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CM - Pediatrics > GI, Ortho, Rashes and Infections > Flashcards

GI, Ortho, Rashes and Infections Flashcards

1
Q

diagnostic landmarks in adult vs child bone

A
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2
Q

What is the system used for grading fx through growth plate?

A

Salter Harris

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3
Q

Why do we care for injuries through growth plate???

A

Injuries to physis can result in premature closure

Partial closure may cause angular deformity

Complete closure may cause limb shortening

Most common locations: distal femur and distal/proximal tibia

Growth plate most susceptible to torsional and angular force

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4
Q

define type I-V Salter Harris grading system

A
  • Type I – fracture through growth plate only
  • Type II – fracture through metaphysis and growth plate
  • Type III – fracture through epiphysis and growth plate
  • Type IV – fracture through metaphysis and epiphysis
  • Type V – Crushed through growth plate
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5
Q

Common sites of grwoth plate fx

A
  • Distal radius
  • Distal tibia
  • Distal fibula
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6
Q

most common salter type fx?

A

Salter II

Fracture through portion of physis and metaphysis

Fracture passes across most of growth plate and up through metaphysis

Good prognosis

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7
Q

Grade fx ?

A

Salter I

Transverse fracture through the physis

Cannot occur if the growth plate is fused

Good prognosis, growth disturbance is unusual

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8
Q

Grade Fx

A

Salter II (most common)

Fracture through portion of physis and metaphysis

Fracture passes across most of growth plate and up through metaphysis

Good prognosis

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9
Q

grade fx

A

Salter III

Fracture through portion of physis and epiphysis into joint

Poorer prognosis because of intra- articular component and because of disruption of growing or hypertrophic zone of the physis

7-10%

Fracture plane passes through epiphysis and growth plate

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10
Q

Grade Fx

A

Salter IV

Fracture through metaphysis, physis, and epiphysis

high risk of complication

Poor prognosis

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11
Q

Grade Fx

A

Salter V(crush)

Crush injury of the physis

Crushing type injury does not displace growth plate but damages it by direct compression

Worst prognosis –>Subsequent growth arrest of this area confirms presence of SalterHarris type V injury

Complete obliteration or diminished physeal distance of the affected extremity confirms the diagnosis

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12
Q

More likely to require surgical fixation if

A
  • Displaced epiphyseal fractures
  • Displaced intra-articular fractures
  • Fractures in child with multiple injuries
  • Open fractures
  • Unstable fractures
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13
Q

complciations of Fx

A

•Overgrowth

  • In long bones, result of increased blood flow associated with fracture healing
  • Femoral fractures in children <10 can overgrow 1-3 cm
    • So end-to-end alignment for femur and long-bone fractures may not be indicated
  • After 10 y/o age, overgrowth less of a problem, end-to-end alignment is recommended

Neurovascular Injury

  • Common locations: distal humerus and knee

Compartment Syndrome

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14
Q

Fracture remodeling Process

A
  • Periosteal resorption
  • New bone formation
  • No need perfect anatomic alignment
  • Younger patients have greater potential for fracture remodeling
  • Rotated fractures, and fracture deformity not in ‘plane of motion’ don’t remodel as well
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15
Q

Incomplete fracture of long bone produced on convex cortex, while concave cortex bends

Dx? MOI?

A

Greenstick Fx

Results from bending force applied perpendicular to shaft

•FOOSH

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16
Q

Type of incomplete fracture

occurs at metaphyseal-diaphyseal junction –>FOOSH

A

Buckle or Torus Fx

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17
Q

How do Toddlers Fx present

A

Presents limping and pain with WB, but minimal swelling and pain

*Often no trauma recalled

*Patients usu. 1-3 y/o

Minimally/nondisplaced oblique fx of- Tibia without fibula fx

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18
Q

define Supracondylar Elbow Fx & MOI

A

Extra-articular fracture of distal humerus at elbow

  • occurs in children between 5-9 y/o
  • 50% to 70% of all peds elbow fracture

Almost always due to accidental trauma

  • FOOSH from a moderate height (bed/monkey-bars)
  • Typically (>90%) onto extended elbow

Result in an extra-articular fracture line

Posterior displacement of the distal component

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19
Q

tx of Supracondylar Elbow Fx

consrvtaive

surgucal

A

Conservative

  • Long arm cast after initial splint
  • Analgesics
  • Serial radiographs (q 1-2 wks.)

