Surgery

Question 1

What are quick ways to work out the weight, blood volume, urine output and blood pressure of a child?

Answer 1

Wt (kg ) = 2 x (Age +4)
Blood Volume (mls) = 80mls/kg
Urine output = 0.5-1ml/kg/hour
Systolic BP (mm Hg) = 80 + (2 x Age )

Question 2

What resuscitation fluid should be used in children?

Answer 2

20ml/kg bolus 0.9% NaCl

Question 3

What are the features of non-specific abdominal pain?

Answer 3

short duration
central 
constant 
not made worse by movement
no GI disturbance
no temperature
site & severity of tenderness vary

Question 4

What is a malrotation?

Answer 4

Malrotation is anatomical failure during development, gut rotates clockwise when coming back inside abdomen, if that rotation doesn’t happen then get malrotation so gut is unstable then midgut pedicle twists (volvulus) then lose function of midgut
Need to do a upper GI contrast study then manage with an open laparotomy

Question 5

What is intussusception?

Answer 5

One bit of bowel slides inside the other, looks like a target sign. Usually happens in babies 6-12 months old, only happens in children. Presents with viral illness, colic, bilious vomiting, redcurrant jelly stools then dying spells (baby goes floppy for 20 seconds then comes around). Do an US abdomen to diagnose then treat with pneumostatic reduction (air enema) or laparotomy

Question 6

What is gastroschisis?

Answer 6

Gut comes outside at ten weeks gestation then doesn’t go back inside, can nip off blood supply and destroy gut
Use siloclosure, put the gut in it and let the bowel fall back in and maintain a weight with TPN
If short gut then makes it more complicated

Question 7

What is exomphalos?

Answer 7

Umbilical defect with covered viscera with associated anomalies (cardiac, chromosomal, renal, neurological)
Beckwith-Weideman syndrome is exomphalos, hypoglycaemia and macroglossia and can have renal tumours
Management is primary or delayed closure