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Paediatrics > Surgery > Flashcards

Surgery Flashcards

1
Q

How would you roughly calculate a childs weight based on their age?

A

(Age + 4) x 2

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2
Q

What is the average urine output for a child?

A

1ml/kg/hour

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3
Q

What is the average insensible fluid loss?

A

20ml/kg/day

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4
Q

How could you calculate the systolic BP based on age?

A

80 + (2 x Age )

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5
Q

What is the average blood volume for a child?

A

80ml/kg

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6
Q

What is the average RR in a infant < 1 year old?

A

30-40

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7
Q

What is the average HR in a infant < 1 year old?

A

110-160

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8
Q

What is the average systolic BP in a infant < 1 year old?

A

70-90

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9
Q

What is the average RR in a 2-5 year old?

A

25-30

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10
Q

What is the average HR in a infant 2-5 year old?

A

95-140

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11
Q

What is the average systolic BP in a 2-5 year old?

A

80-100

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12
Q

What is the average RR in a infant 5-10 year old?

A

20-25

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13
Q

What is the average HR in a 5-10 year old?

A

80-120

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14
Q

What is the average systolic BP in a infant 5-10 year old?

A

90-110

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15
Q

What is the average RR in a >12 years old?

A

15-20

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16
Q

What is the average HR in a infant >12 year old?

A

60-100

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17
Q

What is the average systolic BP in a infant 5-10 year old?

A

100-120

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18
Q

What dose of paracetamol would you give for pain management?

A

20mg/kg

4-6 hly

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19
Q

What dose of ibuprofen would you give to manage pain in a child?

A

10mg/kg

8 hly

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20
Q

What are the red flag signs of abdominal pain?

A
  • FEED REFUSAL
  • BILE VOMITS - means obstruction!!!!
  • COLOUR - grey baby
  • TONE - floppy
  • TEMPERATURE- more anxious about cold than warm babies
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21
Q

What investigations would you perform in the context of abdominal pain?

A
  • Urine
  • FBC - Only if diagnostic doubt
  • Electrolytes - Only if sick / very dry
  • X-rays
22
Q

What is acute appendicitis?

A

Inflammation of the appendix

23
Q

What can cause acute appendicitis?

A

Primary obstruction of the appendix, caused by:

  • Bezoars
  • Foreign bodies
  • Trauma
  • Intestinal worms
  • Lymphadenitis
  • Appendicoliths or fecoliths
24
Q

What are the clinical features of appendicitis?

A
  • Murphy’s Triad
    • Pain - initially central and colicky, then localising to the right iliac fossa; McBurney’s point
    • Vomiting - slight vomiting
    • Fever - low grade
  • Anorexia
  • Flushed face
  • Oral fetor
25
Q

What age range is appendicitis unusual to present in?

A

Rare if less than 5 yrs

26
Q

What on examination would make appendicitis an unlikely diagnosis?

A
  • Appears well
  • Can sit foreward unsupported
  • Can hop
27
Q

What investigations could be done if you suspected appendicitis?

A

No investigations are consistently helpful in making diagnosis - CLINICAL DIAGNOSIS from repeated reviews

28
Q

How would you treat appendicitis?

A
  • Conservative - antibiotics
    • If mass but no signs of peritonitis
  • Pain relief
  • Appendicectomy
    • If signs of perforation -> fluid resus with IV Abx prior to procedure
29
Q

What is the definition non-specific abdominal pain?

A

Abdominal pain which resolves within 24-48 hrs

Most often associated with resp. tract infection + cervical lymphadenopathy

30
Q

What can non-specific abdominal pain mimic?

A

Acute appendicitis

31
Q

What can cause non-specific abdominal pain in children?

A
  • Mesenteric Adenitis
  • Pneumonia
32
Q

What is mesenteric adenitis?

A

Inflammation of the mesenteric lymph nodes in the right lower quadrant, and is clinically often mistaken for acute appendicitis

33
Q

What is mesenteric adenitis caused by?

A
  • Viruses
  • Yersinia enterocolitica
  • Helicobacter jejuni
  • Campylobacter jejuni
  • Salmonella spp
  • Shigella spp
34
Q

What is malrotation?

A

During rotation of the small bowel in foetal life, a lack of fixed mesentery at the duodenojejunal flexure or the ileoceacal region, it’s base is shorter than normal and is predisposed to volvulus

35
Q

How does malrotation present?

A

Bilious vomiting

Tends to present within a few days of birth

36
Q

What is volvulus?

A

Loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction

37
Q

How would you investigate suspected malrotation?

A

Upper GI contrast scan

38
Q

What are the surgical causes of acute abdominal pain?

A
  • Acute appendicitis
  • Intestinal obstruction
  • Inguinal hernia
  • Peritonitis
  • Inflamed Meckel’s Diverticulum
  • Pancreatitis
  • Trauma
39
Q

What are medical causes of acute abdominal pain?

A
  • Non-specific abdominal pain
  • Gastroenteritis
  • Urinary Tract - UTI, acute pyelonephritis, hydronephrosis, renal calculi
  • HSP
  • Diabetic ketoacidosis
  • Sickle cell disease
  • Hepatitis
  • IBD
  • Constipation
  • Chronic abdominal pain
  • Gynaecological pain
  • Psychological
40
Q

What are extra-abdominal causes of abdominal pain?

A
  • URTI
  • Lower lobe Pneumonia
  • Testicular Torsion
  • Hip and spine pathology
41
Q

What proportion of children can develop an umbilical hernia?

A

1/6

42
Q

What are risk factors for the development of Umbilical hernia?

A
  • LBW
  • Trisomy 21
  • Hypothyroidism
  • Mucopolysaccharidosis
43
Q

What indications are there for surgical repair of umbilical hernia?

A
  • Complications
  • Persistence > 4 years
  • Large defect
  • Aesthetics
44
Q

What is gastroschisis?

A

Bowel protrudes through a defect in the abdominal wall, adjacent to the umbilicus, and there is no covering of the sac.

45
Q

What is exomphalos?

A

Abdominal contents protrude through the abdominal ring, covered by a sac formed by the amniotic memebrane and peritoneum

46
Q

What is the volume of resuscitation fluid used in children?

A

20 ml/kg bolus of 0.9% saline

47
Q

How would you calculate the volume of maintenance fluid to give a child?

A

calculate weight based on age = (age+4)x2

4, 2, 1 rule - to get fluid rate per hour

  • 1st 10kg - 4ml/kg
  • 2nd 10 kg - 2ml/kg
  • 1ml/kg every kg thereafter

Example

  • 10 yrs = 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr
48
Q

What intestinal deformity can those with down’s syndrome have?

A

Duodenal atresia

49
Q

What can cause small bowel obstruction in a child?

A
  • Atresia/stenosis - duodenum/jejunum/ileum
  • Malrotation with volvulus
  • Meconium Ileus
  • Meconium Plug
50
Q

What can cause large bowel obstruction in a Child?

A
  • Hirschprungs disease
  • Rectal atresia

Paediatrics (27 decks)

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