Core conditions Flashcards
1
Q
What is bronchiolitis
A
inflammation of the small airways
reduction in lumen size due to mucous hypersecretion, bronchospasm, inflammatory exudate
2
Q
Is bronchiolitis largely bacterial, viral or fungal?
Which pathogen accounts for 80% of cases
90% of children affected are aged?
A
viral
RSV (respiratory syncitial virus)
1-9 months old
3
Q
Clinical features of bronchiolitis
A
- coryza initially
- end-inspiratory crackles
- dry cough
- wheeze
- breathing difficulties
- recessions (intercostal, subcostal, sternal)
- poor fedding
- nasal flaring
4
Q
how is bronciolitis diagnosed?
A
clinically
measure pulse oximetry
blood gas
CXR if concerned about respiratory failure
5
Q
after how long does the severity of bronchiolitis peak?
under what conditions would you admit someone with bronchiolitis? (2)
A
3/4/5 days
admit if needing:
- breathing support
- feeding support
6
Q
Describe the management of bronchiolitis
A
supportive
- humidified oxygen— 2L nasal canula
- CPAP (Continuous positive airway pressure) - if ventilation required
- Feeding support- NG feeds or Iv fluids
7
Q
What is Croup
most commonly caused b y what kind of virus
What is the difference between croup and bronhiolitis
A
viral laryngotracheobronchiolitis
parainfluenza viruses (rhinovirus, RSV, influenza)
croup targets the upper respiratory tract while bronchiolitis targets the lower respiratory tract
8
Q
what is the standard age range for croup
A
6 months to 6 years (peak age 2)
9
Q
clinical featrues of croup
A
coryza and fever
hoarseness
barking cough (worse at night)
stridor
variable SOB
10
Q
management of croup
A
- observe
- oral or nebularised steroids
for a seveere upper airway obstruction (nebularised adrenaline and oxygen)
11
Q
Acute epiglotitis is caused by which pathogen?
what is epiglotitis?
Why is epiglotits an emergency?
A
epiglotitis is caused by H. Influenzae B
intense swelling of the epiglottis and sepsis
12
Q
presentation of epiglotitis
incidence is reduced by 99% due to what
A
- high grade fever
- unwell looking child
- drooling
- no cough
- soft stridor
universal vaccination
13
Q
Constipation what is it
A
infrequent passing of dry, hardened stool
associated with straining, pain or bleeding
14
Q
what numbers does the bristol stool chart range
type 1 on the Bristol stool chart
describe a poo at the highest stage
A
1—->7
1= hard rabbit droppings
stage 7- wet like gravy
15
Q
clinical features of constipation
management for constipation
A
- infrequent bowel movements
- straining
- abdominal pain
- loss of appetite
encourage fluids
encourage healthy, fibre rich diet
toileting routine
16
Q
what are the 4 types of laxative
A
- Bulk forming laxatives
- osmotic laxatives- magnesuim hydroxide
- disaccharides and alditols- lactulose
- Emollients (hydrating)- parafin oil, docusate sodium
- Stimulant laxatives- senna
17
Q
Red flags in paeds. What is each suggestive of?
- failure to pass meconium in 24 hours of life
- faultering growth
- abnormal limb neurology/ deformity
- scaral dimple over natal cleft
- perianal bruising
A
- hirschrpung’s disease
- hypothyroidism, coeliac disease
- lumbrosacral pathology
- spina bifida occulta
- sexual abuse
18
Q
Iron deifiency
presentation
causes
A
- fatigue
- slow feeding
- pica
- pallor
- inadequate intake– diet, growth spurt
- malabsorption- coeliac disease
- blood loss- menstruation, meckel’s diverticulum
19
Q
investigation for iron deficiency
management of iron deficiency
A
FBC— Hb and MCV decreases,,,, look for microcytic cells
look for derceased serum ferritin
management
iron supplementation
dietary advice- iron rich foods, vitamin C
20
Q
ITP- immune thrombocytic cytopaenia
which kind of cell is destroyed? How are they destroyed?
