Paeds 1 🫁 🫀🚽 Flashcards
Renal, Resp, Cardo, GI
causes of UTI?
E.coli enterobacter klebsiella Proteus (phosphate stones) pseudomonas (indicates structural defect)
symptoms of UTI in infants
poor feeding, vomiting, irritability, failure to thrive, diarrhoea
symptoms of UTI in children (4)
abdominal pain, fever, dysuria, increased frequency, haematuria
lower UTI symptoms (5)
urgency frequency nocturia dysuria suprapubic pain fever
upper UTI symptoms (3)
abdominal pain
nausea and vomiting
rigors
UTI investigations (3)
urine collection
bloods - cultures, FBC, U&E, ESR, CRP
urine dip MC and S
USS - check for abnormalities
management of UTI in children?
General: fluid, analgesics, antiemetics
<3 months –> refer to specialist
>3 months
upper UTI - cephalosporin or co-amoxiclav 7-10 days
lower UTI - trimethoprim, nitrofurantoin, cephalosporin or co-amoxiclav for 3 days
what are the clinical features of pyelonephritis?
fever
loin pain
vomiting
white cells in urine
what is enuresis?
involuntary discharge of urine by day or night or both in children aged 5 years or older in the absence of congenital or acquired defects of the nervous system or urinary tract.
what is primary nocturnal enuresis?
the child had never achieved continence
what is nocturnal secondary enuresis?
the child has been dry for at least 6 months before
what is the management of nocturnal enuresis?
look for possible underlying causes/triggers (constipation, DM, UTI)
advise of fluid intake, diet and toilet behaviour
rewards systems
first line treatment for children under the age of 7 is an enuresis alarm
first line treatment for children over the age of 7 - desmopressin.
what can cause daytime enuresis? (4)
lack of attention to the bladder sensation detrusor instability bladder neck weakness UTI, constipation neuropathic bladder
secondary - may be due to emotional upset, UTI, polyuria from DM
what are the classifications of acute kidney injury?
pre-renal - most common in children
renal - there is salt water retention
post renal - urinary obstruction
management of acute kidney injury? (3)
metabolic acidosis –> sodium bicarbonate
hyerkalaemia –> calcium gluconate if ECG changes, salbutamol, calcium change resin, glucose and insulin, dietary restriction
how would you treat pre-renal AKI?
suggested by hypovolaemia - needs to be corrected with fluid replacement
how would you treat renal AKI?
if fluid overload - restrict fluids, emergency management of metabolic abnormalities
how would your treat post-renal AKI?
relief of obstruction with nephrostomy or catheterisation
what is acute kidney injury?
what are pre-renal causes of AKI
- most common cause in children - hypovolaemia (burns, sepsis, gastroenteritis, haemorrhage, nephrotic syndrome), circulatory failure
what are renal causes of AKI
vascular (haemolytic uraemia syndrome (HUS), vasculitis, embolus, renal vein thrombosis)
Tubular (acute tubular necrosis, ischaemic, toil, obstructive)
glomerular - glomerulonephritis
interstitial - interstitial nephritis, pyelonephritis
what are post renal causes of AKI?
obstruction
congenital or acquired
what is the presentation of chronic kidney disease? (5)
anorexia lethary polydipsia polyuria failure to thrive body deformities hypertension acute on chronic renal failure unexplained normochromic normocytic anaemia
management of chronic kidney disease (5)
Reduce CV risk - Control BP, statin
Potassium control - Dietary restriction
Prevention osteodystrophy - Calcium carbonate, vit D
Treat anaemia - Subcut EPO
Treat acidosis - Sodium bicarbonate
Prophylaxis - Influenza and pneumococcal vaccinations
Calorie supplements
NG feeding
Fluid correction
Hormonal abnormalities
Dialysis and transplant
what causes chronic kidney disease? (4)
hypertension diabetes glomerular sclerosis lupus RA HIV NSAIDS toxins - tobacco
what can uraemia cause? (3)
nausea loss of appetite encephalopathy (tremor) pericarditis increase bleeding uremic frost - crystals in skin
what happens to potassium levels in CKD?
less potassium is excreted which leads to build up in blood
hyperkalemia - can cause arrhythmias
what happens to calcium levels in CKD?
low - hypocalcemia
kidneys activate vitamin D which aids the absorption of calcium
What happens when calcium levels are low due to kidney dysfunction?
