Paeds Flashcards
signs of diabetes in children
Tired
Thirsty
Toilet more
Thinner
Babies
- heavy nappy
- oral candidiasis
- constipation
- skin infections
investigations for GH deficiency
Serum IGF-1 (low)
GH stimulation tests
- Insulin tolerance test
- Argine/glucagon
signs of DKA in children
Nausa and vomiting
abdominal pain
ketotic breath
drowsiness
rapid - deep sighing - Kussmaul breathing
start of puberty in boys v girls
girls 8-13
- breast budding (s2)
boys 9-14
- testicular enlargement (s2)
causes of jaundice in the first 24 hours of life
sepsis
haemolysis (autoimmune, inherited , acquired.. trauma)
jaundice is normal in the first 24 hours of life
a. true
b. false
b. false
always pathological - no normal cause of jaundice in the first day of life!!!
- haemolysis
- sepsis
ut
causes of jaundice day 2 - 2 weeks
physiological
breast milk
sepsis
haemolysis
time period of normal physiological jaundice to occur
day 2 - two weeks
why does physiological jaundice occur
born with a high number of RBCs and HbF has a shorter lifespan (80-90) days
the liver is immature and doesnt conjugate biliruben quickly enough to keep up
unconjuated
there is prolonged jaundice in breast fed babies
a. true
b. false
a. true
unconjugated biliruben remains high and can persist for 12 weeks (if after 3 months become worried and always rule out other causes)
potential treatment for unconjugated jaundice that is prolonged
blue light phototherapy
- 450nm light converts biliruben to water soluable form
when would you start to worry about jaundice
prolonged > 2 week in term
> 3 weeks in pre-term
more likely to be pathological
potential causes of jaundice lasting > 2 weeks
breast milk (unconjugated)
Hypothyroidism - unconjugated (prevents conjugation)
Extrahepatic - biliary obstruction (CONJUGATED)
Neonatal hepititis - conjugated
signs of biliary atresia
prolonged jaundice - conjugated
dark urine
pale stools
tests for biliary atresia
split biliruben - conjugated
USS
HIDA/MRCP/Liver biopsy
treatment for biliary atresia
kasai portoenterostomy (Connect direct to intestines)
liver transplant often needed
symptoms of pyloric stenosis
forceful
projectile vomiting (non- billious)
visible peristlasis
firm round mass ‘olive tumor’ in the upper abdomen (hypertrophic pylorus)
tests for pyloric stenosis
ABG
- hypochloraemia
- hypokalaemia
- metabolic alkalosis
USS scan of abdomen!!!
treatment for pyloric stenosis
laparoscopic
ramstedts - pyloroyotomy
why do babies get GORD
- Immature LOS
- Shorter oesophagus
- Slower gastric emptying time (Stomach stays fuller for longer)
- Liquid diet
treatment for GORD
- Gaviscon (mixed with feeds – 1st line if breast fed)
- Thick and easy for formulas (1st line if formula feed)
- PPIs (2nd line)
type of vomiting in GORD
effortless
symptoms of hirshsprungs
acute intestinal obstruction after birth
Failure to pass meconium with 48 hours
- Chronic constipation
- Abdominal pain and distension
- vomiting
- tight rectum with explosive stool (rectal squirt)
gold standard diagnosis of hirschsprings
Rectal biopsy
- absence of ganglion cells
cause of hirschsprungs
congential
Enteric plexus
- myenteric (peristalsis)
- submucosal plexus (fluid secretion, blood flow and absorption)
both are absent!!!!
SECTION DOESN’T RELAX -> becomes constricted -> bowel obstruction -> bowel higher up than effected section becomes dilated and overloaded.
what age group will intusseception become symptomatic
3 months - 2 years
under 2 years
what is intussuception
Section of the bowel slides or folds into itself (often the ileum enters the cecum): effected section is thickened leading to a palpable mass in the abdomen/narrowed lumen which obstructs the passage of faeces
symptoms of inutssusception
- Acute onset of colicky, severe abdomen pain
- Bilous of green vomit
-** Red currant jelly stool (blood mucous and stool) - Sausage shaped mass in right upper quadrant **
- Previous URTI preceding
- Features of abdominal obstruction (distension, vomiting, absolute constipation).
