Abdomen Flashcards

1
Q

Normal liver span children? (3)

A

Neonate: 5 cm
Prepubescent boy: 8 cm
Prepubescent girl: 7 cm
Therafter: <15cm

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2
Q

Describe the abdominal examination (14)

A
  • Introduce, orientate, expose, position, consent
  • General appearance: acute/chronic, syndromic features, equipment
  • vitals
  • anthropometry
  • limbs: jaccold, koilonychia, leukonychia, palmar erythema
  • face: sclera icterus, aniridia, kaiser Fleischer rings, neuroblastoma, corneal arcus, angular stomatitis, glossitis, aphthous ulcers, dental carries, macroglossia, pigmentation/polyps
  • inspection: distension, striae, kaput medusae, spider naevi, hernia, drains/tubes/access, scars
  • Palpate: light (rigidity, tender, guarding, masses)
  • deep palpation: liver edge, gallbladder, spleen, kidney, descending aorta, fluid thrill
  • percussion: shifting dullness, liver, suprapubic
  • auscultate: normal / tinkling / absent bowel sounds, renal artery and aortic bruits
  • genital examination (penile abnormalities, descended testes, scrotal swelling, external Genitalia )
  • rectal: perforate, skin tags (Chrons), prolapse, underwear staining)
  • summarise and differential
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3
Q

What is and causes picture 10? (4)

A

Palmar erythema

  • chronic liver disease
  • polycythaemia (excessive rbc)
  • Kawasaki disease (mucocutaneous lymph node syndrome)
  • Thyrotoxicosis
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4
Q

Name 5 broad causes of oedema and how differentiate

A

With proteinuria
- renal disease

Without proteinuria
- increased vascular permeability (capillary leak)
- increased hydrostatic pressure
- decreased oncotic (colloid osmotic) pressure
- iatrogenic

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5
Q

Name 3 causes oedema with proteinuria

A
  • Glomerulonephritis
  • nephrotic syndrome
  • acute kidney injury
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6
Q

Name 14 causes oedema without proteinuria

A

Increased vascular permeability (capillary leak)
- sepsis
- allergy: histamine mediated , anaphylaxis
- Premature
- post op, burns
- CCF, cor pulmonale

Increased hydrostatic pressure
- Ht and drugs
- heart failure

Decreased oncotic (colloid osmotic) pressure:
- nutritional: PEM: SAM (decreased intake protein)
- liver: cirrhosis (decreased production)
- git: protein losing enteropathy (increased loss)
- short bowel
- nephrotic syndrome (increased loss)

Iatrogenic
- drugs
- fluid overload: Na cl

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7
Q

What is and causes picture 11

A

Aniridia (partial/complete absence iris )
- wilms tumour
- WAGR syndrome

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8
Q

Name 5 causes abdominal distension

A
  • Constipation
  • Hirchsprung’s disease
  • ascites
  • organonegaly
  • malignancy
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9
Q

Identify and name cause of picture 16

A

Caput medusae
- portal ht

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10
Q

Identify and name cause of picture 17 a

A

Spider naevi
Chronic liver disease

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11
Q

Name 2 causes generalised abdominal tenderness

A
  • Mesenteric adenitis
  • peritonitis
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12
Q

Describe the usual character of Wilm’s tumour (3)

A
  • renal mass
  • sometimes visible
  • does not cross midline
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13
Q

Describe the usual character of abdominal neuroblastoma (3)

A
  • Irregular firm
  • may cross midline
  • child very unwell
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14
Q

Most common site intussusception?