parathyroid hormone is released which causes the bones to lose calcium
this leads to bone being brittle which is called renal osteodystrophy
how is CKD diagnosed (3)
changes in GFR
less than 60ml/kg/1.73m2
Proteinuria (ACR >3mg/ml)
kidney biopsy to look for changes such as glomerular sclerosis.
what are the three manifestations of nephrotic syndrome?
proteinuria (>3+ on dipstick)
hypoalbuminaemia
oedema
what is the most common cause of nephrotic syndrome in children ?
minimal change disease
can also be caused by focal glomerulosclerosis and post stept nephritis
what happens in nephrotic syndrome?
there is damage and inflammation to the podocytes which normally help prevent protein loss from the glomerulus. As a result of this, increased protein is lost through the nephron tubules.
How is nephrotic syndrome treated?
90% of proteinuria resolves with corticosteorid therapy (prednisolone for 4 weeks then a smaller dose every other day for 4 weeks)
what are the complications of nephrotic syndrome? (3)
hypovolaemia
thrombosis
infection
hypercholesteroleamia
how does minimal change disease present?
nearly always presents as nephrotic syndrome
What are the causes of minimal change disease? (3)
the majority are idiopathic
drugs - NSAIDS, rifampicin
Hodgkin’s lypmhoma, thymoma
infectious mononucleosis
what are the features of nephrotic syndrome?
Oedema
Proteinuria
Hypoalbuminaemia
Hyperlipidemia
how is minimal change disease managed?
80% of cases are steroid responsive
cyclophoshphamide in the next step for steroid-resistant cases
what is congenital nephrotic syndrome?
when nephrotic syndrome presents within the first 3 months of life.
it is rare
commonest kind is recessively inherited
associated with high mortality usually due to complications of hypoalbuminaemia
what are the causes of acute nephritis? (3)
post infectious (including streptococcus)
Vasculitis (HSP, SLE, wegener granulomatosis)
IgA nephropathy and mesangiocapillary glomerulonephritis
anti-glomerular basement membrane disease (good pasture syndrome)
what are the clinical features of nephritic syndrome?
decreased urine output and volume overload
hypertension which may cause seizures
oedema, characteristically around the eyes
haematuria and proteinuria
how is nephritic syndrome managed?
water and electrolyte balance and the use of diuretics when necessary
what are the features of henoch-schonlein purpura? (4)
characteristic palpable purpuric rash on buttocks and extensor surfaces of arms and legs arthralgia periarticular oedema abdominal pain glomerulonephritis
what are the common factors for HSP to occur? (3)
between 3 and 10 years more common in boys peaks during winter months often preceded by a response infection cause is unknown
what is Alport syndrome
it is a familial nephritis
usually an X-linked recessive disorder that progresses to end-stage renal failure by early adult life in males and is associated with sensorineural deafness and ocular defects.
what is hypospadias?
congenital abnormality of the penis which occurs in approx 3/1000 male infants
an abnormal opening below the urethra
can also happen in girls but way way more common in boys
what is hypospadias characterised by? (3)
a ventral urethral meatus
a hooded prepuce
chord (ventral curvature of the penis) in more severe form
the urethral meatus may open proximally in the more severe variants
How is hypospadias treated?
corrective surgery is performed before 2 years of age
what are the investigations for nephrotic syndrome (5)
LFT lipids infection calcium (low) renal injury urine bloods CXR renal USS
what are the investigations for HSP?
bloods (raised IgA, raised ESR, ASO titre (check for PSG)
urine dip
what is the management for HSP?
Supportive care- rest, rehydration, analgesia for MSK pain
prednisolone if severe
what is the presentation of post streptococcal glomerulonephritis?
URTI or pharyngitis
then 1-3 weeks later
haematuria
oliguria
proteinuria
odema
hypertension
signs of CV overload
what are the investigations for post streptococcal glomerulonephritis? (5)
bloods - FBC - anaemia - U&Es - increased urea and creatinine, increased potassium, acidosis - antistreptolysin O increased anti DNAase B titre low C3 urinalysis - haematuria, proteinuria renal biopsy
what is the management of post streptococcal glomerulonephritis? (3)
penicillin - 10 days
treat hypertension and fluid overload
correct metabolic imbalances
what is vesicoureteric reflux?
there is abnormal back flow of urine from the bladder to the ureter and kidneys
there is abnormal vesicoureteric junction where the ureters enter the bladder - the ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle therefore shortened ureter, and the junction cannot function adequately
what is the grading of vesicoureteric reflux?
