Paeds 4 Flashcards
How are urinary tract calculi managed?
Conservative - fluids, analgesia, antiemetics
Bacterial infection - co-trimoxazole/nitrofurantoin or surgical decompression
Small stones - tamsulosin
Large stones - ESWL or uteroscopy
What are the most common causes of AKI in children?
HUS
ATN
How is haemolytic uraemic syndrome managed?
Admit to hospital
Monitor urine output and fluid balance
Maintain adequate hydration status
Monitor BP (treat with CCB if necessary)
Some will need dialysis
What long-term follow-up should be offered to patients with HUS?
Check for persistent proteinuria, the development of hypertension and progressive CKD
Outline the aspects of managing CKD in a child.
Diet - calorie supplements often necessary
Prevention of renal osteodystrophy - phosphate restriction, calcium and vitamin D supplements
Control of salt and water balance
Anaemia - recombinant EPO
Hormonal - human GH for GH resistance
How does CKD affect the growth of a child?
Delayed puberty
Subnormal pubertal growth spurt
How are hydroceles in children managed?
< 2 years = most resolve spontaneously
2-11 year = open/laparoscopic repair
11-18 years = conservative or surgical
How should unilateral undescended testicles be managed?
Undescended at birth –> review at 6-8 weeks
Undescended at 6-8 weeks –> review at 3 months
Undescended at 3 months –> seen by urologist by 6 months
NOTE: if descended but retractile at 3 months, advise annual follow up due to risk of ascending testes through childhood
How should bilateral undescended testicles at birth be managed?
Urgent referral to a senior paediatrician within 24 hours (genetic or endocrine testing may be necessary)
How is testicular torsion managed?
Urgent exploratory surgery (with orchidopexy/orchidectomy)
How is torsion of the appendix testis managed?
Exploratory surgery is often performed because it may be difficult to distinguish from testicular torsion
Otherwise conservative
How are hypospadias managed?
May not require treatment
May require surgery (from 3 months) for cosmetic/functional purposes
IMPORTANT: do NOT circumcise any child with a hypospadia
How are labial adhesions treated?
Topical steroids or oestrogens
When should phototherapy for neonatal jaundice be stopped?
Once the serum bilirubin is at least 50 µmol below the treatment threshold
Patients should be given folic acid supplements
Why should you check the serum bilirubin level 12-18 hours after stopping phototherapy?
Check for rebound hyperbilirubinaemia
When is IVIG used in neonatal jaundice?
Used alongside intensified phototherapy in cases of rhesus or ABO haemolytic disease where the serum continues to rise by > 8.5 µmol/L per hour
How is biliary atresia managed?
Kasai procedure
Complications can be managed using ursodeoxycholic acid, fat-soluble vitamins and prophylactic antibiotics
How is alpha-1 antitrypsin deficiency managed?
Advise against smoking and drinking
Pulmonary manifestations are managed like COPD
Liver manifestations are managed similar to other liver diseases (e.g. monitoring for coagulopathy, diuretics for ascites)
Which investigations are used for galactosaemia?
Galactose in urine
Measuring red cell Gal-1-PUT
How is galactosaemia treated?
Galactose-free diet
How is Hep A managed?
Close contacts should be vaccinated within 2 weeks of onset of illness
Unvaccinated patients with recent exposure should receive IVIG or the hepatitis A vaccine
How is autoimmune hepatitis managed?
Prenisolone and azathioprine
Ursodeoxycholic acid can help in PSC
Liver transplant in severe cases
How is hepatic encephalopathy treated?
Supportive
Identify and correct precipitating factors (e.g. GI bleed)
Reduce nitrogenous load (dietary protein restriction, lactulose and rifaximin)
How long do patients with ALL tend to have chemotherapy for?
Girls - 2 years
Boys - 3 years
What is the cure rate for lymphoma?
80%
How is neuroblastoma treated?
Localised primaries can be cured by surgery alone
Metastatic disease will require chemotherapy (it may also require stem cell transplantation and radiotherapy)
What percentage of patients with Wilm’s tumour are cured?
