Surgery Flashcards
How would you roughly calculate a childs weight based on their age?
(Age + 4) x 2
What is the average urine output for a child?
1ml/kg/hour
What is the average insensible fluid loss?
20ml/kg/day
How could you calculate the systolic BP based on age?
80 + (2 x Age )
What is the average blood volume for a child?
80ml/kg
What is the average RR in a infant < 1 year old?
30-40
What is the average HR in a infant < 1 year old?
110-160
What is the average systolic BP in a infant < 1 year old?
70-90
What is the average RR in a 2-5 year old?
25-30
What is the average HR in a infant 2-5 year old?
95-140
What is the average systolic BP in a 2-5 year old?
80-100
What is the average RR in a infant 5-10 year old?
20-25
What is the average HR in a 5-10 year old?
80-120
What is the average systolic BP in a infant 5-10 year old?
90-110
What is the average RR in a >12 years old?
15-20
What is the average HR in a infant >12 year old?
60-100
What is the average systolic BP in a infant 5-10 year old?
100-120
What dose of paracetamol would you give for pain management?
20mg/kg
4-6 hly
What dose of ibuprofen would you give to manage pain in a child?
10mg/kg
8 hly
What are the red flag signs of abdominal pain?
- FEED REFUSAL
- BILE VOMITS - means obstruction!!!!
- COLOUR - grey baby
- TONE - floppy
- TEMPERATURE- more anxious about cold than warm babies
What investigations would you perform in the context of abdominal pain?
- Urine
- FBC - Only if diagnostic doubt
- Electrolytes - Only if sick / very dry
- X-rays
What is acute appendicitis?
Inflammation of the appendix
What can cause acute appendicitis?
Primary obstruction of the appendix, caused by:
- Bezoars
- Foreign bodies
- Trauma
- Intestinal worms
- Lymphadenitis
- Appendicoliths or fecoliths
What are the clinical features of appendicitis?
-
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
What age range is appendicitis unusual to present in?
Rare if less than 5 yrs
What on examination would make appendicitis an unlikely diagnosis?
- Appears well
- Can sit foreward unsupported
- Can hop
What investigations could be done if you suspected appendicitis?
No investigations are consistently helpful in making diagnosis - CLINICAL DIAGNOSIS from repeated reviews
How would you treat appendicitis?
-
Conservative - antibiotics
- If mass but no signs of peritonitis
- Pain relief
-
Appendicectomy
- If signs of perforation -> fluid resus with IV Abx prior to procedure
What is the definition non-specific abdominal pain?
Abdominal pain which resolves within 24-48 hrs
Most often associated with resp. tract infection + cervical lymphadenopathy
What can non-specific abdominal pain mimic?
Acute appendicitis
What can cause non-specific abdominal pain in children?
- Mesenteric Adenitis
- Pneumonia
What is mesenteric adenitis?
Inflammation of the mesenteric lymph nodes in the right lower quadrant, and is clinically often mistaken for acute appendicitis
What is mesenteric adenitis caused by?
- Viruses
- Yersinia enterocolitica
- Helicobacter jejuni
- Campylobacter jejuni
- Salmonella spp
- Shigella spp
What is malrotation?
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
How does malrotation present?
Bilious vomiting
Tends to present within a few days of birth
What is volvulus?
Loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction
How would you investigate suspected malrotation?
Upper GI contrast scan
What are the surgical causes of acute abdominal pain?
- Acute appendicitis
- Intestinal obstruction
- Inguinal hernia
- Peritonitis
- Inflamed Meckel’s Diverticulum
- Pancreatitis
- Trauma
What are medical causes of acute abdominal pain?
- 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
What are extra-abdominal causes of abdominal pain?
- URTI
- Lower lobe Pneumonia
- Testicular Torsion
- Hip and spine pathology
What proportion of children can develop an umbilical hernia?
1/6
What are risk factors for the development of Umbilical hernia?
- LBW
- Trisomy 21
- Hypothyroidism
- Mucopolysaccharidosis
What indications are there for surgical repair of umbilical hernia?
- Complications
- Persistence > 4 years
- Large defect
- Aesthetics
What is gastroschisis?
Bowel protrudes through a defect in the abdominal wall, adjacent to the umbilicus, and there is no covering of the sac.
What is exomphalos?
Abdominal contents protrude through the abdominal ring, covered by a sac formed by the amniotic memebrane and peritoneum
What is the volume of resuscitation fluid used in children?
20 ml/kg bolus of 0.9% saline
How would you calculate the volume of maintenance fluid to give a child?
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
What intestinal deformity can those with down’s syndrome have?
Duodenal atresia
What can cause small bowel obstruction in a child?
- Atresia/stenosis - duodenum/jejunum/ileum
- Malrotation with volvulus
- Meconium Ileus
- Meconium Plug
What can cause large bowel obstruction in a Child?
- Hirschprungs disease
- Rectal atresia