A

RUQ

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15
Q

Name 8 red flags constipation <1 year

A
  • no meconium > 24 hours
  • abdominal distention
  • vomiting
  • Failure to thrive
  • bloody stools
  • neurodevelopmental delay
  • anal/sacral abnormalities
  • any signs of other organic causes
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16
Q

Management difficult or rare ( < 1/3 days formula fed, < 1/7 breastfed) defecation (constipation) for at least 2 weeks in infants (10)

A

Check for red flags; if present transfer

child exclusively breastfed and 2 or more weeks old
→ assure, family education, probably normal, follow up

Formula feeding with or without solid food, or <2 weeks old.
→ functional constipation. Reassure,educate, verify proper formula preparation
> good response, maintenance therapy and close follow up
> partial or bad response
- reconsider diagnosis
- < 6 months: lactulose
- > 6 months: lactulose or peg
- Consider switching formula to pHf or eHf
- Rectal treatment for acute relief (glycerine suppository)
- If partial/bad response, transfer. If good, maintenance therapy and close follow up

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17
Q

Define troublesome regurgitation (3)

A
  • 4 or more regurgitations per day
  • 2 or more weeks
  • age of onset 3 weeks - 6 months
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18
Q

Define infantile colic (5)

A
  • 3 months age or less
  • fussy, irritable or frequent crying
  • 3 or more hours per day
  • 3 or more days per week
  • at least 1 week
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19
Q

How differentiate vomiting and regurgitation (3)

A
  • Prodromal period with nausea, autonomic symptoms vs none
  • Retching and muscle contraction vs none
  • forceful expulsion stomach contents vs effortless passive reflex
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20
Q

Name 6 causes vomiting in first week of life

A

Common
- gastric irritation: ingestion blood, mucus
- under/over feeding

Other
- infections: sepsis, meningitis, NEC, UTI, oral thrush
- raised intracranial pressure: hydrocephalus, ich
- intestinal malformation and obstruction: intestinal atresia, hiatus hernia, malrotation, meconium ileus, volvulus
- Toxic and metabolic disorders

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21
Q

Name 6 causes vomiting in early infancy

A

Common
- gord
- feeding faults
- infection: URTI, oral thrush, gastroenteritis

Other
- Intestinal malformation and obstruction: hypertrophic pyloric stenosis, malrotation, volvulus
- intracranial pathology: hydrocephalus
- toxic and metabolic: inborn errors metabolism, uremia, drugs

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22
Q

Name 5 causes vomiting in late infancy

A

Common
- infections: gastro-enteritis, respiratory tract infection, UTI

Less common
- intestinal malformation and obstruction: intussusception, malrotation
- food intolerance: celiac, CMPA
- toxic and metabolic disorders: poisoning, drugs, uremia
- infections: meningitis, hepatitis

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23
Q

Name 7 causes vomiting in childhood

A

Common
- acute: gastro-enteritis, resp tract infection, food poisoning
- acute dietary indiscretion

Other
- Digestive tract disorders: peptic ulcers, appendicitis
- Raised ICP: ht, tumor, hydrocephalus
- infection: UTI, meningitis, encephalitis, hepatitis
- Toxic and metabolic: drugs, poisons, DM
- psychogenic / other: migraine, bulimia, cyclic vomiting syndrome

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24
Q

Significance of vomit containing undigested food?

A

Gastric outlet obstruction

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25
Q

Significance of vomit containing bile?

A

Intestinal obstruction

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26
Q

Significance of vomit containing blood,? (5)

A
  • Esophagitis
  • esophageal varices
  • Gastritis
  • peptic ulcer
  • secondary swallowing nasopharyngeal blood
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27
Q

Significance increased bowel sounds? (2)

A
  • Gastro-enteritis
  • obstruction
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28
Q

Significance decreased bowel sounds?

A

Ileus

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29
Q

What derangement is seen on blood gas after vomiting

A

Hyponatremic hypochloremic metabolic alkalosis

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30
Q

Regurgitation vs gord?

A

Regurg = effortless, gastric contents via oesophagus to orophanynx
Gord = effortless passing of gastric contents to oesophagus, doesn’t have to present at mouth

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31
Q

Name 5 anatomical anti-reflux mechanisms

A

Extrinsic
- Crura
- angle of his

Intrinsic
- Lower oesophageal sphincter,
- increased tone 10 - 40 mm
- fluctuations “normal” reflux

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32
Q

Name 3 predispositions for gor

A
  • Cerebral palsy
  • Tubes in seriously ill patients
  • sliding hiatus hernia
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33
Q

How does milk scan work and what is it indicated for?

