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Paediatrics > Surgery > Flashcards

Surgery Flashcards

1
Q

How do you calculate a child’s weight?

A

Weight (Kg) = 2x(age+4)

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2
Q

How do you estimate blood volume?

A

80ml/kg

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3
Q

What is expected urine output in children?

A

1ml/kg/hour

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4
Q

What is expected insensible fluid losses in children?

A

20ml/kg/day

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5
Q

What is expected blood pressure?

A

80 + (2 x age)

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6
Q

What should be given for pain relief/fever at home?

A

Calpol

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7
Q

What pain relief is used for children?

A

Paracetamol
Ibuprofen
Weak opioid - not codeine in under 12s, tramadol?
Strong opioid - morphine

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8
Q

What is given for fluid resus?

A

20ml/kg bolus 0.9% saline - 1/4 of circulatory volume

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9
Q

What is given for fluid maintenance and how much is given?

A

0.9% saline/5% dextrose/Potassium chloride
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg every kg after

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10
Q

Are crystalloids or colloids given?

A

Crystalloids

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11
Q

What are major red flag clinical features in children?

A 
Feed refusals
Bile vomits - green
Colour of child - grey 
Tone
Temperature - hypothermia - poor perfusion
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12
Q

What should be asked about a child’s pain in the history?

A

Site - close to umbilicus = less chance of pathology
Colic vs constant
Movement (what was car trip like - speedbumps)
Vomiting - increases significane - ask about bilious
Diarrhoea
Anorexia - significant appendicitis
Previous episodes

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13
Q

What is tenesmus?

A

Incomplete evacuation

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14
Q

What is important on examination of abdo pain?

A

Distraction is essential
General appearance
Temperature
Guarding

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15
Q

What investigations can be done for abdominal pain?

A 
Urine for all
CRP/WCC for negative prediction
FBC
Electrolytes if sick or very dry
Rarely X-rays
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16
Q

What are diagnoses for abdominal pain?

A

Appendicitis - will kill you - unusual in under 4s

17
Q

What is Murphy’s triad?

A

Appendicitis:
Pain
Vomiting
Fever

18
Q

What are features of appendicitis?

A

Murphy’s triad

Tenderness over McBurney’s point

19
Q

What are complications of appendicitis?

A

Abscess
Mass
Peritonitis

20
Q

What surgery should be done for appendicitis?

A

Laparscopy

21
Q

What are features of non-specific abdominal pain?

A 
Short duration
Central
Constant
Not made worse by movement
No GI disturbance
No temp
Site and severity of tenderness variable
22
Q

What is the best course of action for non-specific abdominal pain?

A

Watch and wait

23
Q

What are features of mesenteric adenitis?

A

High temo
Often URTI
Not ‘unwell’

24
Q

What are features of abdominal pain causes by pneumonia?

A

Sicker than abdominal signs

Pain referred to right iliac fossa

25
Q

If a baby presents with bile vomiting what is diagnosis until proven otherwise?

A

Malrotation and volvulus

26
Q

What is malrotation?

A

Gut doesn’t rotate properly in development so gut is unstable

27
Q

What is volvulus?

A

Twisted midgut - not survivable if not treated

28
Q

What is the classical age of intussusception?

A

9 months

29
Q

What is history of intsussusception?

A

3 day history of viral illness then intermittent colic and dying spells
Bilious vomiting
4 sec cap refill on admission
Blood mucous post rectal (redcurrant jelly stool)

30
Q

What sign is seen on ultrasound of intussusception?

A

Target sign

31
Q

How is intussusception managed?

A

Pneumostatic reduction (air pressure)

32
Q

What increases risk of umbilical hernia?

A

Increase risk in low birth weight, trisomy 21, hypothyroid
Spontaneous closure by 4 years is rule
Complications rare
Repair if complications
Important to distinguish for paraumbilical hernia - just above umbilicus

33
Q

Where does epigastric hernia appear?

A

Defect in linea alba above the umbilicus

34
Q

What is gastroschisis?

A

Abdominal wall defect - gut exposed

35
Q

How is gastroschisis treated?

A

Primary/delayed closure

Total parenteral nutrition so they can grow

36
Q

What is survival rate of gastroschisis?

A

> 90%

37
Q

What is exomphalos?

A

Umbilical defect with COVERED viscera

38
Q

What are associated anomalies with exomphalos?

A 
Cardiac abnormalities
Trisomies
Renal problems
Neurological
Beckwith-Weideman syndrome
39
Q

What is the main feature of beckwith Weideman syndrome?

A

Overgrowth

Paediatrics (25 decks)

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