Paediatric Flashcards
Necrotising enterocolitis
RF
onset directly proportional to GA
Premature infants
Distension - symmetric, asymmetric with focal distension, persistent loop sign
Pneumatosis
Portal venous air
Pneumoperitoneum
Common associations of intestinal malrotation
5
CDH Omphalocoele Gastroschisis Prune Belly Xd Heterotaxy
DDH - Demo, RF
4
Ossification is delayed
F>M (5:1) Bilateral 25%, L>R Breech Oligohydramnios Swaddling FHx
Perkins line
Hilgenreiner line
vertical line tangential to outer margin of acetabulum
Intersects proximal femoral metaphysis in inner third
Horizontal line through tri-radiate cartilage
Acetabular angle
<28 at birth
<22 at 1 year
Angle formed by line tangential to bony acetabulum and horizontal line through triradiate cartilage
Perthes disease
Demo
5-8 years
M>F 4:1
Caucasians
Bilateral in 15%, asymmetric
SCFE
Demo
12-15yrs M>F African Americans Obese/tall Bilateral 20-30% asymmetric
Bowing of legs
Genu vara/tibia vara
6 causes
Physiological upto 2 yrs Blounts Rickets Renal osteodystrophy Osteogenesis imperfecta Fibrous dysplasia
Prostaglandin periostitis
Administration of PG to maintain patency of ductus causing diffuse, symmetrical periosteal reaction in neonates.
Pentalogy of Cantrell
Cephalic fold defect
CHD Ventral hernia Sternal defect Absent anterior diaphragm Pericardial defect
Choledochal cyst types
6
type I: most common, accounting for 80-90% 1 (this type can present in utero)
Ia: dilatation of extrahepatic bile duct (entire)
Ib: dilatation of extrahepatic bile duct (focal segment)
Ic: dilatation of the common bile duct portion of extrahepatic bile duct
type II: true diverticulum from extrahepatic bile duct
type III: dilatation of extrahepatic bile duct within the duodenal wall (choledochocoele)
type IV: next most common
IVa: cysts involving both intra and extrahepatic ducts
IVb: multiple dilatations/cysts of extrahepatic ducts only
type V: multiple dilatations/cysts of intrahepatic ducts only (Caroli disease)
type VI: dilatation of cystic duct.
Oesophageal atresia types
5
type A: isolated esophageal atresia (8%)
type B: proximal fistula with distal atresia (1%)
type C: proximal atresia with distal fistula (85%)
type D: double fistula with intervening atresia (1%)
type E: isolated fistula (H-N type) (4%)
Duodenal atresia
No recanalisation - atresia
Partial recan - stenosis/web
80% distal to ampulla of Vater
Assoc : annular, preduodenal PV, other atresias, CHD, Down(30%), VACTERL
Functional immaturity of the colon
Abnormal colonic motility
Infants of diabetic mothers, mothers on Mg SO4
No assoc with CF
Urachal anomalies
4
Complication 1
Patent urachus (50%) Urachal cyst ( 30%) Urachal sinus (15%) Vesicourachal diverticulum (5%)
complication : (mucinous) adenocarcinoma
VUR Grade
5
grade 1: reflux limited to the ureter
grade 2: reflux up to the renal pelvis
grade 3: mild dilatation of ureter and pelvicalyceal system
grade 4
tortuous ureter with moderate dilatation
blunting of fornices but preserved papillary impressions
grade 5
tortuous ureter with severe dilatation of ureter and pelvicalyceal system
loss of fornices and papillary impressions
Lost face sign in CT kidney
Loss of normal renal pelvic fat at hilar level in duplicated systems
Weigert Mayer Rule
Upper pole ureter inserts ectpically inferomedially with associated ureterocoele
Lower pole ureter inserts normally and is prone to reflux.
Upper pole seen on USS (hydronephrotic)
Lower pole seen on MCUG ( reflux)
Most common stone types forming staghorn calculi
Struvite
Cystine/uric acid less common
Associations of simple renal cysts (HU<20) in paediatrics (<0.5%)
4
TS
VHL
Carolis
NF
Multicystic dysplastic kidneys
Most common cystic renal disease in infants.
Extra renal atresia causing abnormal cystic expansion of tubules
Usually unilateral ( bilateral- lethal) NON communicating cysts of varying sizes
30-50% contralateral anomalies
Rare - malignancy (wilms/RCC)
DTAP - void. No excretion.
ADPKD
50% cysts within 1st decade Associated cysts ( liver 75%, pancreas 10%, cerebral berry (5-10%)
ARPKD
enlarged hyperechoic kidneys 1-2mm cysts Periportal fibrosis and duct dilatation Pancreatic fibrosis Striated nephrogram
Von Hippel Lindau
manifestations
AD multisystem Haemiangioblastomas Renal cysts/RCC Adrenal phaeo ( Type II) Pancreatic cysts Islet cell cystadenomas
Wilms tumour
demo
B/L
Signs
mean age 3 yrs Bilateral 5% (Beckwith) Claw sign/pseudocapsula Calcifications CE + Tumour thrombus
Paediatric renal malignancy with frequent bone metastases
Renal medullary carcinoma
frequent in sickle cell trait, clear cell sarcomas
`Frontonasal masses
fonticulus frontalis >frontonasal suture
Prenasal space > foramen caecum
Epidermoid/dermoid - anywhere along the tract of patent foramen caecum(prenasal space)
“glioma” - misnomer, brain heterotopia, 15% connection to subarachnoid space.
Encephalocoele - meningo or meningoencephalocoele (naming : roof-floor eg frontonasal
Pott’s puffy tumour - frontal sinusitis > frontal osteomyelitis> subperiosteal abscess
Fibrous dysplasia (leontiasis ossea)
2nd Branchial cleft cyst (80-90%) - mandibular angle
Bailey Classification
4
Type I : superficial to SCM
Type II : between scm and carotid sheath
Type III : splays ICA/ECA
Type IV : deep to carotid, touches pharyngeal mucosa
1st Branchial cleft cyst
Arnot Classification
associated with parotid gland
Type 1 - no connection to EAC
Type 2 - tail or communication with floor of EAC
Paediatric H&N : Cystic masses
6
Encephalocoele Branchial cleft cyst (Dermoid/epidermoid) Thyroglossal duct cysts Ranula/diving ranula Lymphatic malformations Lemierre Xd : septic jugular v thrombophlebitis
Paediatric H&N : Solid masses
LCH - EG, handschuller X, Letterer Siwe (systemic)
Rhabdomyosarcoma -sk muscle malignancy, masticator sp. common
Lymphoma : 50/50 HL/NHL
Neuroblastoma mets
Plexiform neurofibroma-NF1
Fibromatosis coli : enlarged SCM without LN - fibrosis/haematoma.
Paed H&N : Vascular masses
3
Haemangioma (think PHACEs), neoplasm, high flow, involution,
AVM
Venous malformation : phleboliths
Modified Graf DDH
Type 1 (mature) IIA - immature (<3m) IIB- mild-moderate IIC - critical zone dys Type III - severe dysplasia, subluxation Type IV - dislocation
Onion skin appearance of well defined testicular mass
Epidermoid
USS features of pseudomembranous colitis
4
Loss of wall stratification
Accordion sign
Wall thickening with PRESERVATION of folds
Pseudomembranes ( hypoechoic non vascular)
HUS - colon features on USS
3
Colitis may be prodromal
Loss of stratification
Wall thickening with effacement of folds
No visible vascularisation
USS features of neutropenic enterocolitis (typhilitis)
Older children
Loss of stratification
Wall thickening with some preservation of folds
HYPERAEMIA