Reduction with Pin Fixation

  • Two lateral pin technique for stable fixation with a medial pin
  • Correct medial pin placement is critical
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20
Q

comapre contrast

Galeazzi Fracture Dislocation

Monteggia Fracture Dislocation

A

Galeazzi Fracture Dislocation: FOOSH w/ flexed elbow

Fracture of distal radius + Dislocation of distal radioulnar joint (DRUJ)

  • I_ntact ulna_
  • 9-12 years of age

Monteggia Fracture Dislocation: secondary to FOOSH

  • Fracture of ulna shaft+ Dislocation of radial head
  • Displaced and overlapped _fracture of the ulnar shaf_t
  • Radial head is dislocated anteriorly
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21
Q

define MUGR & GRIMUS

A

Galeazzi involves fracture of the radius (MUGR)

Monteggia involves fracture of the ulna (MUGR)

GRIMUS

G: Galeazzi

R: radius (distal radioulnar joint (DRUJ)

I: inferior

M: Monteggia

U: ulna (dislocation of radial head anterioirly)

S: superior

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22
Q

Tx of Monteggia Fracture Dislocation

A

ORIF

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23
Q

Nursemaids Elbow MOI

Tx

A

pulled/lifted by the hand NO FALL!!- yanked by arm

  • Radial head subluxes under Annular Ligament

Tx by pressure on radial head and gentle supination while flexing the elbow

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24
Q

How is DDH dx?

A

Common pediatric orthopedic condition - Focus of newborn evaluation (Barlow THEN Ortolani)

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25
Q

DDH si/sx in infant/child

A
  • Toe walking- can be unilateral
  • Limb length inequality
  • Waddling Gait
  • Hyperlordosis (Swayback)
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26
Q

DDH Diagnosed with spectrum of anatomic abnormalities including:

A
  • Hip that is dislocated and irreducible
  • Unstable (dislocatable and reducible)
  • Dysplastic, but within acetabulum
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27
Q

Tx of DDH

A

Pavlik Harness - Double-diaper

Abduction orthosis (if Pavlik harness fails)

If all conservative measures fail or >6months of age

  • Closed reduction 1st option
  • Open reduction if closed reduction fails
  • •pica cast to hold hip/hips in reduced position

*US post application- verify position of harness

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28
Q

Legg Calve Perthes- LCP stages of Dz?

A
  1. Necrosis: Initial period of ischemia/loss of blood supply to femoral head
  2. Fragmentation: Re-absorption of bone with femoral head collapse
  3. Re-ossification: New bone regrows to reshape the femoral head
  4. Remodeling: Femoral head reshapes itself into spherical shape
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29
Q

define LCP

A

Idiopathic osteonecrosis of capital femoral epiphysis

Vascular interruption to subchondral bone

Peri-articular cartilage not affected

Epiphyseal changes due to subchondral Fx

  • Ages 2-14 (mostly 5-8 years of age)
  • Boys 5x > Girls
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30
Q

si/sx of LCP

A

male - Small for age

Very active or hyperactive

Pain may be non-specific

  • Anterior hip, thigh or knee
  • Insidious onset (maybe weeksmonths)

Mild limp

Usually no history of trauma

Limited motion: abduction + internal rotation

Guarding with leg rolling

Atrophy of quad muscle secondary to disuse

Leg length inequality -collapse of femoral head

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31
Q

imaging of LCP

A

AP Pelvis and Frog Lateral - Compare to contralateral side

  • Early changes: smaller epiphysis, radiodense (sclerosis)
  • Crescent sign or mild flattening
  • Metaphyseal radiolucency
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32
Q

Tx of LCP

A

Self-healing in 2-4 years

Problem: Not all end up with a spherical head

  • Can produce permanent femoral head deformity and early arthritis in adulthood

Poorer outcome in older patients >8 years of age

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33
Q

si/sx of Slipped Capital Femoral Epiphysis- “SCFE”

