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Paediatrics > Paedatric Surgery > Flashcards

Paedatric Surgery Flashcards

1
Q

How can you calculate a child’s average weight from their age?

A

2 x (4 + age)

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2
Q

How do you calculate a child’s blood volume norm?

A

80mls/kg

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3
Q

How do you calculate a child’s urine output norm?

A

0.5-1ml/kg/hr (little less as you age)

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4
Q

How do you measure insensible loss norms of a child?

A

20ml/kg/day

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5
Q

How do you work out systolic BP norms for a child?

A

80 + (2 x age)

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6
Q

What are the vital signs of a <1yo and how do these age with age?

A

RR 30-40
HR 110-160
BP 70-90
BP increases with age and HR and RR decrease

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7
Q

What is the concept of pain barriers?

A

The hurdles to a child receiving analgesia
E.g. telling mum/teacher they are sore, going to GP, going to hospital etc.

Don’t delay giving analgesia to kids - makes them easier to examine

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8
Q

What is the WHO pain ladder for children?

A

Paracetamol - 20mg/kg 4-6hrly
Ibuprofen - 10mg/kg 8hrly
Weak opioid
Strong opioid

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9
Q

What age is codeine licensed for?

A

> 12

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10
Q

What are the issues with codeine?

A

20% people don’t have the enzyme that coverts it into morphine (which supplies pain relief)
A small handful of people have too many enzymes –> respiratory depression & death

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11
Q

What are the two types of fluid manage?

A

Resuscitation - acute fluid depletion

Maintenance

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12
Q

What do you give as resuscitation fluids?

A

0.9% NaCl saline 20ml/kg bolus

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13
Q

What do you give as maintenance fluids?

A

0.9% NaCl 0.5% dextrose, 0.15%KCl

4ml/kg for first 10kg, 2ml/kg for next 10kg, 1ml/kg after that

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14
Q

What are the sentinel signs?

A

Reduced feeding (too tired to fed = v. unwell)
Green bilious vomit (bowel obstruction)
Colour - grey baby
Tone - floppy baby
Temperature - low temp more useful for diagnosing sepsis

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15
Q

What things do you want to clarify in your history of abdominal pain?

A 
Colic vs constant pain 
Vomiting (?green) = sicker
Diarrhoea 
Loss of appetite = sicker 
Movement - pain going over speed bumps? more likely to be peritonitis 
Menstrual pain
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16
Q

What is colic pain more likely to be?

A

Dysfunctional gut

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17
Q

What is constant pain more likely to be?

A

Peritoneal irritation/peritonitis

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18
Q

What kind of menstrual pain can you get?

A

Mittleshmzer and dysmenorrhoea

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19
Q

What are you looking for in examination of a child with abdominal pain?

A

General appearance
Guarding
Temperature

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20
Q

What is guarding?

A

Involuntary contraction of abdominal muscles

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21
Q

What investigations should you do in abdominal pain?

A

Urine dipstick
FBC if diagnostic uncertainty
Electrolytes if v sick/dehydrated
X-ray rarely

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22
Q

What is murphy’s triad?

A

Classical symptoms of appendicitis: fever, pain (McBurney’s point), vomiting

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23
Q

Where is McBurney’s point?

A

2/3rds along the line from the umbilicus to ASIS on the right side

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24
Q

What are the clues that would make you think appendicitis?

A

Periumbilical pain, followed by localised pain in McBurney’s point
Moderate temp <40, vomiting, looks unwell
Unusual <4y

25
Q

What are complications of appendicitis?

A

Abscesses, masses (missed appendicitis that has walled off into appendix), perionitis

26
Q

How do you Rx appendicitis?

A

Laparoscopic appendectomy + paracetamol

27
Q

What is NSAP?

A

Abdominal pain of a short duration (24-48h), that is central, constant, unaffected by movement, no GIT disturbance, temperature and site/severity vary

28
Q

In which gender is NSAP more common?

A

Girls

29
Q

What is mesenteric adenitis?

A

Inflammation of the mesenteric lymph nodes after a viral illness etc. –> pain

30
Q

What are the symptoms of mesenteric adenitis?

A

High temperature (>40), following URT often, not that unwell

31
Q

Pneumonia can sometimes present with abdominal pain - how can you pick this up?

A

Child sicker than abdominal signs (completely soft abdomen)

Look for cough, SoB, tachycardia etc.

32
Q

What kind of pneumonia tends to present with abdominal pain?

A

Right LL

33
Q

What is malrotation and what does it lead to?

A

Abnormal coiling/fixation of the intestines

Leads to volvulus - abnormal twisting of a loop of bowel on its mesentery –> ischaemia, gangrene

34
Q

What is a typical hx for malrotation & volvulus?

A

3 day old baby, w. green bile vomiting = MALROTATION until proven otherwise

35
Q

How do you investigate volvulus & malrotation?

A

Upper GI contrast study ASAP

36
Q

How do you manage malrotation and malrotation?

A

Laparotomy ASAP

37
Q

What is intrussuception?

A

Loop of proximal bowel slides into distal bowel

38
Q

What is a typical hx for intrussception?

A

9m (6-12m) baby hx of viral illness (D/V/cold) + intermittent colic and dying spells + bilious vomiting
Prolonged cap refill & redcurrant jelly stool

39
Q

What causes dying spells in intrussception?

A

Go white, floppy and stop breathing as they get colic waves, then starting breathing etc. 10s later after it passes
Vagal response

40
Q

How do you investigate intrussception?

A

USS abdomen, target sign

41
Q

How do you manage intrussception?

A

Pneumostatic reduction (air enema), laparotomy

42
Q

What is gastroschisis?

A

Paraumbilical herniation of intestines through abdominal wall without sac formation

43
Q

In which direction does a paraumbilical hernia point?

A

Towards the feet

44
Q

In which direction do umbilical hernias point?

A

Towards the ceiling

45
Q

What condition is gastroschisis assoc with?

A

Atresia

46
Q

What is the management for gastroschisis?

A

Primary/delayed closure + TPN

47
Q

What is the prognosis for gastroschisis?

A

90%

Short gut is the biggest killer (constriction of mesenteric arteries –> ischaemia and reduced bowel length)

48
Q

What is exomphalos?

A

Umbilical defect where by abdominal viscera herniate through the abdominal wall with covering viscera

49
Q

What is exomphalos associated with?

A

Cardiac abnormalities, chromosomal abnormalities (trisomy 13, 18, 21), renal & neurological abnormalities
Beckwith-Weideman syndrome

50
Q

What are the three things in Beckwith-Weideman syndrome?

A

Macroglossia, exomphalos, hyperinsulinaemia

51
Q

How do you treat exomphalos?

A

Primary/delayed closure

52
Q

What is the post-natal mortality of exomphalos?

A

25%

53
Q

What is umbilical hernia?

A

Protrusion of a sac (with/without intestines) through umbilicus

54
Q

How do you Mx umbilical hernia?

A

Closure only if not closed itself by 4/5

55
Q

What is umbilical hernia assoc with?

A

Down’s, hypothyroidism, mucopollysaccharidosis

56
Q

What leads to epigastric hernia?

A

Defect in linea alba

57
Q

What is an epigastric hernia?

A

Protrusion of preperitoneal fat

58
Q

How you Mx epigastric hernia?

A

Laparoscopic repair only for cosmetic reasons - must mark before you give anaesthesia as relaxing abdominal wall –> disappearance

Paediatrics (35 decks)

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