GP paediatrics Flashcards
neonatal period is the period up until
4 weeks
neonatal jaundice can be
physiological or pathological
physiological jaunidce
nearly all babies are born with some physiological jaundice the baby transitions from relying on the placenta to clear bilirubin to using its own hepatic system
physiological jaundice is never visible
in the first day of life and if a neonate has jaundice within the first 24 hours f life there is always a pathological cause
in physiological jaundice
levels of conjugated bilirubin never suprasses
- 20% of the total serum bilirubin OR
- 2mg/dl if total serum bilirubin is greater than 5mg/dl
physiological jaundice normally resolved within
- 1 week in a full term infant
- 2 weeks in a premature infant
premature infant
gestation less than 37 weeks
prolonged jaundice
- 14 days or more in full term infants
- 21 days or more in pre-term infant
pathological jaundice definition
any jaundice that does not satisfy the criteria of being physiological jaundice
causes of pathological jaundice
- Rh incompatibility
- ABO incompatibility
- Crigler Najjar syndrome
- biliary atresia
Rh incompatibility
when a Rh negative mother has a resus positive child she produced Rh autoantibodies so if she has another pregnancy with a Rh positive baby the antibodies attack the foetus
ABO incompatibility
attack on red blood cells by maternal anti-ABO antibodies
Crigler Najjar syndrome
absence of the enzyme UGT1A1 resulting in the inability to conjugate bilirubin causing an indirect hyperbilirunaemia
biliary atresia
only prevents in neonates, defect in biliary tract which causes cholestasis, conjugated bilirubin is absorbed into the bloodstream as it cannot be transported into the duodenum therefore= direct hyperbilirunaemia
UTIS in neonates
UTI in neonates is associated with bacteramiea and congenital anomalies in the kidney and urinary tract
congenital hypothyroidism
INADEQUATE THYROID HORMONE PRODUCTION IN NEWBORN INFANT
Cause of congenital hypothyroidism
- anatomic defect in the thyroid gland (thyroid dysgenesis)
- inbred error of thyroid hormone synthesis/ metabolism
- iodine deficniency
- exposure to anti-thyroid medication during pregnancy
congenital hypothyroidism is the
most common neonatal endocrine disorder
symptoms of neonatal hypothyroidism
decreased activity, large anterior fontanelle, constipation, weight gain, jaundice, hypotonia, poor feeding
if congenital hypothyroidism goes untreated it causes
CRETINISM: severely stunted physical and mental development
if hypothyroidism remains untreated in a mother during pregnancy causes
- increased risk of abortion, pre-eclampsia, placental abruption, postpartum haemorrhage and a pre-term labour
- foetal neuropsychosocial development resulting in the child having an IQ of less than 7 points in children
gallactosemia
mutations in GALT, GALK1 AND GALE GENES, result in inability to process galactose, as these genes code for the enzymes that break down galactose
classic galactossemia is
type 1 which is the most common and most severe type if they are not treated with a galactose free diet it can be life-threatening causing failure to gaibn weight and growth, jaundice, liver damage and abnormal bleeding
breast milk intolerance
neonatal jaundice associated with breast feeding characterised by indirect hyperbilurinaemia in an otherwise healthy breastfed newborn where there is no other identifiable cause
breast milk intolerance persists
longer than physiological jaundice and develops and the first 4-7 days of life
causes of neonatal vomiting
- paediatric GORD
- cows milk protein intolerance
- pyloric stenosis
paediatric GORD
caused by immaturity of the lower oesophageal sphincter causing transient lower oesophageal relaxation causing retrograde flow of gastric contents into the oesophagus
cows milk protein intolerance
allergy which most commonly affects children in their first year of life, can be IgE or non-IgE mediated
neonatal sepsis is classified as
early onset or late onset
early onset neonatal sepsis is associated with
the acquisition of micro-organisms from the mother i.e. transplacental infection or an ascending infection form the cervix which may be caused by organisms that colonise a females GU tract and the neonate acquires the micro-organisms as it passes down the colonised birth canal at delivery
common micro-organism associated with early onset neonatal sepsis
- group B strep
- e.coli
- coagulase negative staph aureus
- haemophilia influenza
late onset neonatal sepsis si acquired from the
neonates environment
common micro-organisms in late onset neonatal sepsis
- coagulase negative staph
- staph aureus
- e.coli
- klebsiella
- pseudomonas
what is sepsis
a potentially life threatening complication of an infection, sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body, the inflammation can then trigger a cascade of changers that can damage multiple organ systems causing them to fail
sepsis can progress to
septic shock where blood pressure drops dramatically which can cause death
to be diagnosed with sepsis you must have
at least 2 of the following symptoms plus a probable or confirmed infection
- fever greater than 38.3 or less than 36
- heart rate greater than 90
- resp rate greater than 20bpm
severe sepsis
is sepsis and one of the following
- decreased urine output
- abrupt changes in mental status
- decreased platelet count
- difficulty breathing
- abnormal heart pumping function
- abdominal pain
septic shock
signs and symptoms of severe sepsis plus a low blood pressure which does NOT respond to adequate iV fluid resuscitation
paediatric presentations to GP
- respiratory problems
- GI problems
- dermatology problems
- MSK problems
common respiratory problems in paediatrics
- bronchiolitis
- croup
- asthma
bronchiolitis