A

Consists of 4 parts:
- oesophageal transit
- reflux
- gastric emptying
- pulmonary aspiration

Tests functioning of oesophagus: motility, emptying, esophagitis, aspiration
Non invasive, low radiation
Mix radio pharmaceutical with milk, then picked up on gamma camera

To diagnose gor

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34
Q

Management gor? (5)

A
  • Feeding and post feeding position: prone, elevate
  • change feeding pattern: frequent small feeds, thicken feeds with nestargel/gelatine

Gord:
- H2 receptor antagonists, PpI, antacid
- prokinetics: domperidone or metoclopromide before meals, erythromycin
- surgery: nissen fundoplication

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35
Q

Define functional constipation criteria (6)

A

Two or more in the last 1-2 months:
- 2 or less defecations in toilet each week
- at least 1 episode faecal incontinence each week
- history retentive posturing or excessive volitional stool retention
- history painful/hard bowel movements
- presence large faecal mass in rectum
- history large diameter stools that may obstruct toilet

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36
Q

Name 10 causes constipation in infants and toddlers

A

From history
- genetic predisposition

  • Nutritional Change eg from breastfeeding to cow’s milk
  • cow’s milk protein allergy
  • lack fibre in diet
  • stool withholding behaviour
  • retentive posturing
  • coeliac disease

From examination
- anal fissures
- anorectal malformations

  • spina bifida
  • Hirschprung’s
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37
Q

Name 9 causes constipation for school children and adolescents

A

From history
- inadequate food intake
- toilet training coerced
- attention deficit disorders
- developmental handicaps
- toilet phobia, school bathroom avoidance
- excessive anal interventions

From examination
- Anorexia nervosa
- depression
- slow transit constipation

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38
Q

Name 6 organic causes of constipation

A
  • Neurogenic constipation: Hirchprung’s, spinal dysraphisms, tumor, cp, chronic intestinal pseudo-obstruction
  • anal lesions: fissure, anterior location, stenosis, atresia
  • endocrine and metabolic: hypothyroid, renal acidosis, di, hypercalcaemia, Cf
  • neuromuscular disorders:muscular dystrophy
  • abnormal abdominal musculature: prune belly syndrome, downs, gastroschisis
  • drugs: methylphenidate, morphine, codeine, antacids, phenytoin
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39
Q

Definition and management infant dyschezia?

A
  • Young healthy infants with 10 minutes straining and crying before successful defecation,
  • complex defecation process is a learned practice: immature, failure to coordinate abdominal muscle contraction with pelvic floor relaxation
  • reassure
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40
Q

Definition and management non retentive fecal incontinence

A
  • Repeated socially inappropriate stool passage in absence of fecal retention or predisposing medical condition
  • > 4 years old
  • no evidence constipation
  • educate family, vigorous toilet training, caution against intensive use stool softeners
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41
Q

Name 8 red flags of constipation in children by history

A
  • Onset <12 months
  • delayed passage meconium
  • not stool with holding
  • no soiling
  • intermittent diarrhoea and explosive stools
  • No response to conventional treatment
  • bladder disease
  • extra intestinal symptoms
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42
Q

Name 7 red flags of constipation in children by examination

A
  • Failure to thrive
  • empty rectal ampulla
  • tight anal sphincter
  • gushing of stool with rectal exam
  • abnormal neurological exam
  • pigmentary abnormalities
  • heme positive stools
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43
Q

Constipation disimpaction and maintenance therapy? (5)

A

Disimpaction
- Oral: mineral oil 15 - 30 ml /year of age until 240ml or peg 1,5 g/kg/day
- phosphate enema
- glycerine suppository

Maintenance, At least 6 months
- Osmotic laxatives: lactose or polyethylene glycol 3350
- mineral oil: lubricant and hydroxy fatty acids
- stimulant laxatives
- behavioural modification: gastrocolic reflex,
- dietary measures: high fibre, good floods

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44
Q

Which supplement can prevent diarrhoea

A

Vitamin A

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45
Q

Which supplement can treat diarrhoea

A

Zinc

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46
Q

Name 2 common viral causes diarrhoea in children

A
  • Rotavirus
  • adenovirus
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47
Q