I - Reflux into the ureter only, no dilatation
II -Reflux into the renal pelvis on micturition, no dilatation
III-Mild/moderate dilatation of the ureter, renal pelvis and calyces
IV - Dilation of the renal pelvis and calyces with moderate ureteral tortuosity
V - Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity
what are the investigations (2) and management (3) for vesicoureteric reflux?
micturating cystourethrogram for diagnosis (MCUG)
Management:
Avoid constipation
Avoid an excessively full bladder
Prophylactic Abx
Surgical input from paediatric urology
DMSA (dimercapto succinic acid) scan should also be performed to check for scarring (4-6 months after illness)
what are the triad of features of haemolytic uraemia syndrome (HUS)?
acute renal failure
microangiopathic haemolytic syndrome
thrombocytopenia
what is typical HUS
secondary HUS
classically caused by shiga toxin producing E.coli (STEC)
what is atypical HUS?
primary HUS due to complement dysregulation
What investigations would you perform for HUS? (3)
FBC (anaemia, thrombocytopenia, fragmented blood film)
U&E (acute kidney injury)
stool culture (Shiga toxin-producing Escherichia coli)
LDH (non specific sign for haemolytic anaemia)
What is the management of HUS?
supportive treatment - fluids, blood transfusion and dialysis if required.
what are the most common viral causes of respiratory infections? (4)
respiratory syncytial virus (RSV) rhinoviruses parainfluenza influenza metapneumovirus adenovirus
what are the most common bacterial causes of respiratory infections? (3)
streptococcus pneumoniae streptococci haemophilus influenzae bordetella pertussis mycoplasma pneumoniae
what increases the risk of respiratory infection? (3)
parental smoking overcrowded housing, damp housing poor nutrition underlying lung disease male gender haemodynamically significant congenital heart disease immunodeficiency
whar are the classifications of respiratory infections?
upper respiratory tract infection (common cold, sore throat (pharyngitis including tonsilitis), acute otitis media, sinusitis)
Laryngeal tracheal infection (croup, bacterial tracheitis, acute epiglottitis)
bronchiolitis
pneumonia
what are the symptoms of a common cold? (5)
acute onset rhinitis sore throat sneezing post-nasal drainage/drip cough fever non-specfic red pharynx nasal mucosal oedema
what are the common causes of the common cold (coryza)?
rhinoviruses, coronaviruses, RSV
what is pharyngitis?
pharynx and soft-palate are inflamed and local lymph nodes are enlarged and tender
what are the different types of sore throat?
pharyngitis
tonsilitis
laryngitis
what is tonsilitis?
intense inflammation of the tonsils often with a purulent exudate
what are common causes of tonsilitis? What is the most common cause?
Usually viral - most commonly caused by rhinovirus, coronavirus and adenovirus
group A beta-haemolytic streptococci, and EBV
what are the symptoms and signs of tonsilitis?
pain on swallowing
fever >38
tonsillar exudate
cervical lymphadenopathy
how do you treat bacterial tonsilitis?
1st line - Phenoxymethylpenicillin
2nd line - clarithromycin
what is the criteria used for antibiotic prescription in tonsilitis?
the centor criteria
- presence of tonsilar exudate
- tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
3 must be present
what test can be used to detect group A streptococcus pharyngitis?
rapid antigen detection test
should be used routinely in patients with sore throat to allow immediate point-of-care assessment
What is bronchiolitis? What is the most common case?
it is a condition characterised by acute bronchiolar inflammation and a build up of mucus in the small airways of the lungs.
usually caused by RSV virus - 75-80% of cases
what age group does bronchiolitis usually affect, when is the common time for it to occur?
it is almost exclusively an infantile disease - commonly affecting children under 2
most common cause of serious RTU in children under one
maternal IgG provides protection to neonates
higher incidence in winter months
what can cause bronchiloitis other than RSV?
rhinovirus
influenza virus
may be secondary to a bacterial infection
what are the symptoms of bronchiolitis? (4)
coryzal symptoms, including virus precede:
Dry cough
increasing breathlessness
wheezing, fine inspiratory crackles
feeding difficulties
tachypnoea
increased work of breathing may be present - retractions, grunting, nasal flaring
what are the features of bronchiolitis that NICE recommend immediate referral for? (3)
apnoea child looks seriously unwell to health care professional severe resp distress central cyanosis persistant oxygen sats less than 92%
what are the features of bronchiolitis that NICE recommend consider referral for?