presentation of ITP
A
platelets are destroyed by autoantibodies
presentation
- usually children aged 2-10
- 1-2 weeks after viral infection
- petechiae, purpura, superficial bruising
- epistaxis (nose bleed)
- uncommon to get profuse bleeding
21
Q
how is ITP diagnosed?
investigations
treatment of ITP
A
diagnosis of exclusion
investigations
- FBC- look for low platelets
- blood film
- bone marrow biopsy
treatment of ITP
Observation. Self resolves in 6-8 weeks
may need steroids or IV Ig
22
Q
cystic fibrosis
inheritance pattern
what protein does it affect? what is that protein’s function? what happens without it
A
autosomal recessive condition
(therefore if Xx and Xx have 4 kids; 1 will be affected xx, 2 will be carriers Xx and one will be free of it XX)
it affects the CFTR protein (membrane chloride channel). It carries out sodium transportation. A dysfuncitonal channel will produce thickened, sticky secretions
23
Q
A
24
Q
Presentation of Cystic fibrosis in neonates and children
A
since introduction of the heel prick test, most cases are picked up via screening
neonates- meconium ileus
children- frequent infection, failure to thrive, wheeze, cough, steatorrhoea
25
Which conditions are commonly present with Cystic fibrosis?
* sinusitis
* pancreatitis
* diabetes
* fertility
26
investigations for CF
management in CF
* heel prick test
* sweat test- high chloride
* genetic testing for mutations (change in F508)
***_lifelong MDT aproach_***
* Resp: mucolytics, prophylactic antibiotics, chest physio, vaccines
* GI: annual OGTT, creon replacement
* Targeted: Ivacaftor/ lumacaftor
27
Coeliac disease pathophysiology
gliadin + glutenin =
presentation of coeliac disease
* gluten broken down to gliadin and glutenin. Gliadin causes damaging immune response in proximal small intestinal mucosa
* gliadin + glutenin = gluten
***_presentation of coeliac disease_***
classical presentation vvvv
* malabsorption at 8-24 after weaning
* faltyering growth and buttock wasting
* abdominal pain and distension
* abnormal stools
* dermatitis herpetiformis ( scalp, shoulders, buttocks, elbows and knees)
Non specific GI symptoms
Anaemia (iron and/or folate deficiency)
28
investigations for coeliac disease
management
1**) bloods**- serological screening tests
* Anti-tTG (immunoglobulin A tissue transaminase antibodies)
* EMA (endomysial antibodies)
2) **biopsy**- mucosal changes of the small intestine (villous atrophy, flattened villi, crypt hyperlasia, lymphocyte infiltration)
***_management for coeliac disease_***
gluten free diet under dietician supervision
29
What is meningitis?
Caused more by bacteria or viruses? Which one has more severe consequences?
Presentation?
* inflammation of the meninges
* most commonly viral but bacterial more severe
***_presentation_***
* fever
* headache
* vomitig/ poor feeding
* drowsiness
* photophobia
* hypotonia
* seizures
30
examination findings of meningitis
* purpuric rash (meningococcal disease)
* neck stiffness
* bulging fontanelle (division on superior aspect of infants skull)
* back arching
* Brudzinki + kernig sign positive
* shock
* Altered conscious level
* focal neurology
31
Common casuative agents of meningitis at different ages
***_bacterial_***
* neonates
* 1 mo-6 years
* \>6 years
***_viral_***
***_Neonates_***
* group B streptococcus
* Listeria monocytogenes
* E. Coli
***_1 mo- 6 years_***
* Neisseria meningitides
* Streptococcus pneumoniae
* Haemophilus influenzae
***_Over 6 years_***
* Neisseria meningitides
* Streptococcus pneumoniae
***_Viral causes of meningitis_***
Enteroviruses, Epstein- barr virus (EBV), adenovirus, mumps
32
investigation for meningitis
* FBC, CRP
* coag + U and E's
* LFTs
* Blood glucose
* Blood gas
* Blood cultures
* Viral PCR
* Lumbar puncture
33
* Appearance
* WBCs
* Protein content
* Glucose content
Of csf of someone with normal health, bacterial and viral infection
***_Normal_***
*_Appx:_* clear
*_WBCs:_* 0-5/mm3
*_Protein:_* 0.15-0.5g/L
*_Glucose:_* \>50% of blood
***_Bacterial_***
*_Appx:_* turbid
*_WBCs:_* large increase in polymorphs
*_Protein:_* large increase
*_Glucose:_* large increase
***_Viral_***
*_Appx:_* clear
*_WBCs:_* increase lymphocytes
*_Protein:_* normal/ raised
*_Glucose:_* normal / decreased
34
management of meningitis
IV antibiotics- usually cephalosporin
Dexamethosone in bacterial infections over 3 months
supportive therapy- e.g,. fluids, oxygen
35
What is gastro-oesophageal reflux disease
if it causes significant problems whay is it called
involunatry passage of stomach contents into the oesophagus
common in infancy and is usually benign and self limiting
its called GORD if it causes dysfunction
36
presentation of infants and older chidlren with reflux disease
***_infants:_***
* recurrent vomiting or regurgitation after feeds
* discomfort lying flat after feeds
* usually well and normal growth
***_older children:_***
* heartburn
* epigastric pain
* vomiting
37
How is reflux disease diagnmosed?