A

Obese boy

(+) limping

Intermittent groin/knee pain (weeks –months)

Sudden onset of pain in groin/hip - Maybe after fall or trauma

Inability to walk/bear weight on affected leg

Shortened, externally rotated leg with significant slip/grade

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34
Q

tx of Slipped Capital Femoral Epiphysis- “SCFE”

A

Operative stabilization of the fracture/ ‘slip’

  • Percutaneous Screw Fixation

Goal: to stabilize the physis and prevent any further slippage…ultimately further complication

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35
Q

Most common cause of hip pain in children

A

Transient Synovitis of Hip

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36
Q

si/sx of Transient Synovitis of Hip

A

follows URI. +/- low grade fever :

Rapid onset of limping and subsequent refusal to walk/bear weight

ROM of hip limited by pain and spasm, hip held in flexion

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37
Q

dx of Transient Synovitis of Hip

A

*Diagnosis of exclusion

Labs: +/- mild elevation of WBC, ESR, CRP

X-ray: AP Pelvis/frog-leg lateral. Usu. normal, may show slight joint space widening

US: Evaluate effusion (negative

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38
Q

tx of transient hip synovitis

A

Bed rest until symptoms and signs improve

Gradual increase of activity

NWB generally lasts 1-2 days

May have limp and decrease ROM up to two weeks

NSAIDs – wt. based

No Abx due to not infectious etiology

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39
Q

define Apophysitis & 2 types

A

Apophysitis= painful inflammation of a bony outgrowth and in an area of active Growth at the end of a bone

Osgood-Schlatter’s

Sever’s “Disease”

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40
Q

Traction at insertion of patella tendon into tibial tuberosity

Pain over tibial tuberosity relieved with rest

Can be bilateral

Prominent tibial tubercle

A

Osgood-Schlatter’s

Think ‘4-sport’ per year

During a growth spurt

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41
Q

tx of Osgood-Schlatter’s

A

Rest , Avoidance

Out of sports

Ice & NSAIDs

Knee immobilizer for a few days to quiet symptoms

Reassurance

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42
Q

tx of Severs Dz

A

RICE& NSAIDS, DC sports moderate/severe

Gel heel pads if mild; ½” heel inserts if moderate or worse (wear in both shoes for symmetry)

Stretching of Achilles’;

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43
Q

Common cause of heel pain in children

dx & MOI

A

Sever’s “Disease”

Repetitive stress (Running, jumping, etc.) on growth plate as foot strikes ground results in inflammation/pain

•Often seen beginning of new season of sports

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44
Q

si/sx of severs dz

A

heel pain bad enough to cause a limp

Noticed initially after sports

Then during and after activity ends

As it progresses, pain without running/jumping

Pt. will often report “new cleats” or footwear

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45
Q

compare and contrast physiologic vs pathologic varus/valgus

A
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46
Q

Physiologic Genu Varum AKA ??

A

Bowlegs

Symmetric Varus

Age: 0-2 years

Normal growth plate on x-ray

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47
Q

Physiologic Genu Varum (bowlegs) Worrisome clinical features

A
  • Lateral thrust during gait
  • Short stature
  • Ligament laxity
  • Abnormal location of the deformity
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48
Q

XR for physiology genu varum IF???

A
  • Asymmetry
  • Atypical age
  • Worsening deformity
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49
Q

Name causes of Pathologic Genu Varum

what is diagnostic?

A

Osteochondral dystrophy

Rickets

Tibia varum/Blount’s

DX; X-rays

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50
Q

define Pathologic Genu Varum

blounts

rickets

A

Blounts Dz - Progressive deformity unilateral

  • Early walking, obesity,
  • Family history of Blount’s
  • Lateral Thrust during gait
  • If a child >2 y/o still has Genu Varum → refer

Rickets

  • Short Stature
  • Enlargement of elbow, wrists, knee, and ankles
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51
Q

Physiologic Genu Valgus- AKA???

