Paeds Flashcards
What is croup and it’s primary cause?
What are the major age groups affected?
- Acute laryngo/tracho/bronchitis w sub glottic inflamm and oedema
- 80% cases cause by parainfluenza virus
- 6 months - 6 years. Most common 1-2 years.
- Peaks in autumn
What is the typical presentation of croup?
Including the specification for mild, moderate and severe
What are the signs of impending RF?
- 12-48 Hx fever, non specific cough, rhinorrhoea
- Sudden onset seal like barking cough, hoarseness
- Symptoms worsen at night
Mild –> barking cough, no stridor, no recession, no agitation or lethargy at rest
Mod –> barking cough w stridor and recession. No agitation or lethargy at rest
Severe –> barking cough w stridor and recession. Agitation and lethargy at rest
Cyanosis, decreasing consciousness, pallor, recession
What are the investigations for croup?
What would an x ray show?
Clinical diagnosis
-Antero/post/lateral x ray –> steeple sign –> narrow trachea
What is the management of croup and its differing severity?
- Most cases actually self limiting and resolve w/i 48 hours
- Single dose dexamethasone 0.15mg per kg
Mild
- Manage at home
- Fluids, paracetomal for fever
- Admit to hospital when –> <3 months, congenital heart defect, inad fluid intake (e.g no wet nappy w/i 12 hours or <75% normal), not coping, live far, immunodeficeincy
- Advise to seek Tx when at home and –> continous stridor develops, recession, agitation
Mod-severe
- Admit to hospital
- 8/10L oxygen by blow by
- Possible nebulised adrenaline when agitated
- Too ill to swallow dexa –> consider IM dexa or 2mg nebulised budesonide.
What is pyloric stenosis?
- Pyloric sphincter –> ring of smooth muscle between the stomach and duodenum. When hypertrophies –> narrows lumen.
- After eating increasing peristalsis to move food from stomach to duodenum, when pyloric stenosis food can’t get through and therefore goes up oesophagus and results in projectile vomiting.
What is the typical presentation of pyloric stenosis?
What would be the finding on examination?
- Typically presents in first few weeks of life
- Projectile vomiting typically 30mins after feeding
- Failure to thrive, skinny, pale.
-On examination –> olive like mass in upper abdomen due to pyloric hypertrophy.
What investigations are carried out in suspected pyloric stenosis?
- Blood gas –> hypochloride. Metabolic alkalosis due to vomiting up stomach acid hydrochloric acid.
- Diagnostic –> Abdo US –> visulise thicken pylorus
What is the management for pyloric stenosis?
-Laparoscopic pyloromyotomy –> Ramstedt’s operation. An incision is made in the smooth muscle of the pylorus to widen the canal allowing that food to pass from the stomach to the duodenum as normal.
What is whooping cough?
What causes the characteristic whooping?
- URTI caused by bordetella pertussis –> g-ve bacteria
- Causes bouts of severe paroxysmal coughing –> can’t properly take in air during bouts, results in forceful intake of air when coughing ends w a loud inspiratory whoop
- Spread by aerosol droplets
- Children and pregnant women vaccinated
- Vaccine doesn’t provide lifelong protection –> can still get even though been vaccinate
What is the presentation of whooping cough?
What are the three phases?
1 week of incubation then 21 day period of being infectious
-Phase 1 –> 1/52 of coryzal symptoms w low grade fever and cough.
- Phase 2 –> paroxysmal coughing –> coughing becomes more severe and occurs in bouts w cough free periods in between.
- Coughing can be so severe cause –> vomiting, fainting, pneumothorax
- Not all will have ‘whoop’ can have apnoeic episodes
-Phase 3 –> convalescent –> gradual improvement in symptoms. ‘100 day cough’. Most resolve w/i 2 months.
What are the investigations for whooping cough?
When should you suspect whooping cough?
- Clinical diagnosis
- Suspect when cough >14 days w no other known cause and one or more of –> post tussive vomiting, paroxysmal coughing, inspiratory whoop, apnoeic episodes (previously undiagnosed in infants)
- Can do nasal swab w PCR/bacterial culture –> increasing as availability increases
- Also possible test for anti-pertussis toxin immunoglobulin G when cough present >2 weeks. >5 years then oral fluid, >17 then in blood.
What is the management of whooping cough?
- Notifiable disease –> inform PHE w/i 3 days
- Admit hospital –> <6 months or vulnerable or acutely unwell or episodes of cyanosis/apnoea.
- Conservative –> fluids, rest, analgesia
- Ab –> when presenting w/i 21 days onset symptoms.
- Ab –> macrolides –> azithro/clari/erythro. Cotriamoxaizole an alternative.
- Prophylaxis Ab in close contacts –> ?only when vulnerable e.g pregnant
What is wilms tumour?
- A rare, childhood tumour/cancer
- Embryonic cancer –> undifferentiated mesodermal cells that make up blood vessels walls, kidneys, adrenal cortex
- Presents in those <5, most commonly ages 1-3
- <50 cases annually in UK
What is the typical presentation of a wilms tumour?
- Consider in those <5 presenting w
- Palpable abdominal mass, possibly w abdo pain or haematuria
- Other possible symps –> lethargy, HTN, weightloss
When should you urgently refer for suspected wilms tumour?
VERY URGENT W/I 48 HOURS FOR SPECIALIST ASSESSMENT
- Palpable abdo mass
- Unexplained visible haematuria
- Unexplained abdo organ enlargement
