Case 2- stupid baby Flashcards
Must not miss diagnoses in infant abdominal pain?
obstruction, allergy, reflux, infection
Why is this baby crying?
- drug ingestion/overdose
- skin- hair tourniqut (WTF parent), or diaper pin in skin (WTF parent)
- eye issues
- ear infection, congestions, thrush
- CV- HF, supraventricular tachycardia, Left coronary
- GI- intussesceptions, constipations, gastroeneteritis, anal fissures, inguinal hernia, GERD, volvulus
- Urinary- UTI, meatal ulcer, torsion of testis (or ovary..?)
- Skeletal- break/fracture osteomyeltis
- Neuro- head injury, meningitis
Is it more likely that kid has atypical presentation of something common or that he has a crazy rare disease?
weird presentation. Simplest answer.
GI disease or obstruction?
bilious vomit, GI bleed, projectile vomit, constipation, vomit post 6 months, diarrhea, abd tenderness/distension
Systemic/neuro?
hepatosplenomegaly, fat fontanelle, head size is fucked up, seizures, trisomy 21, chronic infection (HIV)
Projectile vomit/olive in epigastrum=
pyloric stenosis
Intussusception?
Most common cause of intestinal obstruction between 3 mo. and 6 yr. 60% < 1 yr.
X-ray bubble signs
Volvulus
50% of kids diagnosed before 1 month
Baby is vomiting–what should you avoid?
Prone position can lead to SIDS (i don’t believe this is an “accident’)
Baby keeps vomiting, what up?
Check for other warning signs (bilious, forceful, abd tenderness, fever, etc)
No warning signs with vomit, what next?
look for poor weight gain, bloody shit, gets angry from eating, exzema–yes one of those is there? then assess feeding adequacy, sleeping habits, mom-kid bond. Also check for cow milk allergy
Don’t think its from cow milk?
give it thick feedings (no idea wtf this is–sounds gross). Doesnt work, then switch to no cow milk.
Think it’s cow milk issues?
take it out of the diet. no help, then do the thick food diet.
No luck after thick food and no cow milk?
acid suppression for 2 weeks. Still being a shitty baby? then do a million other tests for other issues.
Most common allergy in young children
cow milk allergy. can resolve if not IgE mediated. If IgE= casein and whey protein
cow milk allergy can do these things
IgE response–> angioedema, mixed IgE/non IgE= eczema, esophagitis, no IgE at all- GI issues that are delayed
how to test/diagnose milk allergy?
skin prick and “careful history”
Atopy means what?
out of place. refers to eczema, asthma, allergic rhiniits
Eczema likes what parts of the body? Acne?
places with creases (neck, elbow, knee, groin, ankle)
On face. dunno why this is a slide.
Erythema toxicum neonartorum
whitish/yellow papules on trunk and extremities. resolves in 5-7 days. Will not be on soles/palms
Cradle cap
gross crusty head. Brush it off with a tooth brush…. yeah, def don’t ever want kids.
What if he’s lactose intolerant?
Nope, rare in babies. autosomal recessive inheritance. But, if the kid starts squirting out diarrhea from day 1, its possible.
Sx of lactose intolerance. Lactase enzyme does what?
Lactase breaks lactose into galactose and glucose.
gas, bloating, diarrhea. This is what Mimi’s oatmeal cookies do too.
Infant colic criteria
birth-4 months
crying for no reason (all babies do this, this is pretty bad criteria), no failure to thrive.