A

“Knock Knees”

Normal growth plate on x-rays

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52
Q

Presents when toddler begins to walk +/-Limits ankle dorsiflexion

+/-Reduction of ankle dorsiflexion

Normal neurologic exam

A

Toe Walking

53
Q

toe walking is dx of exclusion , must r/o???

A

Neuromuscular disorder

  • Cerebral Palsy
  • Autism
  • Due to increase in vestibular stimulation
54
Q

tx tow walking

A

PT: Heel-cord stretching

Serial casting

Surgical: Heel-cord lengthening

55
Q

Differentiate from metatarsus varus by seeing the _____ in club foot

A

Differentiate from metatarsus varus by seeing the Equinus in club foot

  • Equinus = the inability of the ankle joint to dorsiflex
56
Q

Pathology of club foot

A

Pathology

•Equinus, Adductus, Varus, and medial rotation

57
Q

tx of club foot

A

surgery (heel cord lengthening) and/or serial casting

Serial casting - Casting 3-6 weeks, heel cord lengthening, shoes with brace full time for thee months, then nights and naps till 4 years old.

PT guided daily stretching, taping

Goal of Treatment

  • Flexible, “shoe-able” foot
  • Foot, leg never looks entirely normal in true congenital clubfoot deformity
58
Q

define scoliosis

3 types

A

Lateral spinal curvature with a Cobb angle of >10°

  1. Idiopathic- 90% F, +/- fam. hx, adolescent growth spurt
  2. Congenital- vertebral abnormality
  3. Neuromuscular- underlying d/o
59
Q

explain scoliosis exam and what we observe for

A

Pt should stand erect with feet slightly apart, knees straight, and arms hanging loosely at sides

Observe for

  • •One shoulder higher than the other
  • •Larger space from arm to side of body(compare both sides)
  • •Uneven waist creases
  • •Uneven iliac crest levels
  • •Forward Bend –> Rib prominence
60
Q

Dx / imaging of scoliosis

A

Full length Scoli X-ray series

61
Q

tx of scoliosis

nfant and Juvenile (3-10 yo)

Adolescent

A

3 - O’s Observe, Orthosis , Operation

Infant and Juvenile (3-10 yo)

  • Observe to 25 degrees
  • Orthosis >25 degrees
  • Operate >40 degrees

Adolescent

  • Observe to 30 degrees
  • Orthosis 30 to 40 degrees
  • Surgery > 40 degrees or rapidly progressing curves
62
Q

the normal bony outgrowths that arise from separate ossification centers and eventually fuse with the bone in time

A

Iliac Apophysis

63
Q

how is Iliac Apophysis classified??

A

Risser classification:

•Grades skeletal maturity based on level of ossification of iliac crest apophyses

64
Q

describe 5 stages of Risser classification of ilkiac apophysiss

A

stage 0: no ossification

stage 1: apophysis 25-50% of iliac crest

stage 3: apophysis >50-75% of iliac crest

stage 4: apophysis >75% of iliac crest

stage 5: complete ossification and fusion of iliac crest apophysis

65
Q

•Most common bacterial infection in children

A

Impetigo

66
Q

name pathogens fo Impetigeo

A

Both - Type 1 Non-bullous (most common)

S. aureus - Type 2: Bullous

Β-hemolytic strep group A - Type 3: Ecthyma

67
Q

si/sx of type 1 , 2 and 3 impetigo

A

Type 1 Non-bullous (most common)

  • Papules on the face ® vesicles & erythema ® pustules ® golden ”honey colored” crusts
  • May have regional lymphadenitis
  • NO systemic symptoms

Type 2: Bullous

  • Vesicles ® flaccid bullae with clear fluid ® rupture leaving thin brown crust
  • Fewer lesions
  • Affects trunk
  • Related to pemphigus
  • Due to Staph Aureus that produce exfoliative toxin A à loss of cell adhesion in superficial dermis

Type 3: Ecthyma

  • “Punched-out” ulcers –> covered w/ yellow crust that is surrounded by violaceous raised margins
  • Affect dermis and epidermis
  • ulcers
68
Q

tx of impetigo

topical

oral

A

Tx for BOTH = Staph Aureus and Strep A

Topical therapy (limited dz)

  • Mupirocin (Bactroban) TID
  • Retapamulin (Altabax) BID

Oral therapy (extensive dz) - bullae, multiple lesions in multiple locations

  • Dicloxacillin 250 mg QID
  • Cephalexin (Keflex) 250 mg QID
  • Clindamycin
  • Bactrim (MRSA)
69
Q

cause of Pinworms

tx?

