Surgery Flashcards
How to quickly work out the weight?
Wt (kg ) = 2 x (Age +4)
Blood Volume (mls)
80ml/kg
Urine output
1ml/kg/hour
Insensible fluid loss
20ml/kg/day
Systolic BP (mm Hg)
80 + (2 x Age )
babies have?
high RR
high HR
low BP
max dose of paracetamol given followed by?
20mg/kg 4-6 hly
IBUPROFEN - 10mg/kg 8 hly
Weak opiod, strong opiod (morphine)
codeine is not recommended?
in <12 - can cause respiratory stress
Resuscitation fluid?
20ml/kg bolus 0.9% Sodium Chloride
1/4 of circulatory volume
Maintenance of fluid?
how much ml per kg?
- 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
what are some of the sentinel signs? (5)
FEED REFUSAL BILE VOMITS COLOUR - grey = poor skin perfusion TONE - floppy, hyperrigid TEMPERATURE
basis of management of abdo pain?
- do they need a surgical opinion?
- do they need an operation?
constant pain indicates ?
pain on movement ?
peritonitis
appendicitis and affect on diarrhoea?
weight?
- retro-ileal / retro-colic
- tenesmus in pelvic appendix
- anorexia
- menstrual history
Examination of abdo (appendicitis) - what are you looking for? (4)
distraction techniques essential
general appearance important
temperature
“guarding and rebound”
investigations for appendicitis?
- Urine
- FBC - if getting fluid bolus
- electrolytes if they are sick
- x-rays - rarely
Is it appendicitis?
- how to tell?
unusual <4 years
can be difficult diagnosis
20% admissions
- 1 in 5 with abdo pain will have appendicitis
- moderate temperature, vomiting, looks unwell!!
what triad is indicative of appendicitis? - what are the features
Murphy’s Triad - pain, vomiting ,fever
appendicitis - where will a tender point be?
Mc Burney’s
- umbilicus and anterior iliac spine
complications of appendicitis?
abscess
mass
peritonitis
management of appendicitis?
analgesis - oral paracetamol
- surgery
NSAP - Non Specific Abdominal Pain - features?
short duration central constant not made worse by movement no GI disturbance no temperature site & severity of tenderness vary
NSAP - Non Specific Abdominal Pain is more common in?
girls
- most common cause
- can mimic early appendicitis (risk is low) , do bloods
Differential Diagnoses of NSAP - (2) - give features
mesenteric adenitis - swollen glands
high temperature
URTI often
not “unwell”
pneumonia - clue “sicker than abdominal signs”
usually Right Lower Lobe - crackles
soft abdomen
bile vomiting presentation? - investigations
- most common diagnosis ?
- management ?
– upper GI contrast study ASAP
- malrotation and volvulus
– Laparotomy ASAP
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?
Intussusception
6-18 months
investigations for Intussusception?
USS abdomen - “target sign”
management for Intussusception?
- most common type
- pneumostatic reduction
(air enema) - laparotomy
– ilecolic Intussusception
presentation of 8 month old with umbilical hernia ?
- umbilical swelling
- present from about 4 days old
- worse with crying
- easily reducible
Umbilical hernia - often close by?
when do you chose to repair?
4 years
- complications
relative
persistance>4yrs, large defect, aesthetic)
paraumbilical hernia tend to point down to?
the feet
Abdominal Wall Defects - Gastroschisis - what is this?
gut eviscerated and exposed
10% associated atresia
(gut outside the abdomen)
management of Gastroschisis
- what can we give?
delayed closure
TPN
short gut usually happens in?
utero
- lose the entire mid gut
- need surgery - lifetime tan , BOWEL AND liver
what is Exomphalos?
- associated anomalies
umbilical defect with covered viscera
- 25% cardiac
25% chromosomal - Trisomy13, 18, 21
15% renal, neurological
Beckwith-Weideman syndrome
Exomphalos management?
outcome?
primary / delayed closure
post natal mortality - 25%
