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common chronic conditions Flashcards

1
Q

what is coeliac?

A

Autoimmune conditions where exposure to gluten causes immune reaction and creates inflammation in small intestine

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2
Q

what is the pathophys of coeliac?

A

Autoantibodies are created in response to gluten
- They target epithelial cells of intestine
- Anti-TTG
- Anti -EMA
Inflammation: small bowel mainly causing atrophy of intestinal villi (causing malabsorption of nutrients)

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3
Q

how would coeliac present?

A

Often asymptomatic
Failure to thrive
Diarrhoea, fatigue, weight loss, mouth ulcers
Anaemia secondary to iron, B12, folate deficiency
Dermatitis herpetiformis  itchy blistering skin rash that typically appears on abdo
Neuro symptoms: peripheral neuropathy, cerebellar ataxia and epilepsy

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4
Q

why would could there be neuro symptoms in coeliac?

A

lac of absorption - lack of B12

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5
Q

how do you diagnose coeliac?

A

Pt needs to remain on gluten diet for diagnostics
Anti TTG and anti EMA  disease specific antibodies
Total immunoglobulin A levels  exclude IgA deficiency
Endoscopy + intestinal biopsy  crypt hypertrophy and villous atrophy

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6
Q

how do you manage coeliac?

A

Gluten free diet  FODMAP diet trial?
Checking antibodies to monitor

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7
Q

what are complications of coeliac?

A

Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T cell lymphoma (EATL) of intestine
Non-Hodgkin’s lymphoma
Small bowel adenocarcinoma

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8
Q

what do T1DM get screened for when they are first diagnosed?

A

coeliac screening

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9
Q

what other conditions are linked to coeliac?

A

Linked to other conditions: T1DM, thyroid disease, autoimmune hepatitis, Primary biliary cirrhosis, primary sclerosing cholangitis, Down’s syndrome

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10
Q

what is the pathophys of T1DM?

A

Mechanism is unclear, potentially genetic component
Could be triggered by certain viruses eg coxsackie B virus and enterovirus
When there is no functioning insulin, cells of the body cannot take glucose from blood  insulin allows glucose into cell
No insulin = cells can not use glucose = blood glucose continues to rise = hyperglycaemia
Insulin is produced from beta cells in Islets of Langerhan’s within the pancreas

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11
Q

how does T1DM present?

A

Most children present with DKA
Hyperglycaemia symptoms: polyuria, polydipsia, weight loss
Other: secondary enuresis (bedwetting when previously dry) and recurrent infections

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12
Q

what diagnostic investigations are done for T1DM?

A

Baseline bloods: FBC, U+E, BMs, HbA1c, TFT and TPO(associated disease)
Need anti-TTG  could have coeliac too
Insulin antibodies, anti-GAD antibodies and islet cell antibodies  destruction of pancreas

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13
Q

how do you manage T!DM in paeds?

A

Want pt and family to be involved in care  complex and chronic
Subcut insulin regimes  long acting and basal bolus

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14
Q

what monitoring is required with T1DM?

A

Monitoring dietary carbs
Monitoring BMs: waking up, each meal and before bed
Monitoring and managing complications: short term and long term
Need HbA1c checked every 3-6mths

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15
Q

what are the short term complications of poorly managed T1DM?

A

hypo/ hyperglycaemia
DKA

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16
Q

what are the different types of complications within diabetes?

A

microvascular
macrovasculAR
INFECTION

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17
Q

what are macrovascular complications of poorly controlled diabetes?

A

Macrovascular: coronary artery disease, peripheral ischaemia (diabetic foot), stroke, HTN

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18
Q

what are microvascular complications of diabetes?

A

Microvascular: peripheral neuropathy, kidney disease – glomerulosclerosis

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19
Q

what infections can arise from poorly controlled diabetes?

A

Infection: UTI, pneumonia, skin and soft tissue in feet, fungal infections – oral and vaginal candidiasis

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20
Q

what is epilepsy?

A

Epilepsy is umbrella term where there is a tendency to have seizures  transient episodes of abnormal electrical activity in the brain

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21
Q

how would a GTC seizure present?

A

Generalised tonic- clonic: loss of consciousness, tonic (muscle tensing) and clonic (jerking)  may have tongue biting, incontinence, ireegular breathing

22
Q

how would a focal seizure present?

A

Focal: start in temporal lobe: affect hearing, speech, memory, hallucinations, memory flashbacks, déjà vu, doing strange things on autopilot

23
Q

how would an absence seizure present?

A

more in children – staring blankly into space and then abruptly returns to normal  can not be broken from ‘day dream’

24
Q

how would an atonic seizure present?