relfux disease has a higher prevalence in children with
management
diagnosed clinically with no need for investigations
higher incidence in cerebral palsy or neurodevelopmental disease
***_management_***
* reassurance- usually resolves by age 1
* feeding assessment
* smaller, more frequent feeding
* feed thickeners
* alginate therapy (gaviscon)
* 4 week trial of PPI or H2 receptor antagonist
38
What is appendicitis
presentation
inflammation of the appendix
***_Presentation_***
*_Symptoms:_*
* abdominal pain (initially central and collicky, later localises to RIF)
* anorexia
* vomiting
*_Signs:_*
* Fever
* Pain aggravated by movement
* Tenderness and guarding in RIF (mcBurney's point)
If unwell abnormal observations, high temperature------ **perforation**?
39
investigations for appendicits
Complications of appendicitis
Management
***_Investigations_***
* Full blood count- increase WCC
* CRP
* Ultrasound scan
***_Complications_***
* Perforation
* Sepsis
* Abscess
* Appendiceal mass
***_Management_***
* Monitor observations
* Analgesia
* Fluid rescusitation and IV antibiotics (if unwell/ concerns of perforation)
* **Appendicectomy**
40
What is pyloric stenosis?
When does presentation occur? What is the presentation?
More common in?
Hypertrophy of pyloric musclce causing gastric outlet obstruction
***_presentation_***
* projectile vomiting
* gradually increases in frequency and forcefulness
* hunger after vomiting
* weight loss
***_more common in_***
* males
* first born child
* those with family history
41
Assessment of pyloric stenosis
test feed
* **Gastric peristalsis**- wave moving from left to right
* **Pyloric mass-** olive shaoed mass in RUQ
Capillary blood gas
* **Hypochloraemic metabolic potassium**
* Low sodium and potassium
Ultrasound scan
42
Management of pyloric stenosis
1. rehydration
2. correct electrolyte imbalances
3. Pylomyotomy
43
***_Pneumonia_***
presentation
examination
***_Pneumonia_***
***_Presentation_***
* Fever
* cough
* increased work of breathing
* tachypnoea
* lethargy
* poor feeding
***_Examination_***
* Tachypnoea
* coarse crackles
* reduced oxygen saturations
* nasal flaring
* recessions
44
***_pneumonia_***
investigations (3)
management (2)
admit if: (3)
***_investigations_***
CXR- may confirm diagnosis
NPA aspirate for viral PCR
Bloods generally unhelpful
***_Management_***
* antibiotics- amoxicillin or clarithromycin
* supportive care- oxygen, fluids
***_Admit if:_***
* Oxygen sats \>92%
* Apnoeas/ grunting
* Unable to maintain fluid intake
* ![]()
45
Causative agents of pneumonia
* newborn
* infantsa nd young children
* children over 5
***_Newborn causative agents pneumonia:_***
Bacteria------- (group B strep) + (gram negative enterococci)
***_Viruses and young children:_***
Viruses-------- (RSV, Adenovirus, Rhinovirus, Influenza)
Bacteria------- (strep pneumoniae, H. Influenzae, chlamydia trochamatis)
***_Children over 5 years:_***
Bacteria ------( mycoplasma pneumoniae, strep pneu., chlamydia pneu.)