a resp rate over 60BPM
difficulty breast feeding or inadequate oral fluid intake
clinical dehydration
how would you diagnose bronchiolitis?
largely clinical
nasopharyngeal aspirate or throat swab - RSV rapid testing and viral cultures
blood and urine cultures if child is pyrexic
FBC
ABG if severely unwell
what is the treatment for bronchiolitis?
supportive care, supplemental oxygen and mechanical ventiliation
what is the prophylaxis for bronchiolitis and who is it given to?
monthly IM injection of palivizumab
given to preterm babies born before 29 weeks, or babies born with chronic lung disease of prematurity before 32 weeks
also can be given to those who are severely immunocompromised
what is croup?
Viral URTI
croup is also known as laryngotracheobronchitis - common respiratory disease of childhood
what are the causes of croup?
usually parainfluenza
other causes include RSV adenovirus, rhinovirus, enterovirus
what age group does croup commonly affect?
what time of year is it common?
commonly children who are between 6 months and 3 years
Autum
what are the features of croup?
stridor (high pitched, wheezing sound caused by disrupted airflow)
barking seal like cough, which is typically worse at night
fever
coryzal symptoms
if severe there may be signs of resp distress
what are the red flag signs of rep failure? (3)
cyanosis
lethargic/decreased level of consciousness
labored breathing
tachycardia
what are the differentials of croup? (3)
epiglottitis inhaled foreign body acute anaphylaxis bacterial tracheitis diptheria
what is pseudomembranous croup? What bacteria is it caused by?
aka bacterial tracheitis
rare but very dangerous
similar to viral croup but child has high fever, appears toxic and has rapidly progressive aiway obstruction with copious amounts of thick airway secretions
it is caused by staphylococcus aureus
treatment is with IV Abx, intubation and ventilation if needed
what is mild, moderate and severe croup defined as?
mild: Occasional barking cough
No audible stridor at rest
No or mild suprasternal and/or intercostal recession
The child is happy and is prepared to eat, drink, and play
moderate: Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings
severe: Frequent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxaemia
when should you consider admission for croup? (3)
moderate or severe croup
< 6 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
how should you diagnose and manage croup?
clinical diagnosis
mild croup - single dose of oral dexamethasone
moderate - single dose of oral dexamethasone plus nebulised adrenaline
severe - single dose oral dexamethasone plus nebulized adrenaline plus oxygen
what are causes of stridor in children? (4)
croup
acute epiglotittis
inhaled foreign body
laryngomalacia
what is asthma?
a chronic respiratory condition characterised by reversible and paroxysmal constriction of the airways
secondary to type 1 hypersensitivity
what are the risk factors for the development of asthma? (5)
personal or family history of atopy antenatal factors: maternal smoking, viral infection during pregnancy low birth weight not being breastfed maternal smoking around the child exposure to high concentrations of allergens (e.g. house dust mite) air pollution premature birth
what other atopic conditions are associated with asthma?
IgE-mediated atopic conditions such as
eczema
alleric rhinitis (hay fever)
what are the precipitating factors for asthma? (4)
cold air
atmospheric pollution
NSAIDs and beta-blockers
exposure to allergens
Exercise
what are the clinical features of asthma? (5)
symptoms worse at night and early morning (diurnal variation)
symptoms that have a non-viral trigger
cough
dyspnoea
wheeze, chest tightness- episodic triggers
increased work of breathing
there may be expiratory wheeze on auscultation
reduced peak expiratory flow rate
what investigations would you perform for asthma? (5)
spirometry - FEV1 and FVC (FEV1 will be reduced, FVC normal )
peak expiratory flow
response to bronchodilator on spirometry
CXR
also consider skin prick testing fractional expired nitic oxide - elevated sputum culture exercise testing
what are the differentials for asthma? (3)
bronchiolitis episodic viral wheeze inhaled foreign body recurrent aspiration cardiac failure CF primary ciliary dyskinesia
how is asthma managed in children?
SABA when required
add a regular preventer - very low dose ICS or LTRA if less than 5.
Initial add on therapy - very low dose ICS plus inhaled LABA or LTRA
next consider increasing ICS dose or add LTRA or LABA
if no response to LABA consider stopping
what are the two clinical patterns of preschool wheeze?
viral episodic wheeze - wheezing only in response to viral infection and no interval symptoms. Usually resolves by 5 years. Triggered by viruses that can cause the common cold.
