acutely ill child Flashcards
what is intussusception?
when bowel rolls up inside itself like rolling up jumper sleeve - makes palpable mass & obstruction
what is presentation of intussusception?
= generally like 6 month old baby, feel sausage mass, vomiting, runny poo (might be red)
- severe colicky abdo pain, pale & unwell
- vomiting
- dehydration
- red current jelly stool
*common after viral infection
what is found on what investigation for intussusception?
target lesion on ultrasound scan
what is management of intussusception?
= tube up bottom, pump in air which pushes bowel along & unfolds (can do surgery if this doesn’t work but air reduction works >85% time)
what is pyloric stenosis?
congenital issue making narrow opening of stomach to 1st part intestine (pylorus)
what is presentation of pyloric stenosis?
= 6wk baby, vomiting milk, sudden, feels bubble (olive feel)
- projectile vomiting (milk)
- dehydration
- peristalsis
what is investigation & treatment of pyloric stenosis?
US scan upper abdo & keyhole operation (pyloromyotomy - cutting chunky muscle which is causing narrowing)
what is gastroenteritis & common presentation? also treatment?
= inflammation all the way from stomach to intestines
typical = >5yr, bumps sore on way to hospital , inflamed, mild temp
treat = conservative, mostly fluids (might need IV)
what is malrotation with volvulus?
it’s when issue where intestine loop around & twist making bowel obstruction= all bowel like jumbled in wrong place
what is presentation of malrotation with volvulus?
= under 1 month, vomiting green (bile)
- abdo pain & bloating
- vomiting green (always need to investigate)
- constipation
- bloody stool
what is investigations for volvulus?
*mostly need to find out why green
- contrast CT confirms diagnosis (NG tube in stomach and see flow not right)
- abdo x-ray = shows coffee bean sign
what is management for volvulus?
endoscopic decompression surgery (need for baby not to die since twisting can cut off blood supply = dead baby)
what is acute scrotum?
when during embryology stuff goes wrong so girl bit left over and might twist becoming ischaemic & sore (muellerian duct structure)
what is presentation and management of acute scrotum?
redness on 1 side or blue bruise
= really sore, acute - emergency to try save testicle (since usually congenital then might happen both sides so stitches on both side to stop twisting)
what is epididymoorchitis and management?
it’s acute bacterial infection in epididymis - it’s very sore and needs prolonged course antibiotics
what is idiopathic scrotal oedema (hydrocele) presentation and management?
when redness all way down to perineum (all red), sometimes oedematous - not sore but itchy (comes & goes). transilluminate with light on pen torch
manage = analgesia & antihistamine (if complicated surgery)
what is bro balanitis xerotica obliterans and management?
it’s a chronic inflammation of foreskin a& also glands and external urethral meatus
since tight & scarred and will stop peeing manage by circumcision
what is hypospadias and management?
congenital issue where tube missing & foreskin not all the way around so urine comes out too low down & just leaks out
MANAGE = surgery
what is paraphimosis? management?
foreskin gets pulled back and then gets stuck back - can get swollen & painful
manage = either manual reduction with local anaesthetic or if not then surgical (small slit to relieve pressure)
what is bronchiolitis? presentation and management?
bronchiolitis is acute inflammatory injury of bronchioles (commonly RSV viral = just like cold in us but causes bronchiolitis in babies under 1)
presents = normal viral URTI symptoms, poor feeding, mild fever
treat supportively
what is croup & presentation?
croup is URTI causing oedema in larynx = usually viral (parainfluenza, RSV, adenovirus)
PRESENTS = increased work of breathing, barking cough, hoarse voice, stridor, low grade fever
what is treatment of croup?
mostly self limiting (single oral dexamethasone dose good tho)
*if more severe and in hospital = dexamethasone, oxygen, nebulised adrenaline, ventilation
what is encephalitis and presentation?
it’s inflammation of brain (mostly viral like HSV)
PRESENTS = altered consciousness & cognition, unusual behaviour, neurological or seizures, fever
what is investigation & management for encephalitis?
investigate with lumbar puncture & imaging
- manage antivirals like aciclovir
what is meningitis and presentation of it?
= inflammation of meninges (lining of brain & spinal cord) - bacterial or viral
- fever, neck stiffness, vomiting, headache, photophobia, altered consciousness or seizures
- also non blanching rash if meningococcal septicaemia
what is management of meningitis?
bacterial = cefotaxime + amoxicillin (under 3 months) and ceftriaxone (over 3 months). chloramphenicol if penicillin allergic, steroids like dexamethasone used for reducing frequency & damage
viral = milder so just supportive like aciclovir
what is most common rhythm disturbance in kids?
supraventricular tachycardia = AF, paroxysmal ventricular tachycardia, atrial flutter, wolf parkinson white syndrome
what is infective endocarditis?
= rare but severe infection of valves
give antibiotics