46
***_Anaphylaxis_*** what is it
Presentation
anaphylaxis is a severe life-threatening systemic hypersensitivity reaction
***_Presentation_***
* Sudden onset and rapidly progressing
* Angioedema
* stridor
* wheeze
* tachypnoea
* tachycardia
* shock
* vomiting
* urticaria (hives- red, itchy welts that result from a skin reaction)
* collapse
47
Anaphylaxis
acute management (7)
***_Acute anaphylaxis management_***
* ABCDE approach
* Adrenaline 1:10000
* Oxygen
* Nebulisers
* fluid bolus
* hydrocortisone
* chlorphenamine
48
What is otitis media
which age group is it most frequent in? Why compared to adults?
what usually precedes OM?
inflammation of the middle ear
most common in infants. this is becasue the eustachian tube is:
* shorter
* horizontal
* functions poorly
a URTI usually precedes OM
49
presentation of OM
On examination
common causative agents of OM: viral and bacterial
***_Presentation of OM_***
* fever
* ear pain
* hearing loss
* loss of appetite
* generally unwell
***_On examination_***
* erythema
* bulging tympanic membrane
* loss of light reflex
* perforation
* effusion
***_Common causative agents of OM:_***
* Viral- RSV, Rhinovirus
* Bacterial- strep pneumonia, haemophilus influenza, moraxella catarrhalis
50
Management of OM (3)
what is glue ear and how is it treated
***_management of OM_***
* reassurance usually self resolves in 3-5 days
* analgesia and fluids
* antibiotics usually not required- can be given if not resolving
***_glue ear_***
-"recurrent ear infections can lead to OM with effusions"
Hearing loss and resultant developmental delay
may be treated with grommets
51
Label which ones are normal, Acute otitis media and OM with effusions
52
Urinary tract infections
presentation- infants and children
***_UTI presentations_***
***_Infants_***
* fever
* vomiting
* lethargy
* poor feeding
* irritability
***_Older children_***
* fever
* dysuria
* increased frequency
* abdominal pain
* vomitinng
* incontinence
53
Initial investigations for a UTI (2)
if there is good clinical evidence and patient is under 3 months what should you do?
***_initial investigatiuons for UTI_***
* urinalysis (if nitrites present start abx, if only leukocytes send for culture)
* urine culture and sensitivity (E.coli and krebsiella)
* no need for further investigations unless concerns of sepsis
start antibiotics
54
***_antibiotics for UTI_***
* upper UTI, prophylaxis
* lower uti
* under months
Further investigationsn for uti (3)
***_upper UTI, prophylaxis-_*** cefalexin ot Co-amoxiclav
***_lower UTI-_*** trimeythoprim
***_under 3 months-_*** IV antibiotics
***_further investigations for UTI-_***
* renal USS
* micturating cystorethrogram (MCUG)
* DMSA scan
55
wheeze
## Footnote
***_what is it_***
***_inspiratory?_***
***_what does it indicate?_***
***_what can cause a wheeze?_***
***_wheeze-_*** high pitched whistling sound, musical like quality
usually heard on **expiration**
indicates a narrowed airway
***_what can cause a wheeze?_***
* asthma
* bronchiolitis
* viruses
* foreign body aspiration
* structural abnormalities
* congenital heart defects
* GOERD
56
Treatment for wheeze? (3)
age based approach to diagnosing cause of wheeze
what does absence of wheeze suggest in acute asthma?