80%
How is retinoblastoma treated?
Chemotherapy to shrink tumours
Laser treatment of the retina
Radiotherapy maybe used in more advanced disease
NOTE: 90% cure rate but many will be visually impaired
Which antibiotics are used for suspected bacterial meningitis in children?
< 3 months = IV cefotaxime + amoxicillin
> 3 months = IV cefotaxime
If > 1 month and caused by H. influenzae, give dexamethasone
What is the definitive management for slipped upper femoral epiphysis?
Internal fixation across the growth plate
Which type of fluid should be given for maintenance requirements in children?
0.9% NaCl + 5% dextrose
How are dehydration corrections calculated when administering fluids?
Usually given over 24 hours Give maintenance + % dehydration Weigh the child if possible (1 kg loss = 1000 mL) Estimate clinically (e.g. each kg = 1000 mL, so 3% weight loss in 20 kg child = 3 x 200 mL = 600 mL)
How should iron deficiency anaemia be treated?
Oral ferrous sulphate 200 mg tablets (2-3/day)
Continue for 3 months after iron deficiency has corrected
What advice would you give to someone who is taking iron tablets for iron deficiency anaemia about side-effects?
May experience adverse effects (constipation, diarrhoea, faecal impaction)
Discomfort could be minimised by taking the iron supplement with food
How should treatment for iron deficiency anaemia be monitored?
Re-check Hb after 2-4 weeks (expect 20 g/L rise)
FBC every 3 months for 1 year
What are the aspects of treating a neonate with hereditary spherocytosis?
Supportive (maybe blood transfusion)
Folic acid supplementation
Phototherapy/exchange transfusion
Outline the aspects of treating hereditary spherocytosis in older children and adults.
Supportive (maybe blood transfusion)
Folic acid supplementation
Splenectomy and vaccination regimen for encapsulated bacteria
Cholecystectomy for gallstones
How can complications of sickle cell disease be prevented?
Immunisation against encapsulated organisms
Daily oral penicillin
Daily folic acid
Minimise exposure to cold, dehydration, excessive exercise and hypoxia
Outline the treatment of acute sickle cell crises.
Oral and IV analgesia Good hydration Antibiotics if necessary Oxygen Exchange transfusion (for acute chest syndrome, priapism and stroke)
Outline the steps in the analgesic ladder.
Step 1: paracetamol
Step 2: cocodamol or NSAIDs (weak opioid)
Step 3: morphine, oxycodone
Which drug treatment can be used to reduce sickling in sickle cell patients?
Hydroxycarbamide
How is haemophilia treated?
Factor 8 concentrate (A)
Factor 9 concentrate (B)
Acute bleed - factor concentrates and anti-fibrinolytics
Which medications should be avoided in patients with haemophilia and von Willebrand disease?
IM injections
Aspirin
NSAIDs
Which treatment can be used for mild haemophilia A?
Desmopressin (stimulates endogenous release of vWF)
What medical treatment can be used for type 1 von Willebrand disease?
Desmopressin
NOTE: risk of hyponatraemia
More severe disease is treated with factor 8 concentrate
Describe the usual natural course of ITP.
In 80% it is an acute, benign and self-limiting disease
Resolves spontaneously within 6-8 weeks
Mild/asymptomatic disease can be managed with observation alone
How can severe ITP be managed?
IVIG + corticosteroid + platelet transfusions
Antifibrinolytics (e.g. tranexamic acid) may be used
How is DIC treated?
Treat underlying cause
Supportive care
Replacement therapy (platelets and clotting factors)
Restoration of physiological coagulation pathways (e.g. using heparins)
How is acute osteomyelitis managed?
High-dose IV empirical antibiotics (for 2-4 weeks)
Switch to oral once clinically recovered (continue for 6 weeks)
Immobilise the affected area
Surgical debridement may be necessary
Possible antibiotics used include flucloxacillin and penicillin
How would you counsel a patient with Osgood-Schlatter disease?
Stop or reduce sporting activity Analgesia - paracetamol and NSAIDs Intermittent ice packs Protective knee pads Stretching