Name the 8 management principles for diarrhoea

A
  • Hydration assessment
  • fluid management
  • metabolic and electrolyte disturbances
  • feeding,
  • anti emetic
  • anti diarrhoeal
  • antibiotics
  • probiotics
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48
Q

Moderate vs severe dehydration? (3)

A

Moderate
- sunken eyes
- slow skin pinch <2 seconds
- drinks eagerly
- irritable/restless

Severe
- sunken eyes
- very slow skin pinch >2 seconds
- drinking poorly

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49
Q

Fluid management for moderate dehydration? (4)

A

ORS trial
- homemade: 1/2 teaspoon salt, 8 sugar, dissolved in 1 L
- 20ml / kg every hour for 4 hours or 5 ml / kg every 15 minutes
- give child more if want more.
- If vomit, wait 10 minutes and continue slowly
- insert NGT if baby refuse to drink/ use regular ORS,
- weigh patient at start without clothes and nappy
- weigh after 4 -6 hours and assess general condition, capillary refill, conciousness,, skin turgor, sunken eyes, passing urine, number and quality stools

worsen: decreased weight or more dehydrated → admit, iv fluids

50
Q

Fluid management for failed ORS trial or severe dehydration?
(3)

A

1/2 Darrows dextrose iv at 5 ml /kg/h for 4 hours then reassess
Plus
ORS 20 ml/kg/hour using frequent sips as before
Plus
Oral feeds

51
Q

Compensated vs decompensated shock? (3)

A

Compensated
- delayed capillary refill > 3 sec
- rapid weak pulses
- cool peripheries

Decompensated
- decreased loc
- decreased pulse volume
- decreased blood pressure

Poor urine output

52
Q

Blood tests for acute hepatitis?

A

Elevated alt and AST

53
Q

Blood tests for biliary atresia?

A

Elevated GGT and alp

54
Q

Blood tests for liver failure?

A

Elevated INR, ammonia

55
Q

Blood tests for hypersplenism?

A

Decreased hb and platelet count

56
Q

What causes the most UTIs in young children?

A

E coli

57
Q

Child with sudden onset severe headache should be investigated for?

A

Hypertension

58
Q

Cause of macroscopic haematuria?

A

Bilharzia

59
Q

Cause of microscopic haematuria?

A

Glomerulonephritis

60
Q

Cause of proteinueria

A

Nephrotic syndrome

61
Q

Approach to hepatomegaly with hyperbilirubinemia? (13)

A

High indirect/mixed bilirubin
- haemolytic anaemia
- CCF
- Toxins
- drugs

Higher direct bilirubin
- with splenomegaly
→ viral infections (torches)
→ Bacterial infections
→ Metabolic disease
- no splenomegaly: do abdominal sonar (consider also biliary scan, liver biopsy)
→ neonatal hepatitis
→ biliary atresia
→ choledochal cyst
→ drugs/toxins
→ TPN
→ tumour

62
Q

Approach to hepatomegaly without hyperbilirubinemia? (10)

A

With splenomegaly: do abdominal sonar, consider Doppler
- vascular malformation /obstruction
- liver tumour
- Portal ht
- lipid/ other sd
- malaria/bilharzia
- metabolic disorder

No splenomegaly: abdominal sonar
- Tumour
- Malnutrition
- maternal dm
- Glycogen sd

63
Q

Name 4 broad mechanisms hepatomegaly

A
  • Increase number/size cells
  • increase vascular space
  • increase biliary space
  • other: trauma, idiopathic benign
64
Q

Name 9 causes hepatomegaly due to increase number/size of cells

A

Storage/accumulation disorders
- fat: malnutrition, obesity, dm, TPN, hepatotoxic drugs, pregnancy, metabolic disorders (reye syndrome, FAOD, galactosaemia)
- Lipids: gaucher, Niemann -pick
- glycogen: glycogen storage disease, TPN, infant of dm, beckwith - wiedemann
- misc: alpha 1 trypsin deficiency, Wilson’s disease, haemosiderosis/-chromatosis, vitamin A toxicity