***_treatment for wheeze_***
* 02 as needed
* SABA
* if the patient doesnt respond to SABA ask why
age based approach to diagnosing cause of wheeze
impending resp failure
57
Asthma-
diagnosis (4)
acute management
long term management
general management strategies
***_Diagnosis:_***
1. Episodic symptoms
2. Wheeze confirmed by HCA
3. Diurnal variability
4. Atopic history
5. Nothing suggesting alternate diagnosis
***_Acute management_***
1. Oxygen
2. Salbutamol + ICS
3. Ipatropium (anticholinergic)
4. Call for help + cardiac monitoring
5. Aminphylline + salbutamol + Mg Sulphate
***_Long term management_***
SABA reliever "blue" PRN up to 10 puffs per 4 hours
"+ ICS brown preventer- budesonide
"+ LABA (e.g., salmeterol). if this fails stop and increase ICS
"+ LTRA (leukotriene receptor antagonist) like monteleukast (at this stage you have SABA,ICS, LABA, LTRA)
***_General management strategies_***
* assess symptoms, measure lug function, check inhaler technique and adherence
* adjust dose to find minimum effective
* update self-management plan
* move up and down medication ladder as required
58
how do you differentiate between causes of wheeze?
***_Onest of symptoms_***
a) gradual onset of wheeze in late infancy or early childhood
1ai) regular daily wheeze symptoms?----
1ai. )improves with salbutamol?
yes- asthma
no- bacterial bronchitis?
1aii) intermittent episodes- interval symptoms (e.g, regular cough/ wheeze at night or after exercise?
yes- improve w salbutamol? (y- asthma n-bacterial bronchitis)
no- recurrent viral induced wheeze
b) sudden onset of coryzal symptoms
1bi) yes- suspect viral lrti like bronchiolitis or viral penumonitis
1bii) no- think inhaled foreign body
59
how can you tell the difference between asthma and viral induced wheeze?
children w viral induced wheeze are well between flare ups while children with asthma are not
60
what is viral induced wheeze
when do children usually grow out of it
Wheezing due to viral-induced wheeze or acute viral-induced asthma is caused by narrowing of the airways due to mucus production and bronchoconstriction.
grow out of it by 6 when their immunity develops
61
common causative agents of V.I.W. (5)
***_presentation of VIW_***
* severe
* life threatening
1. RSV
2. Rhinovirus
3. coronaviruses
4. parainfluenza
5. influenza
***_Presentation of VIW_***
* severe- SpO2 \>92%
* Too breathless to feed or talk
* HR \>125 ( over 5's) or \>140 (under 5's)
* Use of accessory muscles
***_Life threatening_***
* silent chest
* poor respiratory effort
* altered consciousness
* agitation/ confusion
* exhaustion
* cyanosis
62
difference between bronchiolitis and VIW
***_age_***
* bronchiolitis- \<12 months old
* VIW 1-5 years
63
what kind of disease is type 1 diabetes mellitus
what protein is lacking
***_presentation:_***
* Autoimmune endocrine disorder
* insulin lack
***_presentation:_***
* **hyperglycaemia** (frequent urination, increased thirst, blurred vision, fatigue, headache)
* **Polydipsia** (extreme thirst)
* **polyuria** (lots of weeing)
* **polyphagia** (extreme hunger)
* **weight loss**
* **abdo pain** (Diabetic ketoacidosis)
64
management of T1DM
What 2 things do you teach to a T1DM patient?
What is a BM range? and what should a normal range be?
***_management_***
* lifelong insulin replacement
* regular blood sugar checks
* screen for complications and compliance
***_Teach_***
* how to treat hypos
* sick day rules
***_Bm range_***" outdated" but refers to your blood glucose level.
***_Normal range_*** 4-7
65
HYPOglycaemia symptoms
HYPERglycaemia symptoms
what is of concern in adolescent patients
***_HYPO symptoms_***
* Sweating
* Pallor
* Irritibility
* Hunger
* Lack of co-ordination
* Sleepiness
***_HYPER symptoms_***
* Dry mouth
* Increased thirst
* Weakness
* headache
* blurred vision
* frequent urination
compliance is an issue
66
Diabetic ketoacidosis
## Footnote
presentation
3 changes to blood in DKA
***_presentation_***
1. dehydration
2. shock
3. abdominal pain
4. drowsiness
5. acidotic respirations
***_3 changes to blood in DKA_***
* ketonaemia
* hyperglycaemia
* acidaemia
67
diabetic ketoacidosis
treatment
complications of DKA
***_treatment_***
* ABCDEFG-appraoch Don't Ever Forget Glucose
* Complex and requires 1:1 nursing + senior support
* combination of fluids, insulin and postassium
***_Complications_***
* hypokalaemia
* cerebral oedema
* hypoglycaemia
* VTE
68
how does insufficient insulin lead to ketoacidosis?
