Paeds 4A Flashcards
How are urinary tract calculi managed?
Conservative - fluids, analgesia, antiemetics
Medical -
Bacterial infection - co-trimoxazole/nitrofurantoin or surgical decompression
Small stones - tamsulosin (a blocker - relaxes ureters to allow stone passage)
Surgical-
Large stones - extracorporeal shock wave lithotripsy (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?
Kidney function and Blood pressure (may develop high BP from kidney damage)
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
The body slows growth to make up for the lost fluid and minerals. preventing the body from correctly using growth hormone. When the kidneys are damaged, waste builds up in the blood and the body does not properly process growth hormone.
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?
Unilateral: Undescended by 3 months= REFER, ideally you want the pt seeing a urological surgeon before 6 months of age
Orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes: Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
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
If surgery required, then this is normally done at 12 months
IMPORTANT: do NOT circumcise any child with a hypospadia
What are labial adhesions and how are they treated?
This can cause the inner lips of the vulva to Without enough oestrogen in the body, which is quite normal before puberty, the lips can stay stuck together and gradually become firmly joined.
The problem is rarely seen in girls after they begin puberty because this is when they start to produce the hormone oestrogen.
Rx = 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
How is biliary atresia managed?
Kasai procedure
Complications can be managed using ursodeoxycholic acid (helps with bile flow), fat-soluble vitamins and prophylactic antibiotics (prophylaxis for cholangitis as it is common after kasai)
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
Gal-1-PUT is an enzyme in galactose metabolism. Deficiency in this causes the most common form of galactosaemia
How is galactosaemia treated?
Galactose-free diet
How is Hep A managed?
Supportive for pain and nausea
vaccinate close contacts (within 2 weeks of onset of illness)
Unvaccinated patients with recent exposure should receive IVIG (<12 months old) or the hepatitis A vaccine (>12 months)
How is autoimmune hepatitis managed?
Prenisolone and azathioprine
Ursodeoxycholic acid can help in PSC (PSC and Autoimmune hepatitis have a lot of overlap so should also suspect the other at the same time)
Liver transplant in severe cases
How is hepatic encephalopathy treated?
Supportive
Identify and correct precipitating factors (e.g. GI bleed - GI bleeds increase ammonia absorption in gut)
Reduce nitrogenous load (dietary protein restriction, lactulose and rifaximin. Rifaximin is a poorly absorbed antibiotic that targets ammonia producing colonic bacteria)
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%
