paeds 2 Flashcards
Henoch-Schoenlein Purpura
AKA an IgA vasculitis
small vessel vasculitis- affects kidneys, skin, joints and GI tract mainly (rarely lungs + neuro)
can affect any age, but most commonly under 10 years old.
usually self limiting and mild,- espesh if no renal involve but can be bad.
usual prodromal illness Group A Streptococcus- 30% of cases.
affects 10-20 per 100k per year
boys slightly more than girls.
S+S: palpable purpura- buttocks and lower extremes extensor surface, gastrointestinal complaints, arthralgias, and renal involvement.
patho: IgA complexes form in response to something, then end up getting deposited in the small capillaries + subsequent inflammation.
Ix: gold standard - renal biopsy- mesangial, subendothelial and capillary deposits of IgA and some IgG.
Rx: renal involved? – if no– supportive care - paracetamol/ opiate rather than nsaids
renal involved- mild- acei, steds
plasma ex, immunosuppressants.
hepatitis in children.
can get A- faecal oral route
B+C+D- from mother during birth
either a sudden onset of jaundice with a liver aetiology
or a incidentally picked up raised transaminases with evidence of acute onset
failure is INR >2
or INR> 1.5 with encephalitis
Ix: FBC, Urea, LFT etc etc etc.
Rx: Cidofovir is current antiviral of choice.
Hirschsprung disease
birth defect, nerves missing from Large intestine.
classified into short
or long segment-
can occur on its own or part of downs and waardenburg
S+S: constipations, vom, diarrhoea, abdo pain, growth faltering.
Rf: family history, white, male.
occurs in 1:5000 new-borns.
Ix: based on symptoms + confirmed on biopsy- lack of ganglionic nerve cells.
Rx: pull through operation.- 1 stage.
hypoglycaemia in paediatric
if they have DM- 3.9mmol is low cutoff for treatment.
S+S: shakiness, pounding heart, sweatiness, headache, drowsiness, and difficulty concentrating + tantrums etc.
risk of term baby hypo- if mother taken B blockers or had gesty debs.
Rx: if 2.6mmol or lower
conscious and able to swallow- sugar.
if no IV access- glucagon.
if less than 25kgs- 500Um
more than 25kgs 1mg.
IV- 2ml/kg 10% dextrose bolus- followed by continuous 3-5ml/kg/hr 10% dextrose.
juvenile idiopathic arthritis
1:1000 children
chronic inflammatory disease, multiple subtypes.
clinical diagnosis aided by investigations.
onset before 16 with pain in one or more joint for more than 6 weeks. – need swelling, warmth, pain, restriction of movement for the joint to be included.
RF: female, HLA polymorphism, FH of autoimmunity.
Ix: clinical but - CRP, ESR, ANA (30-60%)
consider chalymidia in the teenagers.
MRI/ USS.
Rx: 5 or more joints- methotrexate
4 or less- consider intraarticular joint injections.
paediatric intracranial haemorhage
can get both sub arach and intraparenchymal bleeds
shaken baby syndrome- suspect if seen- causes bleeds. retinal haem is also common.
maj are IP and caused by Arteriovenous malformations- if non traumatic.
consider ischaemic in sickle cell though.
S+S: headache, nausea/vom, altered mental status, seziures, neuro signs.
Ix: head imaging.
Rx: supportive care usually.
correct clotting – platelet transfusion, factor replacement, reverse anticoags.
decompression if gcs <8.
kawasaki disease
an acute febrile self-limiting systemic MEDIUM vessel vasculitis.
exclusively effects young children.
predisposed host gets trigger (any autoimmune)- aberrant inflammatory response.
S+S: fever, polymorphic rash, conjunctivitis, mucosal erythema, strawberry tounge, erythema and swelling of hands and feet, unilateral cervical lymphadenopathy.
complication: coronary arery aneurysms. 25% of untreated patients dev these.
RF: asian ancestry, 3 month-4 years.
Ix: clinical, no unique tests. fever longer than 4 days is significant.
raised inflammatory markers.
may have low hb, albumin.