1. insuficient insulin
2. gluocse can't enter cells
3. need for alternative energy source
* muscle cells broken down to amino acids (gluconeogenesis)
* fat cell- glycerol (gluconeogenesis) and fatty acids (converted to ketones)
* increased glucagon converted to ketones
69
gastroenteritis
most common cause in developed countries and during which seasons
presentation
its important to assess
management
commonest casuative agent- **rotavirus**
***_presentation_***
* diarrhoea
* vomiting
* fever
* poor feeding
* shock
assess hydration
***_management_***
* oral rehydration or IV fluid replacement
70
gastroenteritis
most common viral causes
bacterial
protozoan
Investigations
***_viral_***
* rotavirus
* adenovirus
* norovirus
* astrovirus
***_bacteria_***l
* Campylobavter
* shigella
* salmonella
* E.coli
***_Protozoa_***
* Giardia
* crytposporidium
***_Investigations:_***
* stool culture (if septic or blood in stools)
* U+E's if IV fluids required
* Glucose
* Blood culture (if satrted on antibiotics)
71
Shock presentation
* reduced consciousness
* decreased Urinary output
* pale or mottled
* cool peripheries
* dry mucous membranes
* prolonged cap refill
* sunken eyes
* tachycardia
* hypotension
* tachypneoa
72
1. what is Henoch- Schlonlein purpura
2. what is it usually triggered by
3. What does PPP stand for
immune mediated disorder causing inflammation of small blood vessels, IgA mediated vasculitis
usually triggered by a viral URTI
Painful Palpable Purpura
73
presentation of henoch-schonlein purpura
most commonly affects which aged children
***_presentation of henoch-schonlein purpura_***
* non-blanching rash (100%) found on the buttocks and extensor surfaces of legs and arms
* painful swollen joints
* abdominal pain
* haematauria
most commonly affects 2-10 year olds
74
* investigations to rule out other pathologies and measure extent of organ failure (4)*
* management*
* 2% Of HSP patients develop:*
***_investigations_***
1. FBC
2. CRP
3. Blood cultures
4. U+Es
***_Management of HSP_***
1. Usually self resolves within 6 weeks
2. simple analgesia
3. steroids are sometimes used for joint pain
2% of HSP patients develop **renal failure**
75
4 go to causes of paediatric limp
1. transient synovitis "irritible hip syndrome"
2. septic arthritis
3. Perthe's disease
4. Slipped capital femiral epiphysis
76
Transient synovitis "irritible hip syndrome"
* how common of a problem is it
* associated with what kind of infection
* sudden onset symptoms (2)
* pain at rest?
* affect on ROM?
* how long does it take to resolve?
* average age of affect
Transient synovitis "irritible hip syndrome"
* most common cause of hip pain in children
* associated with viral infection
* sudden onset hip pain or limp
* no pain at rest
* reduced ROM, internal rotation hurts
* resolves itself within 1 week
* age of affect- 2-12
77
***_septic arthritis_***
presentation
investigations
treatment
most common in what age group
***_presentation_***
* red
* hot
* painful joint
* reduced ROM
***_Investigations_***
* FBC, CRP, ESR
* blood cultures
* joint aspirate
* Xray
***_Treatment_***
* Antibiotics +/- surgical washout
Most common in the under 2s
78
***_Limp_***
* What is Perthe's disease
* pathophysiology
* affects which group of people most
* management
***_Limp_***
***_Perthe's disease-_***"avascular necrosis of capital femoral epiphysis"
***_Pathophysiology_***
* Occurs due to interruption of blood supply, followed by revascularisation and reossification over 18-36 months
***_Mainly affects_*** boys + 5-10 year olds
***_Management_***- rest, physio, casts and sometimes surgery
79
Limp
1. What is a slipped capital femoral epiphysis?
2. most common at which ages
3. commonly occurs during which process
4. increased risk with...?
