common chronic conditions Flashcards
what is coeliac?
Autoimmune conditions where exposure to gluten causes immune reaction and creates inflammation in small intestine
what is the pathophys of coeliac?
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)
how would coeliac present?
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
why would could there be neuro symptoms in coeliac?
lac of absorption - lack of B12
how do you diagnose coeliac?
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
how do you manage coeliac?
Gluten free diet FODMAP diet trial?
Checking antibodies to monitor
what are complications of coeliac?
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T cell lymphoma (EATL) of intestine
Non-Hodgkin’s lymphoma
Small bowel adenocarcinoma
what do T1DM get screened for when they are first diagnosed?
coeliac screening
what other conditions are linked to coeliac?
Linked to other conditions: T1DM, thyroid disease, autoimmune hepatitis, Primary biliary cirrhosis, primary sclerosing cholangitis, Down’s syndrome
what is the pathophys of T1DM?
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
how does T1DM present?
Most children present with DKA
Hyperglycaemia symptoms: polyuria, polydipsia, weight loss
Other: secondary enuresis (bedwetting when previously dry) and recurrent infections
what diagnostic investigations are done for T1DM?
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
how do you manage T!DM in paeds?
Want pt and family to be involved in care complex and chronic
Subcut insulin regimes long acting and basal bolus
what monitoring is required with T1DM?
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
what are the short term complications of poorly managed T1DM?
hypo/ hyperglycaemia
DKA
what are the different types of complications within diabetes?
microvascular
macrovasculAR
INFECTION
what are macrovascular complications of poorly controlled diabetes?
Macrovascular: coronary artery disease, peripheral ischaemia (diabetic foot), stroke, HTN
what are microvascular complications of diabetes?
Microvascular: peripheral neuropathy, kidney disease – glomerulosclerosis
what infections can arise from poorly controlled diabetes?
Infection: UTI, pneumonia, skin and soft tissue in feet, fungal infections – oral and vaginal candidiasis
what is epilepsy?
Epilepsy is umbrella term where there is a tendency to have seizures transient episodes of abnormal electrical activity in the brain
how would a GTC seizure present?
Generalised tonic- clonic: loss of consciousness, tonic (muscle tensing) and clonic (jerking) may have tongue biting, incontinence, ireegular breathing
how would a focal seizure present?
Focal: start in temporal lobe: affect hearing, speech, memory, hallucinations, memory flashbacks, déjà vu, doing strange things on autopilot
how would an absence seizure present?
more in children – staring blankly into space and then abruptly returns to normal can not be broken from ‘day dream’
how would an atonic seizure present?
Atonic: drop attacks – brief lapses in muscle tone
how would a myoclonic seizure present?
Myoclonic: sudden brief muscle contractions jump suddenly. Typically within juvenile myoclonic epilepsy
what is another name for infantile spasms?
west syndrome
what are infantile spasms?
Infantile spasms: west syndrome – clusters of full body spasms, poor prognosis
what are febrile convulsions?
Febrile convulsions: occur in children with a high fever. Only in children 6mths – 5yrs. Having this increases risk of epilepsy in future
how is epilepsy diagnosed?
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
how is absence seizures managed?
sodium valproate or ethosuximide
how is infantile spasms managed?
Infantile spasms: prednisolone, vigabatrin
how are febrile seizures managed?
Infantile febrile: symptomatic management of fever
what general advice is given to those with epilepsy?
General advice: showers rather than baths, caution with swimming, caution with heights/ traffic/ heavy + hot equipment
what is the pathology by hayfever?
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
what are common allergy triggers?
- Pollen
- House dust
- Pets
- Weather: can affect pollen count
what symptoms are seen with hayfever?
itchy, red, watery eyes, sneezing and coughing
- Wheezing
- Runny nose/ blocked nose
- Tiredness
- Need to spot pattern of trigger
May need specialist allergen referral
how can you manage hayfever?
- 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
what are types of priton medication?
chlorphenamine or cetirizine hydrochloride
what is difference between food allergy and intolerance?
abnormal response of body to certain food food intolerance does not effect immune system despite similar symptoms
what make sup 90% of food allergies?
: 90% of food allergies are from these 8 foods
- Milk, eggs, wheat, soy, tree nuts, peanuts, fish, shellfish
are food allergies common in paeds?
- Nearly 5% of children under 5 have food allergies
- Most children ‘outgrow’ allergies but peanut, tree nut, fish and shellfish remain lifelong
what are symptoms of food allergies?
: hives, itching in mouth, trouble breathing, stomach pains, vomiting/ diarrhoea
- Cramping, eczema, tightness of throat, wheezing, lowered BP
how do you manage food allergies?
: 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
who is mainly affected by a cows milk allergy?
typically affecting infants and young children <3yrs
- Hypersensitivity to cows milk
what is IgE mediated cows milk allergy?
- IgE mediated rapid response to cows milk, occruing within 2hrs of ingestion
what is non-IgE cows milk mediated?
- Non igE mediated slow response – over 2-3days
how would cows milk allergy present?
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
how would you diagnose cows milk allergy?
full history and examination
- Skin prick testing
- Avoid milk products and symptoms resolve
how would you manage cows milk allergy?
- Hydrolysed formula
elemental formula
try and re assess every 6mths on milk ladder eg trying malted milk first and progress towards normal cows milk
what is hydrolysed formula?
- Hydrolysed formula: contain cows milk but protein have been broken down so do not trigger immune response
what is elemental formula?
- Elemental formula: severe cases and this is made of amino acids
