Surgery Flashcards
How do you calculate a child’s weight?
Weight (Kg) = 2x(age+4)
How do you estimate blood volume?
80ml/kg
What is expected urine output in children?
1ml/kg/hour
What is expected insensible fluid losses in children?
20ml/kg/day
What is expected blood pressure?
80 + (2 x age)
What should be given for pain relief/fever at home?
Calpol
What pain relief is used for children?
Paracetamol
Ibuprofen
Weak opioid - not codeine in under 12s, tramadol?
Strong opioid - morphine
What is given for fluid resus?
20ml/kg bolus 0.9% saline - 1/4 of circulatory volume
What is given for fluid maintenance and how much is given?
0.9% saline/5% dextrose/Potassium chloride
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg every kg after
Are crystalloids or colloids given?
Crystalloids
What are major red flag clinical features in children?
Feed refusals Bile vomits - green Colour of child - grey Tone Temperature - hypothermia - poor perfusion
What should be asked about a child’s pain in the history?
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
What is tenesmus?
Incomplete evacuation
What is important on examination of abdo pain?
Distraction is essential
General appearance
Temperature
Guarding
What investigations can be done for abdominal pain?
Urine for all CRP/WCC for negative prediction FBC Electrolytes if sick or very dry Rarely X-rays
What are diagnoses for abdominal pain?
Appendicitis - will kill you - unusual in under 4s
What is Murphy’s triad?
Appendicitis:
Pain
Vomiting
Fever
What are features of appendicitis?
Murphy’s triad
Tenderness over McBurney’s point
What are complications of appendicitis?
Abscess
Mass
Peritonitis
What surgery should be done for appendicitis?
Laparscopy
What are features of non-specific abdominal pain?
Short duration Central Constant Not made worse by movement No GI disturbance No temp Site and severity of tenderness variable
What is the best course of action for non-specific abdominal pain?
Watch and wait
What are features of mesenteric adenitis?
High temo
Often URTI
Not ‘unwell’
What are features of abdominal pain causes by pneumonia?
Sicker than abdominal signs
Pain referred to right iliac fossa
If a baby presents with bile vomiting what is diagnosis until proven otherwise?
Malrotation and volvulus
What is malrotation?
Gut doesn’t rotate properly in development so gut is unstable
What is volvulus?
Twisted midgut - not survivable if not treated
What is the classical age of intussusception?
9 months
What is history of intsussusception?
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)
What sign is seen on ultrasound of intussusception?
Target sign
How is intussusception managed?
Pneumostatic reduction (air pressure)
What increases risk of umbilical hernia?
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
Where does epigastric hernia appear?
Defect in linea alba above the umbilicus
What is gastroschisis?
Abdominal wall defect - gut exposed
How is gastroschisis treated?
Primary/delayed closure
Total parenteral nutrition so they can grow
What is survival rate of gastroschisis?
> 90%
What is exomphalos?
Umbilical defect with COVERED viscera
What are associated anomalies with exomphalos?
Cardiac abnormalities Trisomies Renal problems Neurological Beckwith-Weideman syndrome
What is the main feature of beckwith Weideman syndrome?
Overgrowth
