Case Studies Flashcards
is it important to calculate feed volumes per feed and per kg per day?
yes
what is the management for milk protein intolerance ?
trial of hydrolysed feed
milk free advice for weaning
may need thickeners/acid suppression
what are the two hydrolysed feeds?
nutramigen
aptimil pepti 1
state some signs that would show if a baby was well?
pink colour active feeding crying babbling development stools urine
state some signs that would show if a baby was unwell?
pale colour less active poor feeding crying airway noises (stridor, wheeze) poor weight gain rash, spots, bruises
4 weeks old otherwise healthy baby. Good weight gain (180g/w), breast fed, presents with streaks of fresh blood in stool for last 4 days.
No fever. General and abdominal examination is normal.
what is a differential diagnosis ?
cows milk protein allergy
(CMPA)
infection
constipation
what are some important questions to ask about streaks of blood in the stool?
change in stool frequency
straining, pain, vomiting
Fhx of atopy
clarify weight gain
what is the management of CMPA?
stool culture
material milk avoidance (milk protein from mother can pass into the breast milk)
mother will need Ca/Vit D supplements
state some possible Fhx atopy
allergies
asthma
eczema
hayfever
what is the prognosis of CMPA?
most children have grown out of it by 1 year
is CMPA IgE mediated ?
no
state some IgE mediated food allergies?
egg, nuts, pulses, fish, grains, milk
state some symptoms of food allergy ?
vomiting, pain, diarrhoea
urticaria, angioedema, pruritis
wheeze, cough, stridor
what test is used for IgE mediated food allergy?
none
does IgE mediated or non mediated allergies symptoms last longer?
non IgE mediated may last for many days whereas IgE mediated only last 12 hours
state some symptoms of CMPA?
vomiting, diarrhoea, abdo pain, reflux, poor feeding, FTT, eczema \
state what food should be used in a milk challenge at home?
baked milk in biscuit/pancake cooked milk in custard yogurt cheese milk
3y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day), flatus. Picky eater, all normal diet, miserable, term, formula fed, tried milk free diet. No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen
what is the possible diagnosis?
coeliac disease
what are the tests done for coeliac disease?
stool screen (faecal elestase, electrolytes)
anti-tissue transglutaminase
anti-endomysial
duodenal biopsy
bloods - FBC, Fe status, CRP, LFTs, Vit D status
what is the treatment of coeliac disease ?
gluten free diet
A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ
what is a diagnosis ?
chronic constipation
state the constipation cycle ?
constipation -> large hard stool -> pain or anal fissure -> withholding of stool
what is a complication chronic constipation ?
faecal incontinence
what is the management of faecal incontinence ?
stool softener increase fluid intake increase fibre intake reduce milk and sweets praise and star charts
A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees).
Examination showed a soft abdomen with no palpable masses.
what is a possible diagnosis?
gastro-oesophageal reflux
what questions should be asked about gastro-oesophageal reflux?
colour of vomit (bilious?)
volume, blood
feeding position, type, volume
weight gain, development, cough
what is the management of GORD?
feeding advice - routines and volume
medical treatment - feed thickeners, PPI, milk free feeding
is GORD common?
yes
what colour is bile?
green
is bilious vomiting serious?
yes
state some causes of the bilious vomiting ?
malrotation
intussusception
ileus (sepsis?)
crohns disease
what is the management of bilious vomiting ?
urgent surgical opinion
IV access and fluids
NG tube
Abdo X ray
A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o
what is the diagnosis ?
bronchiolitis
are any medications that can help bronchiolitis ?
no
- self limiting
on what day do the symptoms of bronchiolitis peak?
4-5days
state some symptoms of bronchiolitis ?
nasal stuffiness
tachypnoea
poor feeding
An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o
what is the diagnosis?
croup
state the symptoms of pneumonia?
fever >38.5 SOB cough grunting wheeze
what 1st and 2nd line antibiotics should be used for pneumonia?
amoxicillin
macrolide
