Paeds A conditions Flashcards
What are innocent murmurs?
Flow murmurs caused by fast blood flow through various areas of heart during systole
What are the features of innocent murmurs?
Soft Short Systolic Symptomless Situation dependent (infection, anaemia, exercise)
What are the features of a pathalogical murmur?
Murmur louder than 2/6
Diastolic Murmurs
Louder on standing
What investigations should be done if a heart murmur is heard in a child?
ECG
CXR
Echo
What are pan-systolic murmurs?
Murmurs that start at s1 and extend up to s2
Sign of Mitral Regurg if heard at 5th ICS mid clavicular line
Tricuspid regurg if heard at tricuspid area
VSD if heard at Left lower sternal border
What conditions are associated with ejection systolic murmur?
Aortic stenosis at aortic area
Pulmonary stenosis
HOCM (fourth intercostal space, left sternal border)
What is heard during auscultation of an atrial septal defect?
Mid-systolic, crescendo-decrescendo murmur loudest at upper left sternal border, with a fixed splitting heart sound.
What is heard in patent ductus arteriosus?
Small patent ductus arteriosus may not cause abnormal heart sounds
Larger ones cause a continuous crescendo-decrescendo machinery murmur that may continue during a second heart sound
What is heard in tetralogy of fallot?
Arises from pulmonary stenosis so ejection murmur at the pulmonary area is heard
What is cyanotic heart disease?
When deoxygenated blood enters the systemic circulation as it bypasses the pulmonary circulation and the lungs.
Occurs due to a right-to-left shunt
What conditions cause cyanotic heart disease ?
VSD
ASD
PDA
Transposition of the great arteries
What is Eisenmenger syndrome ?
When blood flows from the right side of the heart to the left across a structural heart lesion.
What three conditions result in Eisnmenger syndrome?
ASD
VSD
Patent Ductus Arteriosus
What is coeliac disease?
An autoimmune condition where exposure to gluten causes an immune reaction which creates inflammation in small intestines
What autoantibodies are involved in coeliacs?
anti-TTG
antiEMA
Where does the inflammation in coeliacs disease occur?
The jejunum
- causes atrophy of the intestinal villi (malabsorption of nutrients and disease related symptoms)
How does coeliac disease present?
can be asymptomatic if not: - failure to thrive - Diarrhoea - Fatigue - Weight loss - Mouth ulcers - Anaemia second to iron, b12 or folate deficiency - dermatitis herpetiformis
What genes are associated with coeliac?
HLA-DQ2 gene (90%)
HLA-DQ8 gene
How is coeliac diagnosed?
investigations should be carried out whilst patient remains on a diet containing gluten
Total IgA levels
Specific antibodies - anti TTG and anti-EMA
What does coeliac disease show on endocscopy?
Crypt hypertrophy and villous atrophy on intestinal biopsy
What diseases are associated with coeliac?
Type 1 diabetes Thyroid diseases Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Down's syndrome
What are the complications of untreated coeliac disease
Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy-associated T cell lymphoma of the intestine Non-Hodgkin Lymphoma Small bowel adenocarcinoma
How is coeliac disease treated ?
Patient education and a gluten free diet
How does constipation present in children?
<3 stools a week hard stools that are difficult to pass Rabbit dropping stools Straining and painful passages of stools Abdominal pain Holding an abnormal posture Rectal bleeding + hard stools Faecal impaction = overflow soiling. Palpable stool on abdo exam Loss of sensation of need to open bowels
What is encopresis?
Faecal incontinence
Not pathological until age 4
Usually sign of chronic constipation
Large hard stools stay in rectum, loose stools bypass the blockage and leak out, causing soiling
What are some causes of encopresis?
Spina bifida Hirschprung's disease Cerebral palsy Learning disability Psychosocial stress Abuse
What lifestyle factors contribute to constipation?
Habitually not opening bowels Low fibre diet Poor fluid intake and dehydration Sedentary lifestyle Psychosocial problems such as a difficult school or home environment
What are red flag signs regarding constipation?
