Surgery Flashcards
What is the daily fluid requirement for neonates?
150ml/kg/day
What is the most common maintenance fluid given to children?
0.45% saline/5% dextrose
What fluid and what volume is given in paediatric resuscitation?
10ml/kg of 0.9% saline
After which volume of resuscitation fluids with no response from the child should a surgeon/ITU be contacted?
40ml/kg
Give 4 important questions to ask when a baby presents with vomiting
- Is it bilious vomit? (fairy liquid green)
- Projectile?
- Feeding?
- Weight gain?
Give 4 causes of non-bilious vomiting in a baby
Overfeeding
Possetting
GORD
Pyloric stenosis
At which age and gender is pyloric stenosis likely to occur?
2-6 weeks
Male
Give 3 features in a pyloric stenosis history
Acute weight loss
Vomit after feeds
Hungry baby
Give 3 clinical features of pyloric stenosis
Dehydration
Hypokalaemia
Metabolic acidosis
Which 2 methods can diagnose pyloric stenosis?
Test feed (visible peristalsis and ‘olive’ mass)
USS
What is the Tx of pyloric stenosis?
Correct electrolytes with IV fluids
Surgery
Give 4 causes of bilious vomiting in a baby
- Malrotation
- NEC
- Atresia
- Hirschsprung’s
How does malrotation occur?
Failure of intestinal fixation at 4-12 weeks gestation =
narrow midgut mesentery liable to twist
How is malrotation diagnosed?
Barium contrast studies
How is malrotation treated?
Resuscitation then early laparotomy
What is necrotising enterocolitis?
Acute inflammatory disease in intestines of premature babies
Give 4 features of NEC
o Abdominal distension
o Blood in stool
o Feeding intolerance
o Vomiting
How is NEC treated?
Stop feeds
IV Fluids/ABX
Severe: resection + stoma
What is atresia of intestine?
Congenital, narrowed/absent segment of intestine commonly in jejunum/ileum
What is Hirschsprung’s disease?
Congenital ganglionic megacolon starting at anus and progressing upwards
Give 3 features of Hirschsprung’s disease
Delayed meconium
Distension
FTT
Give 4 key questions in an acute abdomen history
- Pain using SOCRATES
- Urinary/bowel symptoms
- Last menstrual period in girls
- Last meal
Give 5 differentials for an acute abdomen
- Acute appendicitis
- Mesenteric adenitis
- Constipation
- Gastroenteritis
- UTI
What is intussusception?
Full thickness invagination of proximal bowel into distal intestine, commonly ileo-colic
What is the triad of intussusception?
Severe intermittent abdominal pain
Redcurrant jelly stools
Vomiting
Give 3 risk factors for inguinal hernias
Male
Premature
Low birth weight
How are inguinal hernias managed?
Elective surgery soon after diagnosis
What is a hydrocele?
Fluid in scrotum due to patent processus vaginalis
Give 3 features of a hydrocele on examination
Swollen
Translluminates
Can’t get above it
When should undescended testes be operated on?
3-6 months and no later than 1st birthday
Give 4 differentials for an acute scrotum
- Testicular torsion
- Torsion of appendage
- Epidydimo-orchitis
- Hydrocele (rarely painful)
Give 5 key questions to ask in head trauma
- How did it happen?
- Vomiting?
- Loss of consciousness or post traumatic amnesia?
- Any other injuries?
- Does the story fit (NAI)?
Give 3 indications for a child with a head injury to have.a CT
- Witnessed LOC >5 minutes
- Abnormal drowsiness
- 3 or more discrete episodes of vomiting