Rx: 1x IVIG dose + aspirin high dose.
steroid if refractory, infliximab as other options.
measles
highly contageous - measles virus- spherical RNA.
S+S: maculopapular rash, cough, coryza, conjunctivitis.
—– Koplic spots– buccal sign– white on red background—- diagostic for measles.
incubation 10 days.
Ix: ELISA IgM, IgG serology.
Rx: supportive care.
vitamin A
vaccination to prevent it becoming endemic.
meiconium aspiration
respiratory distress in the newborn because of meconium in the trachea.
S+S: yellow green coloured skin, long stained nails, dry scailing skin. meiconium coloured fluid.
resp distress can present immediately or within hours.
Rf: late baby, gestational HTN, gest DM, maternal smoking
Ix: CXR for pneumonia, FBC to rule out infection.
Rx: if in distress admit to icu, support with oxygen + a warmer. usually 48-72 hours of support needed.
CPAP if further support needed
then ossicilator +nitric oxide inhailed as max support. or consider ecmo.
mesenteric adenitis
right lower quadrant pain 2’ inflammatory condition of mesenteric lymph
commonly interpreted as appendicitis. can be caused by gastroenteritis.
yersinia bacteria- commonly cause.
self resolving. rare.
Ix: abdominal ultrasound is gold standard. - enlarged hypoechoic mesenteric lymph nodes. 8mm or more node.
Rx: self limiting- so main thing is to rule out appendicitis.
pain relief + hydration.
mumps
virus, spread by resp droplets. usually benign and self limiting.
affects school aged children.
S+S: swelling of parotid glands- almost ubiquitous, salivary glands, meninges, gonads and pancreas all involved.
Rf: unvaccinated, international travel.
Ix: salivary mumps IgM test.
Rx: supportive care.
comlications: epididymo-orchitis, aseptic meningitis.
Necrotizing Enterocolitis
most common life thretening illness of the Gi tract- affects neonates.
bacterial invasion of the intestinal wall– inflammation and damage + destruction.—> perf if not detected.
S+S: poor feeding, vom, lethargy, abdo tenderness, – all non specific. distending abdo can be a sign.
tends to occur in the 2nd to 3rd weeks of life.
Rf: premature, low birth wt, formula fed.
Ix: abdo Xr, AP and lateral.– dilated loops, pneumatosis intestinalis + portal vein air.
Rx: resusitation as needed.
Ng tube,
Iv Abx,
TPN- while on bowel rest— when bowel motions resume pt is recovered.
for those that dont improve- laporotomy + removal of dead bits. remove as little as poss.
nephrotic syndrome
glomerular disorder= nephrotic.
triad: generalised oedema, heavy proteinuria (>200), hypoalbuminaemia (<25)
Rf: asian, 4y/o, boys,
ineffective podocite linkage, bigger slits.
minimal change is most common cause.
Ix: urine dip. urine protein:creatine ratio, U&E, FBC, albumin.
Rx: high dose steroids- biopsy before starting them if you gunna biopsy.
prob will relapse, steroids Rx again, if continued symptoms- then low dose long term.
low salt diet
? prophylaxic antibodies if v leaky (immunoglobulins leak out)
classification of peripheral nerve injuries
neurapraxia- stretch or contusion- reversable conduction block. — will see slowing on NCS, recovers.
axonotmesis- incomplete injury more severe than praxia, focal conduction block with myelin disruption.
NCS- fribrilations and sharp waves. - unpredictable recovery. - wallerian degeneration.
neurotmesis- complete division. wallerian degeneration.
NCS- fribrillation with positive sharp waves.
- no recovery unless surgical repair.
perthes disease
traisient ischaemia and necrosis of the hip joint as a child (4-10).
4 stages:
necrotic- several months, loss of blood supply and bone death.
fragmentation- 1-2 years removal of dead bone and replacement with softer stuff. this is how the shape is made.
re-ossification- bone hardens- longest stage
healed- bone regrowth complete.
? genetic link, males much more affected.
S+S: change in gait, pain, muscle spasm in hip.
Ix: B/L hip x-rays. Ap and Frogleg.