Multiple trigger wheeze - wheeze in response to viral infection but also to another trigger such as exposure to aeroallergens and exercise. A significant proportion go on to have asthma
what would finger clubbing suggest?
CF or bronchiectasis
how do you manage viral episodic wheeze?
treatment is symptomatic only
first-line - SABA
second line - LTRA - montelukast
how do you manage multiple trigger wheeze?
trial of either ICS or LTRA - typically for 4-8 weeks
when should you consider hospital admission for children with asthma?
if after a high dose of bronchodilator therapy they:
- have not responded adequately clinically
- if they are becoming exhausted
- have decreased oxygen sats less than 92%
- if CXR is indicated
- if there are unusual features or signs of severe infection
what are the classifications of a mild, moderate, severe and life threatening acute asthma attack?
MILD: : SaO2 >92% in air, vocalizing without difficulty, mild chest wall recession and moderate tachypnoea
MODERATE: SpO2 >92%, PEF>50% best or predicted, no clinical features of severe asthma
SEVERE: SaO2 <92% PEFR 33-50%, cannot complete sentences in one breath or too breathless to feed or talk. Heart rate >125 (if over 5 years) or >140 (2-5 years) RR > 30 (over 5 years) or >40 (2-5 years)
LIFE THREATENING: SaO2 <92% ,PEFR <33%, silent chest, poor resp effort, cyanosis, hypotension, exhaustion, confusion
how do you manage a mild to moderate acute asthma attack?
- give beta-2 agonist via a spacer - one puff every 30-60 seconds up to a max of 10 puffs
if symptoms not controlled repeat and refer to hospital
how should severe asthma attacks be managed?
if low oxygen sats give high flow oxygen
SABA via nebuliser
ipratropium bromide can be added
if no response to SABA
steroid therapy should be given for 3 days
2nd line IV salbutamol - essential to monitor for salbutamol toxicity
magnesium sulphate can be considered
what are the common causes of pneumonia in different age groups?
Newborn - organisms from the mother’s genital tract particularly group B streptococcus, E.coli, klebsiella, staph aureus
infants and young children - RSV most common, streptococcus pneumoniae, chlamydia trachomatis
Children over 5 - mycoplasma pneumoniae, streptococcus pneumoniae and chlamydia pneumoniae ar the main causes
at all ages mycobacterium tuberculosis should be considered
what are the clinical features of pneumonia in children? (3) and what would examination show? (5)
fever and difficulty breathing = the most common presenting symptoms
usually preceded by an upper RTI
cough
lethary
poor feeding
unwell child
localised chest, abdo or neck pain is a feature or pleural irritation and suggests bacterial infection
examination will show signs of resp distress, desaturation and cyanosis
tachypnoea, nasal flaring and chest indrawing
end inspiratory coarse crackles over the affected area
classical signs of consolidation - dull percussion, decreased breath sounds and bronchial breathing
oxygen sats may be decreased
what are the investigations you would perform for pneumonia?
CXR - may confirm diagnosis but cannot differentiate between viral and bacterial
Nasopharageal aspirate - viral immunoflourenence identify viral causes
blood tests - FBC and acute phase reactants
blood cultures
how should you treat pneumonia in children?
first line treatment is amoxicillin for all children with pneumonia
for children under 5 alternatives include co-amoxiclav for tyical pneumonia (steptococcus oneumoniae) or clarithromycin for atypial pneumonia (mycoplasma pneumoniae and chlamydia trachomatis)
if over 5 years - consider macrolide (clarithromycin) if mycoplasma or chlamydia is suspected, if staoh aureus suspected the consider macrolide or flucloxacillin with amoxicillin
severe pneumonia: co-amoxiclav , cefotaxime or cefuroxime IV
when would you consider admission for pneumonia? (4)
most cases can be managed at home, admission is indicated if:
- oxygen sats less than 92%
- severe tachypnoea
- difficulty breathing
- grunting
- apnoea
- not feeding
what is cystic fibrosis?
an autosomal recesive disorder which leads to a defect in the CF transmembrane receptor protein which causes defective ion transport in exocrine glands.
causes thickening of respiratory mucus - the lungs therfore prone to inadequate mucociliary clearance, chronic bacterial infections
what is the screening for CF?
