26 Feb 24 Flashcards
Common laxatives that give melanosis coli
Anthraquinone (senna) laxative abuse.
Normal crying span in infants
Intermittent consolable <3hr/day
What is Colic
🔹>-3hr/day (usually evening) , >-3days /week
🔹Healthy infant age <3months
🔹peaks at 6weeks
🔹resolves by age 3-4mo
Dx of exclusion
Ttt:
📣Reassure
📣Review soothing techniuqes; pacifier , holding rocking swaddling minimize external stimuli
📣Use swings , carriers , strollers
(To rest from active soothing)
📣Upright feeding (reduces aerophagia)
Causes of crying in Young infants
🔕Colic
🔕GERD :
▪️Freq spit up.
▪️Back arching after feeding
🔕Infection
AOM
Meningitis
Septic arthritis
UTI
🔕Intussusception
▪️Episodic irritability with legs drawn to abd
▪️Bilious emesis , bloodys tools
🔕Torsion
🔕Trauma
▪️Hair torniquet ; hair wrapped around digit
▪️Corneal abrasion : tearing , photophobia , fluorescein testing
▪️Abuse/ fracture : bruising, Laceration , asymmetric movements
Cyclic Vomiting Syndrome Etiology
📣Personal or Family History of Migraine
📣Episodes often have Identifiable trigger (infection, Stress)
Cyclic Vomiting Syndrome S/S
Stereotypical Vomiting episodes
🔹acute onset of Nausea , abd pain , headache , vomiting
🔹 self - limited , lasting 1-2days
Between Episodes
🔹 usually A/S
🔹 often Regular Intervals (2-4weeks)
Cyclical Vomiting Ttt
Abortive : Triptans
Supportives : Antiemetics , Rehydration
Most children have gradual resolution during adolescence.
What are the high risk features for foreign body ?
📣Pt has respiratory or Obstructive symptoms
📣Object is a button battery
📣Magnet
📣Sharp item
How to proceed with ingested Foreign Body
👁🗨PA / Lateral Xrays
(CT scan if object not visible on Xray)
👁🗨High risk features ➡️ do endoscopy
👁🗨. No high Risk features
⬇️
Serial Xrays (4-6hr)
↙️. ↘️
No transit : Object moving
Endoscopic removal Distally:
No intervention
👁🗨if S/S of abd pain / GI bleed develop or if magnets do not progress in the GIT , surgical removal is indicated.
Button battery ingestion
Button batteries create external current that leads to tissue Corrosion.
Leaking Alkaline battery solution causes Liquefactive Necrosis of surrounding mucosa.
Pressure Necrosis can also occur bcz of local inflammation and ischemia.
Prolonged impaction results in ulceration and perforation ,hemmorrhagic shock and death.
Fever , hematemesis and shock are signs of life threatening perforation.
Ttt: ▪️Emergency endoscopic removal
▪️Honey soon after ingestion in AS pts
▪️Delay increases risk for complications
▪️Barium Esophagography is done months after to see stricture formation in pts with severe injury. (Avoid contrast in acute managemnet)
Fish Bone lodged in Esophagus.
Sharp objects (needles , pins , fish bone ) can lead to perforation and symptoms
Severe Acutely worsening Chest/abd pain
Vomiting with or w/o blood
Hemodynamic Instability.
Dx : Xray ( to see for signs organ perforation)
CT scan
Most fish bones are Radiolucent and seen only On CT.
🟤avoid induced emesis in case of FB aspiration , as it can cause esophageal damage and is not recommended.
Splenic Laceration dx and ttt
〰️dx: Follow table for BAT.
Ttt:
🟤Blunt splenic injury: Non operative management
Serial Hb measurement
Embolization
🟤Continuous hemodynamic Instability :
Do exploratory laporotomy.
Elderly with iron def and FOBT negative
Do colonoscopy and endoscopy
A single negative FOBT is not sufficient to exclude occult GI bleed Esp if no other obvious source of chronic blood loss is identified.
Lactation Failure Jaundice pathophys and CF
Age < 1 week
Insufficient intake of breast milk
⬇️ Bilirubin Elimination
⬆️ enterohepatic Circulation
CF :
Suboptimal BF
Signs of dehydration
Breast Milk Jaundice Pathophys and CF
Age > 1weeks (peaks at 2w)
⬆️beta Glucoronidase in breast milk
🔘 inc deconjugation of intestinal bilirubin
🔘 inc Enterohepatic circulation
CF :
▪️Adequate BF
▪️Well hydrated
Common Causes of Unconjugated Bilirubinemia in infants in first week
Physiologic Jaundice
Lactation failure jaundice
Lactation Failure Jaundice. ETIOLOGY
RF :
Exclusive BF
Ineffective latch
Mech:
Normally With freq breast feed (2-3hr) maternal milk production increases by Day 5.
Inadequate breast milk intake develops with infrequent feeding (every 4hrs) and delayed milk production (milk production increased around day 6).
The dec milk intake leads to delayed stooling (dec bilirubin elimination) and increased Enterohepatic Circulation of Unconjugated bilirubin.
Detailed CF of Lactation Failure jaundice.
📣First week of life
📣Jaundice (from UC bili) and signs of dehydration.
📣dec number of wet diapers.
📣 delayed transition from meconium to freq yellow stools )
📣 excessive weight loss >- 10% from birth weight
