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Paediatrics > Surgery > Flashcards

Surgery Flashcards

1
Q

How to quickly work out the weight?

A

Wt (kg ) = 2 x (Age +4)

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2
Q

Blood Volume (mls)

A

80ml/kg

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3
Q

Urine output

A

1ml/kg/hour

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4
Q

Insensible fluid loss

A

20ml/kg/day

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5
Q

Systolic BP (mm Hg)

A

80 + (2 x Age )

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6
Q

babies have?

A

high RR
high HR
low BP

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7
Q

max dose of paracetamol given followed by?

A

20mg/kg 4-6 hly

IBUPROFEN - 10mg/kg 8 hly

Weak opiod, strong opiod (morphine)

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8
Q

codeine is not recommended?

A

in <12 - can cause respiratory stress

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9
Q

Resuscitation fluid?

A

20ml/kg bolus 0.9% Sodium Chloride

1/4 of circulatory volume

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10
Q

Maintenance of fluid?

how much ml per kg?

A
  • 0.9% NaCl/ 5% Dextrose +/- KCl
  • 1.2% can cause hyponatremia - cell oedema - fatal
  • 4ml/kg 1st 10kg
  • 2ml/kg 2nd 10 kg
  • 1mlkg every kg thereafter
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11
Q

what are some of the sentinel signs? (5)

A 
FEED REFUSAL
BILE VOMITS
COLOUR - grey = poor skin perfusion
TONE - floppy, hyperrigid 
TEMPERATURE
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12
Q

basis of management of abdo pain?

A
  • do they need a surgical opinion?

- do they need an operation?

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13
Q

constant pain indicates ?

pain on movement ?

A

peritonitis

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14
Q

appendicitis and affect on diarrhoea?

weight?

A
  • retro-ileal / retro-colic
  • tenesmus in pelvic appendix
  • anorexia
  • menstrual history
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15
Q

Examination of abdo (appendicitis) - what are you looking for? (4)

A

distraction techniques essential

general appearance important

temperature

“guarding and rebound”

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16
Q

investigations for appendicitis?

A
  • Urine
  • FBC - if getting fluid bolus
  • electrolytes if they are sick
  • x-rays - rarely
17
Q

Is it appendicitis?

- how to tell?

A

unusual <4 years
can be difficult diagnosis
20% admissions

  • 1 in 5 with abdo pain will have appendicitis
  • moderate temperature, vomiting, looks unwell!!
18
Q

what triad is indicative of appendicitis? - what are the features

A

Murphy’s Triad - pain, vomiting ,fever

19
Q

appendicitis - where will a tender point be?

A

Mc Burney’s

  • umbilicus and anterior iliac spine
20
Q

complications of appendicitis?

A

abscess
mass
peritonitis

21
Q

management of appendicitis?

A

analgesis - oral paracetamol

  • surgery
22
Q

NSAP - Non Specific Abdominal Pain - features?

A 
short duration
central 
constant 
not made worse by movement
no GI disturbance
no temperature
site & severity of tenderness vary
23
Q

NSAP - Non Specific Abdominal Pain is more common in?

A

girls
- most common cause

  • can mimic early appendicitis (risk is low) , do bloods
24
Q

Differential Diagnoses of NSAP - (2) - give features

A

mesenteric adenitis - swollen glands

high temperature
URTI often
not “unwell”

pneumonia - clue “sicker than abdominal signs”
usually Right Lower Lobe - crackles
soft abdomen

25
Q

bile vomiting presentation? - investigations

  • most common diagnosis ?
  • management ?
A

– upper GI contrast study ASAP

  • malrotation and volvulus

– Laparotomy ASAP

26
Q

presentation .. nine-month baby
3 day history of viral illness then intermittent COLIC and DYING SPELLS
- bilious vomiting
- bloody mucous PR (redcurrant jelly stool)
- 4 second cap refill - delayed perfusion

  • DIAGNOSIS?
  • common in what age group?
A

Intussusception

6-18 months

27
Q

investigations for Intussusception?

A

USS abdomen - “target sign”

28
Q

management for Intussusception?

  • most common type
A
  • pneumostatic reduction
    (air enema)
  • laparotomy

– ilecolic Intussusception

29
Q

presentation of 8 month old with umbilical hernia ?

A
  • umbilical swelling
  • present from about 4 days old
  • worse with crying
  • easily reducible
30
Q

Umbilical hernia - often close by?

when do you chose to repair?

A

4 years

  • complications
    relative
    persistance>4yrs, large defect, aesthetic)
31
Q

paraumbilical hernia tend to point down to?

A

the feet

32
Q

Abdominal Wall Defects - Gastroschisis - what is this?

A

gut eviscerated and exposed
10% associated atresia
(gut outside the abdomen)

33
Q

management of Gastroschisis

- what can we give?

A

delayed closure

TPN

34
Q

short gut usually happens in?

A

utero

  • lose the entire mid gut
  • need surgery - lifetime tan , BOWEL AND liver
35
Q

what is Exomphalos?

- associated anomalies

A

umbilical defect with covered viscera

  • 25% cardiac
    25% chromosomal - Trisomy13, 18, 21
    15% renal, neurological
    Beckwith-Weideman syndrome
36
Q

Exomphalos management?

outcome?

A

primary / delayed closure

post natal mortality - 25%

Paediatrics (49 decks)

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