Common Medical Problems Flashcards
When should infants double their birth weight?
By 4 months
When should infants weight be tripled?
By 1 year
Abdominal Disorders of Pediatric Patients
Pyloric stenosis Necrotizing enterocolitis Other disease of bowel obstruction GERD Colic
Clinical Presentation of Pyloric Stenosis
3-5 weeks "Projectile" nonblious vomiting Infant immediately hungry Dehydrated Jaundiced
PE in Pyloric Stenosis
Check hydration status
Check for jaundice
Palpate abdomen for “olive”
Evaluation of Pyloric Stenosis
Labs
Ultrasound
Treatment of Pyloric Stenosis
Pyloramyotamy
Why is it important to inquire about forcefully a baby is vomiting?
Differentiate between normal spit-up and pyloric stenosis
What is the term commonly used to describe forceful vomiting?
Projectile
What is in a baby’s differential with projectile vomiting?
Infection
Pyloric stenosis
What is the significance of a baby’s weight when presenting with pyloric stenosis?
Above/at/below birth weight
Why is the color of a baby’s emesis important?
Helps to determine if there is a bowel obstruction
How can you determine a baby’s hydration status?
Palpate the fontanelles
What are the 2 categories of vomiting in a baby?
Bilious
Non-bilious
Examples of Bilious Vomiting
Malrotation Volvulus Hirschsprung disease Incarcerated hernia Intussusception Intestinal atresia
Examples of Non-Bilious Vomiting
GERD
Cow/soy milk protein intolerance
Pyloric stenosis
Gastritis
Differential Diagnosis of Abdominal Pain in Newborns
GERD
Necrotizing colitis
Volvulus
Differential Diagnosis of Abdominal Pain in Infancy to 2 years
Intussesception
Meckel’s diverticulum
Bacterial enteritis
Warning signs of underlying pathology in GERD
BIlious vomiting GI bleeding Forceful vomiting Prolonged constipation Dirrhea Abdominal distension HSM Bulging fontanelle Seizures Micro/macrocephaly Hyper/hypotonia Stigmata of genetic disease Chronic infections Fever Pneumonia Lethargy Failure to thrive
If GERD warning signs are absent and infant has these symptoms, a workup can be considered.
Poor weight gain
Irritability
Feeding refusal
Gross blood in stool
Workup of GERD
Esophageal pH monitoring
Endoscopy
GERD Treatment Options
Lifestyle changes
Positioning therapy
Pharmacotherapy
Lifestyle Changes for the Treatment of GERD
Avoid tobacco smoke
Smaller feedings
Remove all cow’s milk
Positioning Therapy for the Treatment of GERD
Keep infant upright 10-20 minutes after a feed
Indications for Pharmacotherapy in GERD
Mild esophagitis
Significant symptoms when conservative measures have failed
3-6 months therapy with repeat esophagoscope
PPI preferred
How to Diagnosis Colic?
Rule of Threes >3 hours/day crying >3 days/week Lasts >3 weeks Infant
Associated Characteristics of Colic
Paroxysmal More often in evening Qualitatively different than normal crying Hypertoina Inconsolability Normal when not colicky First few weeks unremarkable
Colic Soothing Maneuvers
Pacifier Car/stroller ride Place them in front carrier Rock them Change scenery Infant swing Warm bath Rub abdomen Provide white noise CD of heartbeats Sing to baby Quiet time in crib 5-10 minutes
Colic Treatment Suggestions
Elemental formula for one week
Hypoallergenic diet for mom
Probiotic
Support the parents
How to asses a baby’s level of hydration?