Inflammation
- hepatocytes: hepatitis (infections, Tb treatment, anticonvulsants, analgesia, antibiotics, burns/radiation, hypothermia )
- kupffer cells: RES hyperplasia (septicaema, granulomatous disease, metastases)
- auto-immune: chronic active hepatitis, sclerosing cholangitis, sarcoidosis, SLE

Infiltration.
- Primary tumours: hepatoblastoma, hepatocellular carcinoma, haemangioma
- secondary: leukemia, lymphoma, nephroblastoma, neuroblastoma, histiocytosis

Erythroblastosis
- Rh incompatibility, extra-medullary haemopoiesis

65
Q

Name 5 causes hepatomegaly due to increase vascular space

A

Intrahepatic obstruction
- veno-occlusive disease

Suprahepatic
- Ccf
- pericardial tamponade
- Pericarditis
- budd-chiari

66
Q

Name 6 causes hepatomegaly due to increase vascular space

A

Intrahepatic obstruction
- biliary atresia/paucity
- Cirrhosis
- fibrosis
- abscess
- tumour

Extra hepatic
- biliary atresia
- space occupying lesions: pancreas head ca, choledochal cyst

67
Q

How test synthetic liver function (3)

A
  • Albumin
  • pt
  • ammonia
68
Q

Define acute liver failure (4)

A
  • severe impairment liver function with or without encephalopathy
  • usually < 8 weeks
  • no underlying chronic liver disease, hepatic based coagulopathy with
    → INR 1,5 or more with encephalopathy or
    → INR 2 or more without encephalopathy
69
Q

Define chronic liver failure (4)

A
  • Continuous inflammatory disease liver at least 3 months
  • Progresses to cirrhosis, fibrosis, regenerative nodular formation
  • distorted architecture with compression hepatic vasculature and biliary structure
  • leads to PHT
70
Q

Name 4 symptoms glomerulonephritis

A
  • Edema
  • haematuria
  • polyuria
  • nocturia
71
Q

Name 4 characteristics nephrotic syndrome

A
  • proteinuria: urine dipstick 3+ or more; spot protein: creatinine ratio > 0,2 g/mmol
  • hypo albuminaemia < 25 g/l
  • oedema
  • hypercholesterolaemia
72
Q

Name 7 indications for kidney biopsy in nephrotic syndrome

A
  • Steroid resistant: not in remission after 8 weeks steroid therapy
  • mixed nephritic nephrotic presentation
  • persistent low serum complement C3
  • family history kidney disease
  • renal impairment and persistent ht
  • secondary nephrotic syndrome
  • < 2 years or > 6 years
73
Q

Treatment primary, non-congenital nephrotic syndrome?

A

Prednisone

74
Q

Name 8 clinical and pathophysiological differences between acute nephritis and nephrotic syndrome (urine, associated symptoms, bloods, cause, relapse)

A
  • Haematuria vs nephrotic range proteinuria
  • hypertension vs none
  • Oligoanuria vs normal
  • normal albumin vs low
  • normal cholesterol vs high
  • both edema
  • 90% post infectious vs 90% idiopathic
  • usually one attack vs relapses common
75
Q

Name 2 differences in investigation between acute nephritis and nephrotic syndrome

A
  • blood urea and creatinine high vs normal
  • urine: RBC cast, haematuria, proteinuria vs hyaline cast, proteinuria
76
Q

Approach to vomiting? (3)

A

Non-bilious vomiting
- Intestinal obstruction
- non-obstructive

Bilious vomiting
- intestinal obstruction

77
Q

Name 3 causes non-bilious vomiting caused by intestinal obstruction

A

Obstruction above ampulla of vater

  • pyloric stenosis
  • upper duodenal stenosis
  • annular pancreas
78
Q

Name 7 causes non-obstructive non-bilious vomiting

A
  • Physiological: overfeeding!, incorrectly placed ng tube
  • infection: systemic! (Septicaemia, UTI, meningitis); local (gastroenteritis, NEC )
  • CNS: raised intracranial pressure, intracranial bleed
  • endocrine: congenital adrenal hyperplasia
  • Drugs: neonatal abstinence syndrome! , aminophylline, caffeine
  • Inborn errors of metabolism
  • cow’s milk protein allergy
79
Q

Name 5 causes bilious vomiting

A

Intestinal obstruction distal to ampulla of vater.

