Fever & Vomiting Flashcards
Define fever of unknown origin
Daily temperatures >38c for at least 8-14 days with no diagnosis
Mechanisms that cause fever x3
Pyrogens
Heat production exceeding loss
Defective heat loss
Role of endotoxin in fever x2
Stimulate endogenous pyrogens
Directly affect thermoregulation in the hypothalamus
Role of hypothalamus in temperature regulation x6
Generates physiologic changes like shivering and vasoconstriction to increase core temperature
To reduce- sweating, vasodilation, sensation of feeling hot
2 causes of defective heat loss
Ectodermal dysplasia
Victims of severe heat exposure
State 5 autonomic changes associated with nausea
Salivation
Cold sweating
Peripheral vasoconstriction
Proximal gastric relaxation
Retrograde movement of intestinal contents
Events accompanying retching x4
- Spasmodic contraction of diaphragm and abdominal wall
- Closing of the glottis
- Relaxation of the lower esophageal sphincter
- Movements of gastric contents into esophagus
Events associated with vomiting x2
- Relaxation of diaphragm and upper esophageal sphincter
- Reversal of intrathoracic pressure from negative to positive
Describe effects of high and low tone of LES
High- leads to simple esophageal emptying > achalasia
Low- leads to reflux when gastric musculature contract
Multifactoral causes of rumination x4
Psychological
Behavioral
Involuntary
Dyspepsia (indigestion)
Vomiting centre is stimulated by x4
Chemoreceptor trigger zone
Vestibular system
Gastrointestinal
Cerebral cortex
Complications of vomiting x6
Metabolic alkalosis and electrolyte imbalance
Nutritional- malnutrition and failure to thrive
Mallory Weiss tear
Esophagitis
Aspiration
Shock
State location of thermoregulatory centers
Preoptic area of the anterior hypothalamus
Define malignant hyperthermia
A genetic disorder of the skeletal muscles that results in hypermetabolic response upon stimulation by volatile inhaled anesthetics or depolarizing muscle blockers
Infectious causes of fever x4
Malaria
Common cold
Gastroenteritis
Uncomplicated bacterial infections eg OM, pharyngitis, sinusitis
Inflammatory causes of fever x2
Vasculitis
Connective tissue disorder- IBD, SLE, RA
Neoplastic causes of fever 2x2
Haematological: lymphoma, leukemia
Solid tumors: wilms, neuroblastoma
Amber grading of fever characteristics x5
Wakes only with prolonged stimulation
Not responding normally to social cues
Nasal flaring
Crackles
RR >50bpm
Red high risk grading of fever characteristics x5
Does not wake, if aroused does not stay awake
No response to social cues
RR > 60bpm
Chest indrawings
Grunting
Investigations done on a febrile neonate x5
Blood culture
Urine culture
Stool culture
CSF culture
Chest radiograph
Causes of Late onset neonatal bacterial diseases x4
E coli
Group B strep
L monocytogenes
Perinatally acquired HSV (give acyclovir)
Serious bacterial infections in neonates x4
Meningitis, pneumonia, osteomyelitis, UTI
Treatment of febrile infant x4
Benzylpenicillin, gentamycin, ceftriaxone
Acyclovir if HSV is suspected
IV empiric antibiotics
Organisms causing serious bacterial disease in 1-3M infants x4
Hib, Ecoli
S aureus, L monocytogenes
S pneumonia, GBS