acute inflammatory injury of the bronchioles usually caused by a viral infection most commonly the respiratory syncytial virus (RSV)
most common cause of bronchiolitis
respiratory syncytial virus
bronchiolitis occurs primarily
in children between the ages of 2-6 months of age
symptoms of bronchiolitis
breathing difficulties, cough, decreased feeding, irritability, wheeze or crepitations heard on auscultation
other causes of bronchiolitis
human metapneumovirus, adenovirus, parainfluenza virus
croup is also known as
laryngeotacheobronchitis
what is croup
inflammation of the upper respiratory tract predominantly the larynx and the trachea but it may affect the bronchi and is caused by a viral infection
symptoms of croup
non-specific symptoms of a viral URTI (runny nose, sore throat, fever, cough) which progresses over a few days to cause the classical BARKING cough and hoarseness, symptoms tend to be worse at night. stridor may be hear and there may be a mild to moderate fever
most common cause of croup
parainfluenza virus types 1,2,3 and 4
other causes of croup
RSV, adenovirus, rhinovirus, enterovirus, measles, metapneumovirus, influenza virus types A and B (type A is associated with severe croup)
management of croup
- oral dexamethasone for all
- nebulised adrenal in emergency
asthma
constriction of the bronchioles causing an obstructive lung defect resulting in wheezing, diurnal cough, chest tightness and difficult breathing
rare respirator presentation in GP
- cystic fibrosis
- acute epiglottis
- foreign body inhalation
cystic fibrosis
autosomal recessive disease caused by mutation in the CFTR gene on chromosome 7
cystic fibrosis results in
- high sodium content of sweat because CFTR does not absorb chloride ions which remain in the lumen and prevent sodium reabsorption
cystic fibrosis causes pancreatic insufficieny because
the production of pancreatic enzymes is normal but defects in ion transport produces relative dehydration of pancreatic secretions causing their stagnation in the pancreatic ducts
cystic fibrosis causes respiratory disease because
dehydration of the airway surfaces which reduces muco-cilliary clearance and increases bacterial colonisation, local bacterial defences are impaired by local salt concentrations and bacterial adherence is increased by changes in cell surface glycoprotein increased bacterial colonisation and reduced material clearance causes inflammatory lung damage due to an exuberant neutrophilic response involving mediators such as IL-8 and neutrophil elastase
cystic fibrosis causes biliary disease because
defective transfer across the bile duct causes reduced movement of water in the lumen so the bile becomes concentrated causing plugging
cystic fibrosis causes GI disease because
of intra-luminal water deficiency
acute epiglottitis
acute inflammation of the epiglottis which is rapidly progressive
usual age of presentation of acute eppiglotitis
in children between the ages of 2- 5 years old
most common cause of acute epiglottitis
haemophilia influenza but can also be caused by strep pneumonia
why is children epiglottis different to an adults epiglottis
because it is more anterior and superior
symptoms of acute epiglottis
fever, severe sore throat, drooling, muffled hot potato voice
management of acute epiglottis
IV ceftriaxone and emergency AIRWAY MANAGEMENT
FOREIGN BODY INHALATION
right bronchi is the most common site for foreign bodies to become lodged
respiratory rate in children aged less than 1
30-40
respiratory rate in children between 1-2
25-35
respiratory rate in children between 2-5
25-30
respiratory rate in churn between 5-12
20-25
repsiroaty rate in children over 12
15-20
medical causes of abdominal pain from birth to 1 year
- gastroenteritis
- UTI
- constipation
surgical causes of abdominal pain from birth to 1 year
- intussusception
- volvulus
- incarcerated hernia
other causes of abdominal pain from birth to 1 year
- infantile coli
- hirssprungs disease
medical causes of abdominal pain in 2-5 years old
- gastroenteritis
- UTI
- constipation
surgical causes of abdominal pain in 2-5 year old
- intussusception
- volvulus
- appendicitis
other causes of abdominal pain in 2-5 years old
- mesenteric lymphadenitis
- hence schenlen purpura
- DKA
- sickle cells disease
medical causes of abdominal pain in 6-11 years
- gastroenteritis
- UTI
- constipation
surgical causes of abdominal pain in 6-11 years
- appendicitis
- trauma
- testicular torsion
other causes of abdominal pain in 6-11 years
- mesenteric lymphadenitis
- abdominal migraine
- hence schoenlen purpura
- DKA
- sickle cell disease
- pneumonia
- functional abdominal pain
medical causes of abdominal pain in 12-18 years
- gastroenteritis
- UTI
- constipation
surgical causes of abdominal pain in 12-18 years
- appendicitis
- trauma
- ovarian torsion
- testicular torsion
other causes of abdominal pain in 12-18 years
- dysmenorrhoea
- DKA
- mittelschmerz
- ectopic pregnancy
- pelvic inflammatory disease
- IBD
dermatological presentaiotn
- erythema infectiosum
- molluscs contagiousm
- impetigo
- hand foot and mouth disease
- scarlet fever
scarlet fever
complication of a strep throat infection usually caused by group A strep most common in children under 10 years old
symptoms of scarlet fever
fever, redness of tongue with tiny white spots, sore throat, erythematous rash over cheeks abdomen and chest
red flags in paediatrics
- unresponsive to social cues and difficult to rouse
- health professional very worried
- weak, high pitched or continues cry
- grunting respiration or apnoea epidosed where Sp02 is less than 90%
- severe tachycardia/ tachypnoea or bradycardia
- no wet napped or not passed urine in the last 18 hours
- non- blanching purpuric rash/ mottled ashen or cyanotic
- temperature less than 36 degrees of if under 3 months greater than 38 degrees