A

Enterobius vermicularis

Albendazole (Albenza) 400 mg

  • (tx & repeat- 2 wks to kill eggs)

Pyrantel pamoate (OTC)

T_x family members & Good hygiene_

70
Q

tx of Enuresis

A

DDAVP–> ↑ ADH –> ↓ in urine output

Other treatments…

  • •Moisture alarms
  • •Scheduled voiding
  • •Decrease bladder stimulants like caffeine
  • •Limit fluid intake before bed
71
Q

Anatomical abnormalities: Vesicoureteric reflux

•If family history of GU reflux…watch for unexplained fevers in new sibs

responsible for???

A

pedi UTI

72
Q

si/sx of UTI in infancy

dx??

A

URI SXS WITH FEVER AND <3MO

Dx: catheterized specimen

73
Q

si/sx of UTI in

children

teens

A

CHILDREN:

  • Toilet training & poor wiping
  • Constipation / withholding
  • ABDOMINAL PAIN, maybe dysuria and frequency
  • CLEAN CATCH SPECIMEN WHEN TOILET TRAINED
  • Male – get workup !!
  • Female – workup second UTI

TEENS:

  • STI / sexually related until proven otherwise
  • E COLI
  • PROTEUS (does not show on cx)
  • Pee after se F
74
Q

pathogens responsible for??

Measles (Rubeola)

Rubella (German measles)

Fifth disease (Erythema infectiosum)

Infectious Mono

Roseola

Hand, foot, & mouth

A

Measles (Rubeola) - Paramyxovrius

Rubella (German measles) - Toga virus

Fifth disease (Erythema infectiosum) - Parvovirus 19

Infectious Mono - EBV)

Roseola =HHV-6 & 7

Hand, foot, & mouth - Coxsackie virus

75
Q

Prodrome (ex. cough, coryza, conjunctivitis, fever)

•Macular, morbilliform rash starting on head, spreading to extremities (cephalocaudal)

Erythematous papules (palms/soles affected)

Koplick spots - white spots on mouth (“stuck on appearance”

A

Measles (Rubeola)

76
Q

dx Measles (Rubeola)

A

Measles IgM abs

Measles RNA by PCR

Serum and NP swab

Can also collect urine

77
Q

tx measles

A

MMR vaccine ppx - within 72 hours of exposure Immunoglobulin – 6 days of exposure

Vitamin A - administered immediately on diagnosis and repeated the next day.

  • Vitamin A deficiency –> delayed recovery and high rate of complications.
  • measles infection =acute vitamin A deficiency & xerophthalmia (severe dry eye).
  • measles –> preventable childhood blindness,
78
Q

si/sx of Rubella

cpmplications

A
  • No prodrome +/- low-grade fever
  • +/- lymphadenopathy , arthralgia – older kids & adults
  • Pale pink morbilliform macules

complications: birth defects in pregnant women

79
Q

si/ sx of Fifth disease (Erythema infectiosum)

Day 1-2

Day 2-5:

A

Day 1-2

  • Fever
  • HA
  • N/V/D

Day 2-5: RASH (no transmission after rash)

  • Acute onset asymptomatic diffuse, macular erythema (slapped cheek)
  • Lacey, reticular pattern formation
  • Circumferential pallor
80
Q

si/sx of mono

A
  • Fever, fatigue
  • Pharyngitis/tonsillitis (“kissing tonsils”) - pharyngeal erythema; exudates; petechiae
  • Posterior cervical lymphadenopathy
  • Splenomegaly
  • Non-specific rash- maculopapular~ urticarial~ petechial (following use of PCN/Ampicillin or azithromycin, levoquin, cephalexin
81
Q

dx mono

A

Atypical lymphocytosis – early

Heterophil Ab monospot - horse RBC agglutination

EBV panel – si/sx of IM , heterophile (-)after retesting 1 week later -> EBV panel