all newborn babies are screened for CF
blood spot analysis on the Gurthrie card
what are the presentations of CF at different age groups (6)
infancy - meconium ileus, prolonged neonatal jaundice
Childhood - recurrent lower respiratory chest infection, bronchiectasis, poor appetite, rectal prolapse, nasal polyps, sinusitis
Adolescence: bronchiectasis, DM, cirrhosis and portal hypertension, distal intestinal obstruction, pneumothorax, haemoptyysis, male infetiltiy
short stature
delayed puberty
female subfertility
weight loss or poor weight gain
90% of children with CF have pancreatic exocrine insuficiency (lipase, amylase and proteases) resulting in maldigestion and malabsorption
how do you diagnose CF? (4)
sweat test - abnormally high sweat chloride
immunoreactive trypsinogen test (new born screening)
CXR
glucose tolerance test
LFT
faecal elastase to assess pancreatic function
genetic analysis
what could cause a false positive sweat test for CF ? (3)
malnutrition adrenal insufficiency glycogen storage disease nephrogenic diabetes insupidus hypothyroidism G6PD ectodermal dysplasia
How do you manage CF? (6)
MDT approach
annual review in specialist center
For ongoing respiratory disease:
twice daily physiotherapy to clear airway secretions and postural drainage, inhaled bronchodilator (salbutamol), inhaled mucolytic (dornase alpha), if they have chronic pseudomonas infection give inhaled tobramycin
GI disease:
monitoring and optimising nutrion
pacreatic insuficiency - pancreatic enzyme replacement (pancreatin), H2 antagonist or PPI (ranitidine or omeprazole), fat soluble vitamin supplementation (A, D, K and E)
liver disease - ursodeoxycholic acid
what investigations would you perform for suspected epiglottitis? (3)
lateral neck radiograph (thumb print sign)
FBC
blood cultures
Direct visualisation by senior (diagnosis)
what usually causes heart failure in the first week of life?
left heart obstruction e.g. coarctation of the aorta
*if obstruction is very severe then arterial perfusion may be predominantly by right to left flow of the blood via the ductus arteriosus (duct dependant circulation) - closure of the duct = severe acidosis, collapse and death unless duct patency is restored
what are the 4 cardinal anatomical features of tetralogy of Fallot?
- ventricular septal defect (VSD)
- right ventricular hypertrophy
- pulmonary stenosis (right ventricular outflow tract obstruction)
- overriding aorta
what is transposition of the great arteries?
the aorta is connected to the right ventricle and the pulmonary arteries are connected to the left ventricle - this means there is two parallel circulation
*incompatible with life unless there is a mixing of blood - often there is naturally occurring VSD, ASD, PDA which can achieve mixing short term
leads to right to left shunt
what would you see on CXR and ECG in coarctation of the aorta? (3)
CXR - rib notching due to the development of large collateral intercostal arteries running under the ribs posteriorly to bypass the obstruction, 3 sign - visible notch in the descending aorta at the site of the coarctation
ECG- LV hypertrophy
what is interruption of the aortic arch?
Interrupted aortic arch is a very rare heart defect in which the aorta is not completely developed. There is a gap between the ascending and descending thoracic aorta. In a sense it is the complete form of a coarctation of the aorta.
usually VSD is present
presentation is with shock in the neonatal period - circulatory collapse with absent femoral pulses and absent left brachial pulse
what are the clinical signs of infective endocarditis? (7)
what would an ECG show when there is pericarditis?
how is pericarditis managed?
analgesia
anti-inflammatory drugs (colchicine, aspirin, ibuprofen)
pericardiocentesis for pericardial effusion
what causes pyloric stenosis in children?
idiopathic hypertrophic pyloric stenosis
hypertrophy of the pylorus muscle causing outlet obstruction
What is a congenital diaphragmatic hernia? What can this result in?
it is characterised by the herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm - this can result in pulmonary hypoplasia and hypertension which can cause respiratory distress shortly after birth
what is a hiatus hernia and what are the two types of hiatus hernia?
herniation of the stomach into the chest wall through the oesophageal hiatus in the diaphragm
sliding
rolling
What are some signs of kwashiorkor? (5)
bilateral pitting oedema
a flacky-paint skin rash with hyperkeratosis (thickened skin) and desquamation
distended abdomen and enlarged liver
angular somatitis
hair which is sparse and depigmented
diarrhoea, hypothermia, bradycardia and hypotension
low plasma albumin, potassium, glucose and magnesium
How is biliary atresia treated?
kasai procedure AKA hepatoportoenterostomy - although even when successful can progress to cirrhosis and portal hypertension
What are choleductal cysts?
cystic dilations of the extrahepatic biliary system