A

Atonic: drop attacks – brief lapses in muscle tone

25
Q

how would a myoclonic seizure present?

A

Myoclonic: sudden brief muscle contractions  jump suddenly. Typically within juvenile myoclonic epilepsy

26
Q

what is another name for infantile spasms?

A

west syndrome

27
Q

what are infantile spasms?

A

Infantile spasms: west syndrome – clusters of full body spasms, poor prognosis

28
Q

what are febrile convulsions?

A

Febrile convulsions: occur in children with a high fever. Only in children 6mths – 5yrs. Having this increases risk of epilepsy in future

29
Q

how is epilepsy diagnosed?

A

EEG: can show typical patterns in different forms of epilepsy
Children can have one simple seizure before investigation
MRI brain: investigate potential structural problems
ECG, electrolytes, BM

rule out Infection ?: blood cultures, urine cultures, lumbar punctures

30
Q

how is absence seizures managed?

A

sodium valproate or ethosuximide

31
Q

how is infantile spasms managed?

A

Infantile spasms: prednisolone, vigabatrin

32
Q

how are febrile seizures managed?

A

Infantile febrile: symptomatic management of fever

33
Q

what general advice is given to those with epilepsy?

A

General advice: showers rather than baths, caution with swimming, caution with heights/ traffic/ heavy + hot equipment

34
Q

what is the pathology by hayfever?

A

Allergy path: caused by when the body’s natural defences mistake a generally harmless substance (pollen/ certain food) as something harmful and this triggers immune response  imbalance of histamine

35
Q

what are common allergy triggers?

A
  • Pollen
  • House dust
  • Pets
  • Weather: can affect pollen count
36
Q

what symptoms are seen with hayfever?

A

itchy, red, watery eyes, sneezing and coughing
- Wheezing
- Runny nose/ blocked nose
- Tiredness
- Need to spot pattern of trigger
May need specialist allergen referral

37
Q

how can you manage hayfever?

A
  • Petroleum jelly/ special pollen barrier blam around nostrils to trpa pollen
  • Washing clothes after being outside – get rid of pollen
  • Keeping windows/ doors shut in high pollen days
  • Vacuuming regularly and dusting with damp cloth
  • Buying pollen filter for in car air vents
  • Priton antihistamine liquid medicine
38
Q

what are types of priton medication?

A

chlorphenamine or cetirizine hydrochloride

39
Q

what is difference between food allergy and intolerance?

A

abnormal response of body to certain food  food intolerance does not effect immune system despite similar symptoms

40
Q

what make sup 90% of food allergies?

A

: 90% of food allergies are from these 8 foods
- Milk, eggs, wheat, soy, tree nuts, peanuts, fish, shellfish

41
Q

are food allergies common in paeds?

A
  • Nearly 5% of children under 5 have food allergies
  • Most children ‘outgrow’ allergies but peanut, tree nut, fish and shellfish remain lifelong
42
Q

what are symptoms of food allergies?

A

: hives, itching in mouth, trouble breathing, stomach pains, vomiting/ diarrhoea
- Cramping, eczema, tightness of throat, wheezing, lowered BP

43
Q

how do you manage food allergies?

A

: no medication to prevent food allergy  want to avoid triggering foods
- If child allergic and breastfeeding – mum should avoid those foods
may need an epi-pen

44
Q

who is mainly affected by a cows milk allergy?

A

typically affecting infants and young children <3yrs
- Hypersensitivity to cows milk

45
Q

what is IgE mediated cows milk allergy?

A
  • IgE mediated  rapid response to cows milk, occruing within 2hrs of ingestion
46
Q

what is non-IgE cows milk mediated?

A
  • Non igE mediated  slow response – over 2-3days
47
Q

how would cows milk allergy present?

A

usually <1yr when weaning from BF to formula/ food containing milk
- GI symptoms: bloating and wind, abdo pain, D+V
- Allergic symptoms: urticarial rash, angio-oedema, cough/ wheeze, sneezing, watery and eczema
- Can cause anaphylaxis

48
Q

how would you diagnose cows milk allergy?

A

full history and examination
- Skin prick testing
- Avoid milk products and symptoms resolve

49
Q

how would you manage cows milk allergy?

A
  • Hydrolysed formula
    elemental formula
    try and re assess every 6mths on milk ladder eg trying malted milk first and progress towards normal cows milk
50
Q

what is hydrolysed formula?

A
  • Hydrolysed formula: contain cows milk but protein have been broken down so do not trigger immune response
51
Q

what is elemental formula?

A
  • Elemental formula: severe cases and this is made of amino acids
52
Q
A

paeds (10 decks)

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