  • IgM and IgG VCA and EBNA (nuclear antigen –only in latency stage)
  • If EBV panel (-)–> CMV, HIV, Toxo, HHV6 or 7, Hep B
82
Q

mono Splenic Rupture Precautions

A

3 weeks mild activity

min 4 weeks for contact/high risk sports and activities

Or longer if spleen enlarged by palpation or ultrasound

REST during periods of fatigue but bedrest not necessary

83
Q
  • Sudden onset high fever (102-104)- fver subsides and THEN —>
  • Asymptomatic SUDDEN rash (trunk & extremities)

pathogen & Dx?

A

Roseola

HHV-6 & 7

84
Q

si/sx of hand, foot and mouth

A
  • Aphthous stomatitis
  • Rash on hands & feet
  • Fever
  • Poor-feeding
  • Irritability
85
Q

tx of hand foot and mouth

A
  • Supportive (self-limiting)
  • Antipyretics (ex. Tylenol, Motrin)

•Magic mouthwash- Benadryl and maalox to coat the oral lesions

•Anticipatory guidance

86
Q

•Faint macules = vesicular eruptions (dew on a rose petal)

dx?

A

Varicella

dx Tzank smear (multinucleated giant cells)

87
Q

define straabismus

eso vs exo

latent

manifest

A

Nasal Deviation (eso-)vs. Temporal Deviation (exo-)

Latent = Phoria

  • present when fixation interrupted (Esophoria vs exophoria)

Manifest = Tropia

  • present without interruption of gaze (Esotropia vs exotropia)
88
Q

dx strabismus

A
  • Hirshberg
  • Cover
  • Cover/uncover
  • Bruckner red reflex
89
Q

tx of strabismus

A

Medical

  • Glasses
  • Miotic drops
  • Patching
  • Visual training exercises

Surgical: Reposition/shortening

90
Q

when to refer strabismus

A

+constant esotropia at any age

+ persistent esodeviations after 4 mo

+deviation with corneal light reflection test or cover test

+ Asymmetry of appearance on Bruckner test

+ deviations that change with position of gaze (incomitant)

+ inexplicable torticollis with strabismus

Any parental or provider concerns

91
Q

define kawasaki dz

A

Widespread inflammation of medium sized blood vessels throughout the body

VASCULITIS - Most common childhood vasculitis

  • Most importantly affects the vessels of the heart
  • Long term affects seem to be only on ARTERIES
  • Most visibly affects mucous membranes
92
Q

si/sx of kawasaki

A

CRASH” and BURN

Non- exudative Conjunctivitis (bilat bulbar conjunctival injection)/cheilitis

Rash (polymorphous, desquamations involving perineum)

Adenopathy (cervical) - sinuglar and large

Strawberry tongue

Hand & feet (desquamation, swelling, erythema)

Fever (>5 days)

Redness and induration at the site of a previous vaccination with Bacillus Calmette-Guérin (BCG

93
Q

dx studies for kawasaki

A

Baseline echocardiogram

INC ESR & PLTS

Sterile pyuria

Each patient with diagnosis will have cardiac echo to detect CA aneurysms

  • repeat in 4-6 weeks to document resolution
94
Q

dx criteria for kawasaki

A
95
Q

tx of kawaskai

A

Hospital admission for CV monitoring

  • Must have cardiology consult at DX

IVIG 2g/kg - ↓ RISK OF CA ANEURYSM (day5-7)

Aspirin

Steroids- if IVIG fails twice (methylprednisolone)

TNF-I (infliximab)- consider only if IVIG fails twice

96
Q

complciation of kawasaki

A

•Coronary artery aneurysm

97
Q

Fetal hydrops in utero - hydrops-fetal demise

is a complication of??