Mucus membranes
Lethargic
Skin turger
Fontanelles
Oral Rehydration Therapy
Small amounts of liquid
Pedialyte 1st choice
Coat esophagus without causing a large bolus in stomach
Increase as tolerated
Characteristics of Mild Dehydration
Full, normal rate Normal BP Normal respirations Normal fontanelles Normal eyes Normal skin turgor Normal skin Normal urine output Increased thirst
Characteristics of Moderate Dehydration
Rapid pulse Normal to low BP Deep respirations Dry mucosa Sunken fontanelle Sunken eyes Reduced skin turgor Cool skin Reduced urine output Irritability, listlessness
Characteristics of Severe Dehydration
Rapid, week pulse Low BP Deep, tachypnic Parched mucosa Sunken afontanelle Sunken eyes Tenting skin turgor Cool, mottle, acrocyanosis Anuria Grunting, lethargy, coma
Severe Hypovolemia Treatment
Rapid infusion of 20mL/kg of isotonic saline
Reasses
Reasons to Hospitalize a Child with Diarrhea
Life-threatening diarrhea Severe dehydration or electrolyte abnormality Lack of improvement with rehydration Copious diarrhea Inability to drink
Define Constipation
Decrease in a person’s normal frequency of defections accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool
4 Reasons US Citizens are Constipated
Lack of fiber
Inadequate fluids
Sedentary lifestyle
Too busy
Functional Retention Due to Traumatic Events
Painful passage of stool
Painful diarrhea
Physical/sexual abuse
Functional Retention Due to Difficult Psychosocial/ Environmental Changes
Difficulty potty training
Divorce
Define Encopresis
Stretching of rectum and decreased sensation to empty bowel
Liquid stools leak around stool mass
Organic Causes of COnstipation
Hirschsprung's disease Anatomic abnormalities Meds: antacids, opiates, phenobarbitol Spinal cord abnormalities Infant botulism Hypothyroidism Celiac disease DM CF Cow's milk intolerance
Warning Signs of Constipation
Weight loss Anorexia Delayed growth Delayed passage of meconium Urinary incontinence Blood in stool Fever Vomiting/diarrhea Extraintestinal symptoms
Concerning Findings on PE
Failure to thrive Abdominal distension Lower spine abnormalities Anteriorly displaced anus Tight, empty rectum Absent anal wink Absent cremasteric reflex Decreased lower extremity tone Absence of delay in lower limp DTR's
Findings that Support Functional Etiology
Dietary change Toilet training Painful BM Stool withholding behavior Good response to laxatives
Various Meds for Constipation
Docusate sodium (Colace) Polyethylene glycol (Miralax) Mineral Oil Lactulose Psyllium (Metamucil) Methylcellulose (Citrucel) Senna (Ex-Lax) Besacodyl (Dulcolax)
Treatment of Encopresis
Clear child's bowel Continue laxative Regular toilet sitting time 2-3 x a day Stool near toilet Rewards for sitting on toilet Note time when BM occurs & in toilet Wean off laxatives
Define Enuresis
Involuntary discharge of urine after the age at which bladder control should have been established
Enuresis
Genetic component
Exacerbated with stress/emotional problems
Define Monosymptomatic Enuresis
Children without history of urinary tract symptoms or bladder dysfunction
Characteristics of Monosymptomatic Enuresis
No daytime symptoms
Primary- never had nighttime dry period
Secondary- enuresis after 6+ months dry period
Neurologic/Anatomic Problem for Enuresis
Urinary tract abnormality UTI Kidney disease Trauma of spinal cord Seizures Hyperthyroidism DM Sleep apnea Pinworms
Treatment Options for Enuresis
Behavior modifications
Bedwetting alarms
Medications
Define Amblyopia
Unilateral or bilateral reduction in central visual acuity due to the sensory deprivation of a well-formed retinal image that occurs with or without a visible organic lesion commensurate with the degree of visual loss
Types of Amblyopia
Strabismic amblyopia
Refractive amblyopia
Deprivation amblyopia
Define Strabismic Amblyopia
Occurs in non dominant eye of strabismic patient
Define Refractive Amblyopia
Results from refractive errors
Unilateral/bilateral
Define Deprivation Amblyopia
Occurs with congenital cataracts, unilateral ptosis, corneal opacities, or vitriol hemorrhage
How to Test the Nonverbal Child
Fixation test
Differential occlusion test
Prism test
Define Strabismus
Misalignment of the visual axes of the two eyes
Define Esotropia
Inward turning misalignment of the eyes
Define Exotropia
Outward turning misalignment of the eyes
Treatment of Strabismus
Glasses
Patches
Surgical correction