Anatomical obstruction
- small bowel stenosis or atresia: duodenal, jejenal, ileal
- large bowel stenosis or atresia
- imperforate anus

Functional obstruction
- Hirschprung’s disease
- Meconium ileus

80
Q

Approach to proteinuria? (9)

A

Urine dipstick shows trace: repeat.
- negative/trace → repeat in 6 months - 1 year
- 1 + or more → see below

Urine dipstick 1 + or more: obtain first morning urine for protein: creatinine and urinalysis with microscopy
- protein: creatinine < 0,02 g/mmol and no microscopic haematuria
→ false positive
→ transient proteinuria eg fever, heavy exercise
→ postural/orthostatic proteinuria (benign)
- protein: creatinine > 0,2 g/mmol with or with out microscopic haematuria
→ nephrotic syndrome (proteinuria > 0,2 g/mmol )
→ ht
→ renal dysfunction eg glomerulonephritis
- Non-nephrotic range proteinuria 0,02 - 0,2 g/mmol, normal renal function, no ht
→ tubular proteinuria
→ tubular interstitial diseases

81
Q

How investigate for glomerulorephritis and nephrotic syndrome when significant proteinuria > 0,2 g/mmol with or without microscopic haematuria? (6)

A
  • History and physical including bp
  • bloods: UCE, total cholesterol (nephrotic syndrome hyper), albumin (nephrotic syndrome <25 g/l), complements C3 C4 , IgA
  • Ana, anti-ds DNA, ASOT, anti DNase B
  • Viruses (secondary cause)
  • Tb work up (secondary cause)
  • Renal ultrasound
82
Q

Management nephrotic syndrome and glomerulonephritis? (6)

A
  • monitor balance, urine output strictly
  • Assess hydration
  • restrict salt intake
  • treat underlying causes eg infections, systemic, SLE, HUS, drugs (ace inhibitors, NSAID), toxins (mercury)
  • diuretics
  • Pneumococcal booster
83
Q

Investigations for tubular proteinuria and tubulointerstitial diseases? (4)

A
  • Beta 2 microglobulin (marker for tubular proteinuria )
  • toxins
  • drug levels
  • renal biopsy
84
Q

Approach and causes macroscopic haematuria with positive dipstick? (11)

A

positive: blood, hb
- red blood cells
→ first exclude Acute nephritic syndrome. Then do urine protein:creatinine
→ nephrologic/glomerularRBC = dysmorphic RBC = Coke colour
> proteinuria and / or casts
: glomerulonephritis
: apsgn
: HSP /iga gn
: HUS
> inherited
: Alport syndrome (audiology)
: thin basement membrane disease
→ non nephrologic/non-glomerular/ urologic RBC = isomorphic RBC, no casts, no proteinuria = bright red/pink
> UTI /bilharzia (ELISA)
: hypercalciuria (Ca:creatinine ratio)
: urolithiasis (u/s; 24h urine ca, uric acid, oxalate, cysteine; AXR)
: UGT abnormalities
: tumours (CT abdo)
- No RBC

85
Q

Cause macroscopic pseudo haematuria (negative dipstick) (3)

A
  • colorants
  • myoglobin
  • medicines eg rifampicin,
86
Q

Approach and causes microscopic haematuria > 5 RBCs / HPF? (8)

A

Examine and test for:
- proteinuria
- nephritic urinary sediment
- Ht
- abnormal renal function
- family history CKD
- family / personal history deafness

If any of above positive, consider
- glomerulonephritis
- AlpOrt syndrome
- tubulointerstitial nephritis
- Acute nephritic syndrome nb to rule out.