5. which movements are restricted
6. management
7. should be treated promptly to prevent...?
1. ***_Slipped capital femoral epiphysis_***- "displacement of epiphysis of femoral head postero-inferiorly
2. 10-15 years
3. common during adolescent growth spurt
4. increased risk in obese patients
5. restricted abduction and internal rotation
6. surgical management
7. should be treated promptly to prevent avascular necrosis
80
Leukaemia is a cancer of which cells
how common is leukaemia
presentation (7)
white blood cells
most common cancer in children
***_presentation_***
1. lethargy
2. pallor
3. generally unwell
4. non-blanching rash
5. frequent infections
6. lymphaednopathy
7. hepatosplenomegaly
81
leukaemia
## Footnote
investigations
peak age for incidence
80% of leukaemias in children are
***_investigations_***
* FBC
* Blood film
* bone marrow arpirate/ biopsy
* lumbar puncture
incidence peaks at age 2-3 years
ALL most common childhood leukaemia
82
***_inflammatory bowel disease_***
## Footnote
a quarter of IBD cases present at which stage of life
IBD includes 2 distinct diseases, what are they?
What are the differences between these 2
presentation
* childhood
* IBD= crohn's + IBD
* ***_Crohn's disease_***- affects any part of the GI tract from mouth to anus. Diffuse pattern of affect. Transmural. Non-caseating granulomata
* ***_Ulcerative colitis-_*** confined to the colon. Continuous inflammation. Damage limited to mucosa. Mucosal inflammtaiton and crypt cell damage..
***_Presentation of IBD:_***
* Abdominal pain
* diarrhoea
* failure to thrive
* weight loss
* delayed puberty
* extra-intestinal manifestations: oral lesions, uveitis (looks like red eye), arthralgia, erythema nodosum
83
Investigations for IBD
management for Crohn's
management for Ulcerative colitis
***_Investigations for IBD_***
* FBC
* CRP and ESR
* foecal elastase
* *biopsy*
***_management for Crohn's_***
* nutritional therapy
* systemic steroids
* immunosupressants
* anti-TNF (infliximab)
***_management for Ulcerative colitis_***
* aminosalicylates
* topical or systemic steroids
* immunosupressants
84
Paediatric normal values- \<1 year
## Footnote
HR/ min
RR/ min
Systolic BP
***_Paediatric normal values- \<1 year_***
## Footnote
***_HR/ min-_*** 110-160
***_RR/ min-_*** 30-40
***_Systolic BP-_*** 70-90
85
***_Paediatric normal values- 1-2 years_***
## Footnote
HR/ min
RR/ min
Systolic BP
***_Paediatric normal values- 1-2 years_***
***_HR/ min-_*** 100-150
***_RR/ min-_*** 25-35
***_Systolic BP_***- 80-95
86
***_Paediatric normal values- 2-5 years_***
HR/ min
RR/ min
Systolic BP
***_Paediatric normal values- 2-5 years_***
***_HR/ min-_*** 95-140
***_RR/ min-_*** 25-30
***_Systolic BP-_*** 80-100
87
Paediatric normal values- 5-12 years
HR/ min
RR/ min
Systolic BP
***_Paediatric normal values- 5-12 years_***
***_HR/ min-_*** 80-120
***_RR/ min-_*** 20-25
***_Systolic BP-_*** 90-110
88
***_Paediatric normal values- over 12 years_***
HR/ min
RR/ min
Systolic BP
***_Paediatric normal values- over 12 years_***
***_HR/ min-_*** 60-100
***_RR/ min-_*** 15-20
***_Systolic BP_***- 100-120
89
***_General trends in paediatric vital signs with increasing age_***
Heart rate
Respiratory rate
Systolic blood pressure
_as age increases:_
## Footnote
**HR-** decreases
**Respiratory rate-** decreases
**Systolic blood pressure-** increases