Rx:
under 5- mobilisation to maintain rom and monitor- healing potential good
5-7- more than 50% involved- surgical containment, less- mob and monitor
7-12- mild - mod- surgical containment
mod severe- salvage procedure.
after 12- salvage, or arthroplasty when mature if arthritis.
pneumothorax in children
no official guidence on what makes a big pneumothorax. 3cm in someon over 12 is definitly big.
for primary- which is common in young tall boys- 2cm or more- 16-18 gauge needle + aspirate.
chest drain if that does not work.
can get them in CF patients etc. so can be common.
usually acute onset pleuritic chest pain with SOB at rest.
pyloric stenosis
repeat projectile vomiting in children. 2-12 weeks old, male infant. first born
feeding intolerance with multiple different formulas.
weight loss + an olive shaped mass may occur in the right upper abdo.
Ix: assess U&E due to poss malnutrition.
Uss- railroad sign - >15mm long and >3mm thick.
Rx: pyloromyotomy.
correct any metablic changes before surgery- not an emergency.
reactive arthritis
inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections.
asymmetrical oligo- large joints of lower limb.
S+S:fever, peripheral and axial arthritis, enthesitis, dactylitis, conjunctivitis and iritis, and skin lesions including circinate balanitis and keratoderma blennorrhagicum
Rf: HLA b27, male, chlamydia,
Ix: CRP, ESR, ANA, RF (both negative), cultures, x-rays of si joint (may show sacriolitis).
Rx: NSAIDS
2’ Steroids
if chronic DMARD- sulfasalazine.
respiratory distress syndrome
a respiratory syndrome affecting preterm infants mostly- the more pre-term the more likely to be affected.
a loss of surfactant - either because of immature lungs or deficiency.
S+S: preterm baby, inc wob, dec 02- respiratory distress signes, shortly after birth. – dec breath sounds globally.
Ix: CXR- diffuse atelectasis, ground glass, air bronchograms.
ABG- hypoxia
Rx: antenatal corticosteroids.
exogenous surfactant supplimentation
assisted ventilation- cpap 1st line
rubella
mild, self limiting systemic infection caused by rubella virus.
can cause congenital rubella syndrome is caught in preg- cause spontaneous abortion, fetal death, or a wide spectrum of anatomical and laboratory anomalies– worse if caught early.
S+S:mild fever, a generalised rash, lymphadenopathy, conjunctivitis, and arthralgias or arthritis.
Ix: salivary IgM, or ELISA.
Rx: supportive care
if preg- refer to specialist early- maybe some role for immunoglublin therapy.
Slipped Upper Femoral Epiphysis
most common hip disorder in adolescent group
weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis
weakness caused by- hormonal/ metabolic problems, growth spurts, obesity. males more at risk.
S+S: hip, groin, thigh, and medial knee pain, new limp. can be traumatiic or insideous.
Ix: physical exam- Obligatory external rotation on hip flexion
bloods to rule out undiagnosed meta conditions
x-rays- 2 view (AP, Lat) - use klein lines (follow fem neck- if dont hit ball then +ve)
Rx: ORtho bro,
unstable- urgen fixation-
in situ screw fixation for both.
complications: osteonecrosis
talipes
club foot.- maximum plantarflexion, inversion, turned under the tibia almost.
quite common 1:1000
picked up on antenatal ultrasound 85% of time.
RF: fam hist, male, other congen abnormalities.
Ix: clinical, unless already known before birth.
should also recieve hip screeninng due to high coexistance.
Rx: manipulation + casting (ponseti method) - serially each 4-7 days
usually- needs an additional achilles tenotomy + 3/52 final cast.
cryptorchidism
where one, or both testicles are undecended.
can come down over the first 6 months.
if not- refer to surgeon at 6 months. to be done within 18 months of life.
Rf: family history, prematurity, low birth weight.
Ix: clinical diagnosis, ultrasound if its not able to be found at all.
Rx: if non decending surgery to move down within 18/12. + orchidopexy
gives better long term fertility, reduced malignancy potential and increaces average size of testicle.