A

Fifth disease (Erythema infectiosum

98
Q

dz characterized by

post prandial non bilious PROJECTILE VOMITING –> feel better then want to eat again

Hungry after vomiting

A

Pyloric Stenosis

P - Peristalsis (Visible peristalsis in abdomen)
Y - Yuck! So the kid vomits everything he eats (non bile stained vomiting)
L - Lump in abdomen which is on the Left side
O - Olive mass, Doughnut sign on USG
R - Ramstedt’s pyloromyotomy, mass moves on Respiration
I - Imbalance of electrolytes
C - Circular muscle hypertrophy

99
Q
  • Palpable OLIVE RUQ (felt best after vomiting)
  • Peristaltic Waves may be visualized pre-emesis
A

pyloric stenosis

100
Q

dx pyloric stensosi

A

ULTRASOUND (or ugi)

Endocscopy (only if above inconclusive)

Check electrolytes to measure (de)hydration status (BMP)

101
Q

tx pyloric stenosis

A

Correct hydration status FIRST

SURGICAL : PYLOROMYOTOMY

Ramstedt pyloromyotomy

  • •Minimally invasive
  • •Low complication Rate
  • •Longitudinal incision over pylorus with blunt dissection
  • •To level of submucosa,
  • •relieves the constriction
102
Q

TRIAD of pain-palpable mass- current jelly stool

A

Intussusception

103
Q

pathogens responsible for Intussusception

A

Virus: Rotavirus, Uri, OM, flu

104
Q

Intussusception Lead point from underlying pathology

A

Meckel diverticulum

  • Polyp
  • Lymphoma
  • Cysts
  • Vascular malformations parasites

•HSP- Henoch Schonlein Purpura

105
Q

define Intussusception

A

Invagination (telescoping) of the intestine into itself

•Most common cause of obstruction 6-36 mo of life

106
Q

dx imaging for Intussusception

A

Xray to r/o obstruction

  • Lack of colonic gas with massively distended loops of bowel
  • Target sign over right kidney (peritoneal fat surrounding intuss)
  • Crescent sign is soft tissue density procting into gas of large bowel

Ultrasound

  • Sensitivity/specificity close to 100% if skilled rads
  • Classic appearance is “bull’s eye” or “coiled spring”
  • Doppler may show poor/absent perfusion
107
Q

•Classic appearance is “bull’s eye” or “coiled spring” on US id Dx for??

A

Intussusception

108
Q

tx Intussusception

A

Non-operative: Tx of choice in stable pts w/o__perforation

  • Enema with hydrostatic (barium) or pneumatic (air) pressure
  • flouroscopic or u/s guidance
  • 80-95% successful (best if idiopathic etiology)
  • PPX antibiotics considered but not necessarily used
  • 10% recurrence
  • Requires surgeon in the suit in case of perforation

SURGICAL: Indicated if failed non operative approach

  • Suspected or proven perforation or bowel necrosis
  • Risk approx 1 % after surgical rx.
109
Q

etiology of PKU

A

Deficiency of Phenylalanine Hydroxylase (PAH)

  • PAH catalyzes conversion of phenylalanine to tyrosine

No PAH = increase serum and urine phenylalanine

  • INCREASE phenylalanine–>intellectual disability
  • ↑ phenylalanine may interfere with brain growth, myelination and neurotransmitter synthesis
110
Q

si/sx of PKU

A

Mental disability and impaired IQ

Epilepsy

Abnl gait

Blood and urine may smell “mousy”

Pigmentation issues

Eczema

111
Q

dx PKU

tx

A

Method of testing is tandem mass spectrometry

avoidance of PKU foods

112
Q

si/sx of Appendicitis

<1mo

<5 yo

​5-12 yo :

A

<1mo – RARE

<5 yo

  • Listless
  • Low grade fever (100.2-101)
  • w/ diffuse pain, anorexia, vomiting
  • rebound, guarding … perf!!

