritonitis
abdo pain investigations
urine - all
FBC - if diagnostic doubt
electrolytes - only if sick/very dry
x-rays - rarely
management of apendicitis
analgesia - oral paracetamol
surgery
features of non-specific abdominal pain
short duration central - periumbilical constant not made worse by movement no Gi disturbance no temp site and severity vary
investigation if presents with bilious green vomiting
upper GI contrast study asap
intussusception
prolapse of part of intestine into lumen of adjoining distal part
most often ilio-caecal region
causes intenstinal obsrtuction
intussusception features
bilious vomiiting
colicky abdo pain
bloody mucous PR - redcurrant jelly stool
pallor
palpable abdo mass
lethargy/irritability between waves of pain
USS intussusception
target sign
intussusception Rx
pneumostatic reduction - air enema
laparotomy
malrotation and volvulus
Malrotation predisposes patients to a risk of midgut volvulus
volvulus have twisting and loss of blood supply
malrotation and volvulus features
bilious vomitng
abdo pain, distention
normal abdo exam
tachycardia
malrotation and volvulus Ix
upper GI contrast study
malrotation and volvulus Rx
laparotomy asap
umbilical hernia
defect of anterior abdominal wall
umbilical rings fails to close
umbilical hernia features
umbilical swelling
worse when crying
easily reducible
most close by 4yrs
umbilical hernia complications
strangulation
incarceration
rupture
when to repair umbilical hernia
complications
persists >4yrs
large, aesthetic reasons
gastroschisis
abdo wall defect, gut eviscerated and exposed with no protective sac
10% assoc atresia
exomphalos
umbilical defect with covered viscera
assoc anomalies: cardiac, neurological, renal, trisomy 21
