Surgery Flashcards
How do you calculate children’s weight?
2 x (age + 4)
How do you calculate children’s blood volume?
80mls/kg
How do you calculate children’s urine output?
0.5-1mls/kg/hours
How do you calculate children’s insensible fluid loss?
20ml/kg/day
How do you calculate children’s systolic BP?
80 + (2 x age)
What are the normal vitals of a child < 1?
- RR 30-40
- HR 110-160
- SBP 70-90
What are the normal vitals of a child 2-5?
- RR 25-30
- HR 95-140
- SBP 80-100
What are the normal vitals of a child 5-10?
- RR 20-25
- HR 80-120
- SBP 90-110
What are the normal vitals of a child >10?
- RR 15-20
- HR 80-120
- SBP 100-120
What are the big differences between children and adults?
- Communication
- Signs
- Disease processes
- Physiological parameters
- Expectations
- STRESS
What is the WHO pain ladder?
- Paracetmol
- NSAIDs
- Weak opioid
- Strong opioid
What sentinel signs occur in children?
- Feed refusal
- Bile vomits
- Colour
- Tone
- Temperature
What history may be obtained from a child with abdominal pain?
Pain
- Closer to umbilicus less chance of pathology
- Colic vs constant
- Movement (speed bump test)
Vomiting
- Increases significant
- Bile is important
What colour is bile vomit?
Green
What investigations should be carried out for abdominal pain?
- Urine
- FBC if diagnostic doubt
- Electrolytes if sick or dry
- Rarel x-rays
What is the basis of management?
- Does this child need a surgical opinion?
- Does this child need an operation?
What is the incidence of classical appendicitis?
- Unusual >4 years
- Can be difficult diagnosis
- 20% of admissions
How does classical appendicitis present?
- Murphy’s triad (pain, vomiting, fever)
- Tenderness over Mcburney’s point
What clues point to classical appendicitis?
- Moderate temperature with vomiting
- Child looks unwell;
What are the possible complications of classical appendicitis?
- Abscess
- Mass
- Peritonitis
What is the incidence of non-specific abdominal pain?
- F>M
- 45% of admissions
- Often recurrent
What are the features of non-specific abdominal pain?
- Short duration
- Central
- Constant
- Not made worse by movement
- No GIT disturbance
- No temperature
- Site and severity of tenderness vary
What can non-specific abdominal pain mimic?
Appendicitis
What would suggest non-specific abdominal pain was due to mesenteric adenitis?
- High temperature
- URTI often
- Not unwell
What would suggest on-specific abdominal pain was due to pneumonia?
- Child sicker than the abdominal signs
- Usually RLL
What is the incidence of pyloric stenosis?
- M:F 5:1
- Often have FMH
How does pyloric stenosis present?
- 4-16/52 history
- Non bilious projectile vomiting
- Weight loss
What would you find on capillary gases of pyloric stenosis?
- Alkalosis
- Hypochloraemia
- Hypokalaemia
How is pyloric stenosis investigated?
- Test feed
- US
How is pyloric stenosis treated?
- IV fluids with saline /dextrose with KCl
- Periumbilical pyloromyotomy
How does malrotation present?
Young baby with bile green vomiting
How is malrotation investigated?
Upper GI contrast study ASAP
How is malrotation managed?
Laparotomy ASAP
How does intussusception present?
- Baby (6-12 months)
- Short history of viral illness
- Intermittent colic
- Dying spells
- Bilious vomit
- Delayed cap refill
- Bloody mucous PR
How is intussusception investigated?
-USS abdomen (target sign)
How is intussusception managed?
- Pneumostatic reduction (air enema)
- Laparotomy
What is gastroschisis?
Abdominal wall defect where gut is eviscerated and exposed
What is gastroschisis sometimes associated with?
Atresia
How is gastroschisis managed?
-Primary or delayed closure
What are the survival prospects of gastroschisis?
- 90%+
- Short gut
What is exomphalos?
Umbilical defect with covered viscera
What are the associated anomalies of exomphalos?
- 25% cardia
- 25% chromosomal
- 15% renal, neurological
- Beckwith-Weideman syndrome
How is exomphalos managed?
Primary or delayed closure
What is the prognosis for exomphalos?
Post natal mortality is 25%