USS for intussusception
target or dougnut sign
treatment for interussuception
therapeutic enemas (contrast, water or air to force folded section of bowel out and into normal position)
surgical reduction
bowel resection if gangrene, or bowel perforation,
- Red currant jelly stool (blood mucous and stool) and
- Sausage shaped mass in right upper quadrant
are associated with
intussuception
sections of bowel most involved in intussusception
the ileum entering the cecum
age range most often affected by intersussception
3 months to 2 years
appearance of stool in intersussception
red current jelly stool
palpation of abdomen in interussception will find
sausage shaped mass in the RUQ
diagnostic of intersussception
USS
first line treatment for interussception
therapeutic enemas (contrast, water or air to force folded section of bowel out and into normal position)
surgical reduction
bowel resection if gangrene, or bowel perforation,
signs of intestinal atresia in pregnancy
Polyhydramnios (excess fluid in pregnancy due to inability to swallow)
what is intestinal atresia
- Portion of the intestine is completely blocked or absent – preventing the normal passage of foods and fluids.
- Due to disruption of blood flow to developing intestine during foetal development
- Most commonly – duodenum
downs syndrome is associated with increased risk of intestinal atresia
a. true
b. false
a. true
symptoms of intestinal atresia
bilious vomiting in newborn (24-48 hours)
abdominal distension/failure to pass myconium
polydraminous in pregnancy (unable to swallow fluid)
signs of intestinal atresia on Abominal XR
double buble sign - dilation of stomach and proximal duodenum
dilated loops of bowel and air flud levels
peak incidence of appendicitis
Peak incidence 10 to 20 years old
- Less common in young children
symptoms of appendicitis
Abdominal pain – starts centrally (umbilicus and moves to Right iliac fossa)
- Eventually becomes localised in the Right iliac fossa
Tenderness at McBurney’s point (1/3 distance from ASIS to umbilicus)
Anorexia/loss of appetite
Vomiting and nausea
Fever – low grade
Palpation of Left iliac fossa causes pain in the RIF (rovsings sign)
Guarding and rebound tenderness (increased pain when suddenly releasing pressure of deep palpation
Percussion tenderness – pain and tenderness on percussion
Features suggestive of innocent murmur?
- soft < 2/6
- systolic
- symptomless
- situation dependent (gets quieter when standing or only appears when unwell or feverish)
*no thrills
may not need further investigation
Features of murmurs which would prompt further investigation
louder than 2/6
diastolic
louder on standing
failure to thrive, feeding, cyanosis, SOB
Name two ejection systolic mumurs
- aortic stenosis ( 2nd ICS right sternal boarder)
- pulmonary stenosis (2nd ICS left sternal boarder)
crescendo descrendo (peak in middle)
symptomatic aortic stenosis would cause what symptoms
reduced exercise tolerance
exertional chest pain
syncope
murmur for aortic stenosis
ejection systolic
crescendo decresendo
radiates to carotids
palpable thrill through systole
slow rising pulse + narrow pulse pressure
aortic stenosis is assoicated with which conditions
Turners
- bicuspid aortic valve
Williams syndrome
- supraclavicular stenosis
describe features of murmur in pulmonary stenosis
ejection systolic
crescendo-decresendo
2nd ICS - left sternal edge
RADIATES to the BACK
exertional SOB, fatigue and dizziness
signs of pulomonary stenosis
radiates to the back (ejection systolic murmur)
palpable thrill + RV hypertrophy
raised JVP (giant A wave)
widely split second heart sound!!! (takes longer for RV to empty through narrow valve)
o
pulmonary stenosis is associated with what conditions
Noonans
Teratology of Fallot
Williams
Congenital rubella syndrome
pan-systolic murmurs in children
- mitral regurgitation - 5th ICS midclavicular
- tricuspid regurgiation - 5th left sternal boarder
- VSD - louder on left sternal boarder
describe murmur in VSD
left sternal boarder
pansystolic
what kind of murmur in hypertrophic obstructive cardiomyopathy
4th ICS left sternal boarder
ejection systolic
what two vessels does the ductus arteriolus connect
pulmonary artery with the aorta (allowing blood to bypass the lungs in foetus)
usually stops functioning and closes shortly after born
what keeps the ductus arteriolus open in utero
prostaglandin E2 which is produced by the placenta (falls during birth resulting in closure)