Not passing meconium within 48 hours of birth (CF/Hirschsprung’s)
Neurological signs or symptoms (cerebral palsy or spinal cord lesion)
Vomiting (intestinal obstruction or Hirschsprung’s disease)
Ribbon stool (anal stenosis)
Abnormal anus (anal stenosis, IBD, sexual abuse)
Abnormal lower back or buttocks (spina bifida, spinal cord lesion, or sacral agenesis)
Failure to thrive (coeliac disease, hypothyroidism or safeguarding)
Acute severe abdominal pain and bloating
What are the complications of constipation?
Pain Reduced sensation Anal fissures Haemorrhoids Overflow and soiling Psychosocial morbidity
What is the management of constipation?
Idiopathic constipation can be diagnosed without investigation, provided red flags have been considered
Correct reversible contributing factors (dehydration, low fibre diet)
Start laxatives (movicol)
Disimpaction regimen
Encourage and praise visiting the toilet
What is acute gastritis?
Inflammation of the stomach and presents with nausea and vomiting
What is enteritis?
Inflammation of the intestines and presents with diarrhoea
What is gastroenteritis?
Inflammation from the stomach to the intestines, presents with nausea, vomiting and diarrhoea
What viruses are responsible for viral gastroenteritis?
Rotavirus
Norovirus
Adenovirus
What bacteria can cause gastroenteritis?
E.Coli
- E.Coli 0157 - produces shiga toxin = HUS
Campylobacter Jejuni
- Raw or improperly cooked meat, untreated water, unpasteurised milk
Shigella
- faeces contaminated drinking water, swimming pools and food
Salmonella
- raw eggs or poultry
Bacillus Cereus
- fried rice
Giardia
- foods contaminated with giardia cysts
What is treatment for campylobacter jejuni?
Incubation lasts for 2-5 days and symptoms end after 3-6. Usually supportive management
Azithromyin or ciprofloxacin if severe symptoms or patient is HIV positive or has Heart Failure
What are symptoms of salmonella?
Watery diarrhoea +/- mucus or blood, abdo pain and vomiting
What are the symptoms of bacillus cereus?
Abdo cramping and vomiting within 5 hours of ingestion, followed by watery diarrhoea around 8 hours after ingestion of food.
Resolves within 24 hours
How should gastroenteritis be managed?
Barrier nursing and infection control
Staying off school for 48 hours after symptoms have completely resolved
Microscopy, culture and sensitives of stool
Fluid challenge
Rehydration (dioralyte)
IV fluids
AVOID ANTIDIARRHOEALS AND ANTIEMETICS
What are the complications of gastroenteritis ?
Lactose intolerance
Irritable bowel syndromes
Reactive arthritis
Guillian Barre
What is pyeloric stenosis?
Thickening of the pylorus of the stomach which prevents food travelling from the stomach to the small intestine
After feeding, there is increasingly powerful peristalsis as it tries to push food into the duodenum and eventually ejects food into the oesophagus = projectile vomiting
What are the features of pyloric stenosis?
Presents in first few weeks of life = failure to thrive
Projectile vomiting
Mass that feels like an olive in the upper abdomen
Visible peristalsis
What will blood gas analysis look like in pyloric stenosis?
Hypochloric metabolic alkalosis as baby is vomiting hypochloric acid from stomach
What is the management of pyloric stenosis?
Abdo ultrasound - thickened pylorus
Laparoscopic pyloromyotomy
What is intestinal obstruction ?
Physical obstruction prevents flow of faeces through the intestines = back pressure through the GI system, causing vomiting
What are the causes of intestinal obstruction?
Meconium ileus Hirschsprung's disease Oesophageal atresia Duodenal atresia Intussusception Imperforate anus Malrotation of the intestines with a volvulus Strangulated hernia
How does intestinal obstruction present?
Bilious vomiting
Abdo pain and distension
Failure to pass stools or wind
Abnormal bowel sounds (high pitched and tinkling, or absent)
How is intestinal obstruction diagnosed?
Abdo X-Ray
- dilated loops of bowel
- absence of air in the rectum
How is intestinal obstruction managed?
Nil by mouth
NG tube to drain stomach and stop vomiting
IV fluids
Look for underlying cause
