12.09.05 Teaching notes

Key Surgical Conditions

    • Undescended testes

    • Inguinal hernia

    • Hydrocoele

    • Circumcision

    • Umbilical hernia

    • Tongue tie

    • Pyloric stenosis

    • Intususception

    • Causes of bowel obstruction

      • Malrotation volvulus

      • Intestinal atresia

      • Meconium ileus

      • Hirschprung's

Acid-base Tutorial

    • SBE vs BE

      • Base excess is the quantity required to return the plasma in-vitro to a normal pH

      • Standard base excess is the quantity required to fix the whole ECF

      • In practice they're quite similar, since the plasma does most of the buffering

    • Anion gap

      • = Na - (HCO3- + Cl-)

      • Should be around 12

      • Good measure of ketones, lactate

        • Not used much now, as lactate is measured directly

    • Chloride rise

      • Chloride "displaces" HCO3- and so causes a metabolic acidosis

      • This is "hyperchloraemic acidosis" and doesn't change the anion gap

    • Other causes of metabolic acidosis cause an isolated HCO3- fall and thus a fall in the anion gap

    • TPN contains acetate which is converted to HCO3- and causes a metabolic alkalosis

Retinopathy of prematurity (ROP)

    • Previously known as retrolental fibroplasia (RLF)

    • Caused by disorganized growth of retinal blood vessels

    • May result in scarring and retinal detachment

    • All preterm babies are at risk for ROP

      • Very low birth weight is an additional risk factor

    • Both oxygen toxicity and relative hypoxia can contribute to the development of ROP

VACTERL

    • Vertebral anomalies

    • Ano-rectal malformation

    • Cardiac anomalies

    • Tracheo-oesophageal fistulae

      • Most have NO patant oesophagus

      • End of oesophagus joins into trachea

      • Causes mucousy-bubbly-frothy mouth

    • Renal anomalies

    • Limb anomalies

Notes

    • Paediatric history

      • Developmental history

        • Scans

        • Milestones

      • Birth history

      • Neonatal history

      • Allergies

        • Pets, carpets, cigarettes

    • Babies breathe through their NOSE

    • Babies need FLUIDS and GLUCOSE but can survive without other stuff for quite a while

    • Umbilical arteries and vein remain patent for weeks

      • Can be used for venous/arterial access

    • Threshold for admission to NNU = 1.8 kg

    • ROP