5-12 yo : much more common

  • Present with abd pain, anorexia and vomiting.
  • migratory pain to RLQ
  • Kids may limp or bend over
  • May complain of hip pain
113
Q

dx apendicitis

A

CBC/diff- elevated wbc and polys

UA- r/o uti- sterile pyuria in kids, do NOT let it fool you

UHCG- r/o pregnancy (nl and ectopic)

US - young, thin, female or male that are at no more than moderate risk after pe and labs

Consider CT without rectal contrast if :

  • Ultrasound inconclusive
  • Not a good u/s candidate

•The surgeon requests the CT

114
Q

tx apendicitis

non perf

perf

A

Non perforated :

  • •Fluids
  • •Pain control- anti pyretics& emetics
  • •NPO
  • •Pre op antibiotics (cefoxitin)
  • •Surgery

Perforated

  • •Fluids
  • •Pain control + anti pyretics/ emetics
  • •NPO
  • •Triples (amp/gent/flagyl)

SURGERY:

  • within 6-8 hours of dx if non perforated
  • If perforation, may use IV antibiotics for 24-48 hours and then surgery
115
Q

tx of constipation

infants

older children

A

Infants

  • Glycerine suppository
  • Lubricated thermometer

Older children

  • Glycerine suppository
  • MIRALAX
  • Enema ?
  • Laxative ?
116
Q

causes of constipation

organic

functional

A

Organic <5%

Anatomic: Anal Stenosis, imperforate anus, pelvic mass

Metabolic: hypothyroid, cf, dm, gluten

Neuropathic: spinal cord, neurofibromatosis, tethered cord

Intestinal nerve or muscle disorders: eg Hirschsprung

Abd musculature disorder: Prune belly, Down Syndrome

Food intolerance heavy metal ingestion, meds

Functional

  • Painful defecation
  • Toilet training issues
  • Dietary issues
  • Trauma
117
Q

etiology of Hirschsprung Disease

A

Primarily mutations of the RET proto-oncogene

  • Incomplete migration of neural cells in the myenteric and submucosal plexus

PART OF THE COLON LACKS GANGLION CELLS

  • This results in the affected segment constricting, thus the normal PROXIMAL segment becomes distended with feces

75% of the time the aganglionic region is rectosigmoid

8% of the time it is the entire colon

118
Q

si/sx of Hirschsprung dz

newborn

child

A

Newborn: Failure to have complete stooling or stool

Child:

  • Swollen belly, vomiting, constipation, diarrhea
  • Failure to thrive, fatigue
119
Q

dx & Tx of Hirschsprung Disease

A

dx: Biopsy- gold standard

  • Manometry of anorectum
  • Barium enema
  • Xray

tx: Surgical excision of the affected area with anastomosis of the healthy ends.

120
Q

explai rule of 2s and where meckles dievrticulum is located

A

Rule of 2’s:

  • •2 % of population
  • •2:1 males to female ratio
  • •2 years old is the most common time of presentation

Where is it ?

  • •2 feet proximal to the ileocecal valve
  • •2 inches in length
121
Q

Hirschsprung dz 75% of the time the aganglionic region is _______.

A

Hirschsprung dz 75% of the time the aganglionic region is rectosigmoid

122
Q

dx and tx or meckles

A

dx (“incidentaloma”)

treated with excision

123
Q

define malrotation

A

Congenital anomaly of the mid gut leading to:

  • Small intestine found on R side abdomen
  • Cecum displaced into epigastric region
  • Ligament of Treitz displaced
  • Fibrous bands form leading to obstruction
  • Narrow base of small intestine –>è volvulus

volvulus - Twisting that can –> ischemia –> perforation etc

124
Q

si/sx of malrotation

A

Infants present with symptoms of volvulus or obstruction

  • BILIOUS vomiting
  • Abdominal pain= fussy, crying, not eating/drinking
  • Abdominal distention
  • Melena and or mucousy stool
125
Q

dx of malrotation

A

Abd xray: obstruction

UGI series if not emergent

  • corkscrew appearance of the distal duodenum

Contrast enema if very doubtful

126
Q

Most common cause of Encopresis is ____?

A

Most common cause of Encopresis is constipation

127
Q

dx criteria for encopresis

A
  1. Voluntary / involuntary passage of stool outside bathroom or diaper
  2. One event a month for at least 3 mo
  3. >4 yrs old
  4. Stooling not result of laxatives or illness involving colon such as colitis
128
Q

tx of encopresis

A

Miralax – LOTS

Stool softeners

Scheduled stooling

CM - Pediatrics (3 decks)

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