If negative, check parents and siblings for haematuria
- Positive and normal renal function : benign familial haematuria
- negative: do urine ca/creat ratio, renal ultrasound
→ elevated and renal stones: hypercalciuria
→ normal but abnormal ultrasound:
> investigate urologic haematuria
> structural renal disease

87
Q

Name 5 indications renal biopsy if haematuria

A
  • Persisent/recurrent
  • abnormal renal function
  • significant proteinuria
  • decreased complement, positive Ana or anti-ds DNA
  • family history kidney disease
88
Q

Name 4 symptoms and 3 signs apsgn (acute post streptococcal glomerulonephritis)

A

Symptoms

  • Acute onset macroscopic haematuria
  • recent throat / skin infection (impetigo)
  • decrease urine output
  • headache/ convulsions

Signs

  • Periorbital edema
  • ht
  • volume over load
89
Q

Special investigations for apsgn (acute post streptococcal glomerulonephritis) (3)

A

Positive strep serology

  • anti DNase B titre
  • ASOS
  • decreased serum complement C3
90
Q

How choose appropriate cuff for bp measurement (2)

A
  • bladder width at least 40% of arm circumference at point midway between olecranon and acromion
  • length cover 80 - 100% of circumference of the arm
91
Q

Define stage 1 ht for children aged 1-13

A

Whichever is lower
- 130 / 80 to 139/89
- more than or on 95th to 95th percentile + 12 mm Hg

92
Q

Define stage 2 ht for children aged 1-13

A

Whichever lower
- on or more than 95th percentile + 12 mm Hg
- 140/90 or more

93
Q

Define normal blood pressure for child aged 1-13

A

50th to 90th percentile

94
Q

Define elevated blood pressure for children aged 1-13 (2)

A

Whichever lower
- on 90th percentile or more to < 95th or
- 120 / 80 mmHg to < 95th percentile

95
Q

Define normal blood pressure for children aged 13 or more

A

<120 / < 80

96
Q

Define elevated blood pressure for children aged 13 or more

A

120/<80 - 129/80

97
Q

Define stage 1 ht for children aged 13 or more

A

130/80 - 139/89

98
Q

Define stage 2 ht for children aged 13 or more

A

140/90 or more

99
Q

Name 5 characteristics primary / essential ht

A
  • At least 6 years
  • Positive family history
  • obese/overweight
  • normal urinalysis
  • isolated systolic ht
  • diastolic ht may indicate secondary cause!
100
Q

Name 4 causes secondary ht in newborns/ infants

A
  • Parenchymal infarct: umbilical a catheter
  • prematurity with chronic lung disease
  • renal artery/vein thrombosis (rat/RVT)
  • coarctation aorta
101
Q

Name 4 causes ht in children aged 1-6 years

A
  • Parenchyma scarring from UTI
  • coarctation aorta
  • renal artery stenosis
  • Glomerular disease (ns, gn )
102
Q

Name 4 causes ht in children aged 6-12 years

A
  • Glomerular disease (acute glomerulonephritis = macroscopic haematuria, edema; chronic = poor growth, oedema, anaemia )
  • Parenchymal scarring from UTI
  • renal artery stenosis
  • primary ht
  • chronic renal failure
103
Q

Name z causes ht in children aged 12 years and more

A
  • Primary ht
  • Glomerular diseases (chronic pyelonephritis = recurrent UTIs, enuresis )
  • Chronic renal failure
104
Q

Name 5 signs haemolytic uraemic syndrome

A
  • Preceding bloody mucous diarrhoea!
  • edema
  • oliguria
  • pallor
  • ht
105
Q

Name 5 causes renovascular ht

A
  • Fibromuscular dysplasia
  • syndromic: neurofibromatosis type 1, tuberous sclerosis, William’s syndrome
  • vasculitic: takayasu (absent pulses, abdominal bruit), Polyarteritis nodosa
  • extrinsic compression: neuroblastoma, Wilm tumour
  • other: umbilical vein catheter
106
Q

Symptoms UTI infants <3 months? (5)

A
  • Fever!
  • poor feeding!
  • lethargy
  • jaundice
  • offensive urine
107
Q

Symptoms UTI children 3 months -3 years? (5)

A
  • Fever!
  • vomiting!
  • abdominal pain
  • loin tenderness
  • poor feeding
108
Q

Symptoms UTI children > 3 years? (5)

A
  • Frequency!
  • fever!
  • urgency
  • dysuria
  • dysfunctional voiding
109
Q

Diagnosis UTI in children?

