Paediatric Surgery

Question 1

What are the physiolical indices in children?

Answer 1

• 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 )

Question 2

What are the normal vital signs in children?

Answer 2

Question 3

What are some of the main differences in treating children compared to adults?

Answer 3

Communication

Signs

Disease processes

Physiological parameters

Expectations

STRESS

Question 4

What is the “pain barrier”?

Answer 4

What stops children getting anagesia

Question 5

What are the doses of paracetamol and ibuprofen for children?

Answer 5

Paracetamol 20mg/kg 4-6 hly

Ibuprofen 10mg/kg 8 hly

Question 6

Both weak and strong opioids can be given to children but which weak opioid cannot?

Answer 6

Codeine not recommened in <12 years

Question 7

What is the type/volume of fluid given for child resus?

Answer 7

20ml/kg bolus 0.9% Sodium Chloride

Question 8

What types of fluid are used for child maintenance?

Answer 8

• 0.9%NaCl/ 5% Dextrose +/- KCl
  
  • 4ml/kg 1st 10kg
  • 2ml/kg 2nd 10 kg
  • 1ml/kg every kg thereafter
• 10yrs= 2 x (10+4) = 28kg = 40+20+8 = 68mls/hr

Question 9

What are the sentinel signs?

Answer 9

FEED REFUSAL

BILE VOMITS

COLOUR

TONE

TEMPERATURE

Question 10

What are the types of abdonimal pain?

Answer 10

“closer to umbilicus, less chance of pathology”

Colic vs constant

Movement (car trip)

Question 11

Why is vomiting important?

Answer 11

Increases significance

Bile important (bile is green notyellow!)

Question 13

What is the relevance of diarrhoea?

Answer 13

Retro-ileal/retro-colic

Tenesmus in pelvic appendix

Question 14

What is the relevance of anorexia in surgical?

Question 15

What do previoud episodes tell you?

Answer 15

Lessens chances of surgical diagnosis

Question 16

What else is relevant in abdominal presentation?

Answer 16

Menstrual history

Question 17

What is important when doing an abdominal examination?

Answer 17

Distraction techniques essential

General appearance important

Temperature

“Guarding and rebound”

Question 20

What investigations can be carried out for abdominal presentation?

Answer 20

• Urine
  
  • all…
• FBC
  
  • only if diagnostic doubt
• Electrolytes
  
  • only if sick / very dry
• X-rays
  
  • rarely

Question 21

What indicates appendicitis?

Answer 21

• Unusual <4 years
• Can be difficult diagnosis
• 20% admissions
• Clues:
  
  • moderate temperature
  • vomiting
  • looks unwell
• Murphy’s triad
• Tenderness over Mc Burney’s point

Question 22

What is Murphy’s Triad?

Answer 22

Indicators of appendictis:

pain

vomiting

fever

Question 23

What are the complications of appendicitis?

Answer 23

Abscess

Mass

Peritonitis

Question 24

What is the manegment of appendicitis?

Answer 24

• Analgesia
  
  • not a problem
  • shouldn’t be with held
  • oral paracetamol best option
• Surgery

Question 25

What are the features of non-specific abdominal pain (NSAP)?

Answer 25

short duration

central

constant

not made worse by movement

no GI disturbance

no temperature

site & severity of tenderness vary

Question 27

How common is NSAP?

Answer 27

girls > boys

45% admissions

often recurrent

can mimic an early appendicitis

Question 28

What are differentials for NSAP?

Answer 28

• Mesenteric adenitis
  
  • high temperature
  • URTI often
  • not “unwell”
• Pneumonia
  
  • clue “sicker than abdominal signs”
  • usually Right Lower Lobe

Question 29

When a child presents with bile vomiting taht is “fairy liquid” green, what investigation should you do?

Answer 29

Upper GI contrast study ASAP

Question 30

A cause of bile vomit in a child is malrotation and subsequent volvulus. What are these and how are they managed?

Answer 30

Malrotation is an abnormality of the bowel, which happens while the baby is developing in the womb

Volvulus is a complication of malrotation and occurs when the bowel twists so the blood supply to that part of the bowel is cut off

LAPAROTOMY ASAP

Question 31

What is intussusception?

Answer 31

A serious condition in which part of the intestine slides into an adjacent part of the intestine

Question 32

How might intussusception present?

Answer 32

• 3 day history of viral illness then intermittent COLIC and DYING SPELLS
• Biliousvomiting
• Bloody mucous PR (redcurrant jelly stool)
• On admission – 4 seconds capillary refill

Question 33

What investigations can be carried out for intussusception?

Answer 33

USS abdomen

“target sign” appearance

Question 34

What is the management of intussusception?

Answer 34

Pneumostaticreduction (air enema)

Laparotomy

Question 35

How may an umbilical hernia present?

Answer 35

8 month baby

Umbilical swelling

Present from about 4 days old

Worse with crying

Easily reducible

Question 36

How is an umbilical hernia managed?

Answer 36

• 1 : 6 children
• Spontaneous closure by 4 years is rule
• Complications rare
• Repair if:
  
  • complications
  • relative
    
    • persistance>4yrs, large defect, aesthetic)
• Important to distinguish from paraumbilical hernia

Question 37

What are 2 types of abdominal wall defects?

Answer 37

Gastroschisis

Exomphalos

Question 38

What is gastroschisis?

Answer 38

Gut eviscerated and exposed

10% associated atresia

Question 39

What is the management and prognosis of gastroschisis?

Answer 39

• Management
  
  • delayed closure
  • TPN - total parenteral feeding
• Survival
  
  • 90%+
  • short gut

Question 40

What is exomphalos and what are its associated anomalies?

Answer 40

• Umbilical defect with covered viscera
• Associated anomalies
  
  • 25% cardiac
  • 25% chromosomal - Trisomy 13, 18, 21
  • 15% renal, neurological
  • Beckwith-Weideman syndrome

Question 41

What is the managemnet of exomphalos?

Answer 41

• Management
  
  • primary/delayed closure
• Outcome
  
  • post natal mortality - 25%