what direction is the shunt in PDA
from left to right (high pressure aorta -> into the pulmonary arteries)
the additional blood creates pressure within the pulmonary circulation
signs that there is a PDA
- increased HR
dyanamic apex beat
bounding pulses
SOB, difficulty sleeping
poor weight gain
LTRI
risk factors for PDA
preterm
downs
diabetes/rubella in mother
murmur heard in PDA
Continuous crescendo-decrescendo machinery murmur
**- Loudest below the clavicle **
Normal S1 but S2 can be difficult to hear over the murmur
what is given to close the PDA
IV ibuprofen or indomethacin
prostaglandin inhibitors
(surgical if doesnt work and symptomatic)
good chance of closure in term babies
signs of aortic co-artaction in newborn
weak or absent femoral pulse!!! - checked on first day baby check
co-artaction is common in turner syndrome
a. true
b. false
a. true
radial-femoral delay is a late sign in
coarctation of the aorta
what might you see in the blood pressure in aortic coarctation
increased pressure in limbs supplied by vessels proximal to it (e.g. ARMS)
and decreased pressure distal to the narrowing (limbs)
murmur heard in coarctation of the aorta
Harsh systolic murmur – left sternal edge
/loudest on the back /left scapula
what might compensate /delay deterioration in coaratation of the aorta
if the PDA is open - can compensate (and then becomes suddenly unwell when it closes)
reopen PDA with prostaglandin E1 and E2 to stabalise
what are the 4 abnormalities in fallots teratology
- Pulmonary valve stenosis - due to narrowing of the RV outflow tract
- Large VSD
- Overiding aorta (sticks into RV)
- RV hypertrophy - due to (R-L shunt)
risk factors for fallots teratology
increased maternal age
alcohol
maternal diabetes
diGeorge/Downs
congenital rubella
where is the blood shunted in teratory of fallot
right to left shunt
The overriding aorta and pulmonary stenosis encourage blood to be shunted from right to left
treatment of teratoly of fallot
Correction operation at 6 months
- Once 5kg bodyweight
treatment for Tet spells
- Give high flow 02
- IV Fluid
- IV beta blockers
- Phenylephrine infusion
- Sodium bicarb (will be acidotic)
- Beta-blocker – reduce spasm/outflow tract
- IV morphine
tet spells are emergencys
what is transposition of the great arteries
(pulmonary trunk comes out of LV and back to lungs) and aorta out of RV
If no shunt – between vessels (ASD or PDA) survival is low
Causes of a pan-systolic murmur:
VSDs, mitral regurgitation and tricuspid regurgitation.
shunting of blood is in what direction in transposition of the great arteries
right to left – Deoxygenated blood bypasses the lungs and enters systemic circulation causing cyanosis
CENTRAL cyanosis (blue tongue and lips) due to
RIGHT to left shunt
Blue baby – Is IMMEDIATE in neonatal period – newborn will be cyanotic
heart defects associated with turners
- Bicuspid aortic valve -> stenosis/regurgitation
- Coarctation of aorta – usually descending (increased afterload on heart)
thickening (hypertrophy) of the left ventricle muscle, particularly affecting the ventricular septum
Hypertrophic obstructive cardiomyopathy (HOCM)
thickening reduces the space inside the ventricle and blocks blood flow up to the aorta (left ventricle outflow tract obstruction.
Arrhythmia and sudden death often occur during exertion, when there is extra demand on the heart in what condition
Hyoertrophic obstructive cardiomyopathy
what is cause of HOCM
autosomal dominant genetic condition resulting from a defect in the genes for sarcomere proteins.
can occur via de nova mutation (new mutation) without familey history
diagnosis of HOCM
echocardiogram or cardiac MRI
treatment for whooping cough
azithromycin or clarithromycin if onset of cough is within the last 21 days
when does cows milk allergy typically present?
first 3 months of life in formula feed infants
rarely - seen in breast fed infants
what type of immune reactions take place in Cows milk protein allergy
both immediate IgE
and non immediate (non IgE)
features of CMPA
regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
wheeze, chronic cough
rare - angioodema/anphylaxis
diagnosis of CMPA
clinical (improvement once stoped)
Skin prick/patch
total IgE and specigic IgE RAST for cows milk
treatment for CMPA
extensive hydrolysed formula = eHF
what kind of mass would you see in intusseption
sausage shaped - upper left quandrant
medication for febrile seizures
buccal or rectal midazolam