A

Dipstix:
- leucocytes and
- Nitrites

Urine MCs
- culture single uropathogen or
- Any culture from suprapubic or
- 50000 col/ml or more from catheter sample

110
Q

Empirical antibiotics for UTI? (3)

A
  • Ampicillin and amikacin or
  • augmentin or
  • cefepime

Don’t use! 3rd generation cephalosporin (can induce esbl K pneumonia ), amoxyl ( E. coli resistance) , bactrim ( E. coli resistance)

111
Q

Name 4 indications kidney sonar in children with UTI

A
  • All with febrile UTI
  • atypical UTI
  • Infants < 6 months
  • older with recurrent UTI
112
Q

Lab tests for AKI? (8)

A
  • Osmolality
  • UcE
  • CMP
  • LFT
  • FBC
  • clotting profile
  • urinalysis, urine electrolytes, microscopy
  • feNA
113
Q

Name 10 broad causes AKI

A

Prerenal
- volume depletion
- decreased effective blood volume
- nephrotoxic drugs

Intrinsic
- vascular damage
- glomerular damage
- Atn
- acute interstitial nephritis

Postrenal
- bladder outlet obstruction
- ureteral obstruction
- pelvis /tubular

114
Q

Name 10 prerenal causes AKI

A

Volume depletion
- Haemorrhage
- gi damage losses
- renal losses (drug induced, osmotic diuresis, diabetes insipidus)
- skin losses (burns)
- third space losses (hypoalbuminaemia)

Decreased effective blood volume
- pulmonary ht
- decreased cardiac output
- Sepsis
- liver failure

Nephrotoxic drugs
- NSAIDs
- ace I
- ARBs

115
Q

Name 4 broad causes and 2 examples each intrinsic causes AKI

A

Vascular damage

  • renal artery/ vein thrombosis
  • vasculitis
  • ht
  • HUS
  • Ttp

Glomerular damage

  • nephrotic / nephritic syndrome
  • glomerulonephritis
  • autoimmune

ATN (acute tubular necrosis)

  • ischaemic: hypotension, sepsis
  • endogenous toxins: Eric acid, myoglobin
  • exogenous toxins: nephrotoxic drugs, contrast

Acute interstitial nephritis
- drugs: NSAIDs, antibiotics
- infections

116
Q

Name 7 postrenal causes AKI

A

Bladder outlet obstruction
- Posterior urethral valve
- urethral strictures

Ureteral obstruction
- nephrolithiasis
- Bilateral ureteric stenosis

Pelvis /tubular
- renal PUJO
- nephrolithiasis
- hydronephrosis
- VUR

117
Q

Management AKI? (9)

A
  • ABC
  • catheter
  • fluids balance
  • weigh 6 hourly
  • inotropes
  • Antibiotics if septic

Assess hydration status:

  • hypovolaemia → fluid resuscitation (nacl bolus 20 ml/kg up to 3x) , rehydrationand maintenance fluids, inotropes
  • normovolemia (anuric) → fluid challenge bolus 20 mg / kg NaCl once, Lasix 2 mg/kg stat
  • hyper volemia (anuric) → fluid restriction, sodabiC and lasix infusion, dialysis after 24 hours if still anuric
118
Q

Differential and investigations hypertension with hypotension in lower limbs?

A

Coarctation aorta.

Do echo, Ct angio.

119
Q

Differential and investigations hypertension with abnormal urinalysis?

A

Kidney / urinary tract disease (cakut / parenchyma)

Do UCE, aldosterone, renin, abdominal ultrasound

120
Q

Differential and investigations hypertension with neurocutaneous lesions, seizures, abdominal mass? (2)

A
  • Tuberous sclerosis
  • neurofibromatosis

Do abdominal sonar, MRI brain/chest/ abdomen

121
Q

Differential and investigations hypertension with abdominal bruit, poorly palpable pulses? (2)

A
  • Takayasu disease
  • renal artery stenosis

Do sonar Doppler, Ct AngiO

122
Q

Differential and investigations hypertension with sweating, palpitations? (2)

A
  • Hyperthyroid
  • phaechromocytoma

Do TFT, urine VMA, urine catecholamines