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

    • May lead to blindness in serious cases

  • 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