paeds common / serious presentations Flashcards
FEVER DDx
- infective? (4 groups of causes)
- autoimmune? 4
- other? 5
INFECTIVE
- bacterial (incl atypical)
- TB
- viral
- parasites (eg malaria)
AUTOIMMUNE
- kawasaki
- thyroidoxicosis
- JIA
- SLE
OTHER
- haem cancers
- solid tumours
- dehydration
- post-immunisation (also post-surgery)
- factitious (eg thermometer in tea)
nb if acute fever almost always infection, if prolonged or can’t find site of infection, start to consider other causes!
If you suspect an infective cause of fever, what locations should you think of? 9
and what hx/exam/investiagtions might you consider for each ‘location’
what investigations should you consider for all children with suspected infection? regardless of cause
EAR
- ear pain / tugging
- examine ear
THROAT
- examine throat + tonsils
- feel for cervical lymphadenopathy
- throat swab for strep
CHEST
- resp exam (incl auscultate lungs AND heart)
- CXR
GI TRACT
- hx of diarrhoea/vomiting (esp blood)
- (consider stool sample)
URINARY
- hx of urinary symptoms (freq, pain, new nocturnal enuresis) and/or abdo pain
- urine dip / culture
SKIN (rash or wound)
- hx of any rashes or wounds
- examine body for rashes or wounds
JOINTS
- hx of any painful joints or limp
- MSK exam (general or specific to one joint)
BLOOD
- listen to heart
- blood cultures
CNS
- hx of meningism, sick contacts
- brief neuro exam (incl conciousness, fontanelle, mengism signs)
- lumbar puncture
BLOODS FOR ALL
- FBC
- CRP
RED FLAGS FOR FEVER ON HX/EXAM/OBS
- colour? 1 (exam)
- activity? 4 (1 exam, rest mixed)
- resp? 3 (all exam)
- circulation/hydration? 1 (exam)
- other? 6 (mainly neuro, mainly exam)
- red/orange flags for degree of fever with respect to age? 2
ORANGE FLAGS FOR FEVER ON HX/EXAM/OBS
- colour? 1 (hx)
- activity? 4 (all hx)
- resp? 4 (all exam/obs)
- circulation/hydration? 5 (1 obs, 2 exam, 2 hx)
- other? 4 (1 hx, 3 exam)
RED EXAM / OBS:
- pale / mottled / ashen / blue
- no response to social cues
- appears ill to a health professional
- does not wake or, if aroused, does not stay awake
- weak, high pitched or continuous cry
- grunting
- tachypnoea (RR>60)
- moderate/severe chest indrawing
- reduced skin turgor
- non-blanching rash
- bulging fontnelle
- neck stiffness
- status epilepticus
- focal neuro signs
- focal seizures
AGE
- age < 3 months with temp >/= 38
- age 3-6 months with temp >/= 39
ORANGE EXAM / OBS
- pallor reported by parent / carer
- not responding normally to social cues
- no smile
- wakes only with prolonged stmulation
- decreased activity
- nasal flaring
- tachypnoea (RR>50 age 6-12m, RR>40 age >12m)
- O2 sats <95
- crackles in chest
- tachycardia (look up individual age ranges)
- CRT >/= 3sec
- dry mucous membranes
- poor feeding in infants
- reduced urine output
- fever for 5 days or longer
- rigors
- swelling of limb or joint
- non-weight-bearing limb/not using an extremity
nb so GREEN flags for fever (ie low risk) are absence of any red/amber incl:
- normal colour
- responds normally to social cues
- content / smiles
- stays awake or wakens quickly
- strong normal cry / not crying
- normal skin + eyes
- moist mucous membranes
nb this all comes from NICE traffic light system - look it up!
What are the constituents of a ‘septic screen’:
- bedside? (2, 2 others to consier)
- bloods? 5
- imaging? 1
also what 2 obs and 1 clinical test are expecially important to do in every child?
- urine dip + culture
- LP (esp if under a year)
- stool sample (if stool present)
- throat swab (i tonsilitis)
- FBC
- U+E
- blood gas
- CRP
- blood cultures
- CXR
ALWAYS DO:
- HR
- RR
- cap refill
What specific questions should you ask (in addition to norm hx Qs) in these sections of a hx in a child presenting with fever:
- PMHx? 1
- BINDS? (which 2 especially important)
- SHx? 2
PMHx
- any predisposition to infection (eg steroids, immunodeficiency)
BINDS
- birth Hx
- Immunisation Hx
SHx
- Hx of foreign travel
- any sick contacts
groups of DDx for ‘collapse’? (3 groups come round from, 6 groups may still be altered level of consciousness when arrive in A+E) - 9 overall
(nb one of these is ‘fit mimics’ - list 5 examples)
SYNCOPE
- vaso-vagal
- cardiac (long QT most common in children)
SEIZURE
- lots of diff types
- incl prolonged febrile convulsion
FIT MIMICS
- anoxic attacks
- breatholding spells
- migraine
- non-epileptic seizures
- “faking it”
INFECTION
- meningitis
- encephalitis
RAISED ICP
- space-occupying lesion
HEAD INJURY
- sub-dural/extradural haematoma
- diffuse axonal injury
- NAI
ACUTE ASPHYXIA
- near miss cot-death (SIDS)
- CV accident (rare in kids)
METABOLIC
- hypoglycaemia
- DKA
- inborn errors of metabolism
DRUG OVERDOSE
- intentional / deliberate
nb another way of dividing up is ‘structural’ (tumour, haematoma, abscess, hydrocephalus) to ‘non-structural’ (infection, metabolic, poisoning)
- structural tend to have focal neuro signs, non-structural tend not to - though infection sometimes can
Way to structure a history of ‘collapse’? 3
- specific questions to especally ask (in addition to normal HPC/PMH/DH/SH) ? 6
BEFORE
- possibility of drug ingestion (deliberate or accidental)
- any prodromal illness (incl fever + personality change) or contact with serious infection
- any head trauma
- any Hx of seizures
- any developmental concerns prior to this
DURING
- assess posibility of NAI
AFTER
nb also ask all the obvious stuff like what they were doing before it happened, any tongue biting/incontinenece, how long they were ‘out’ for, any drowsiness afterwards etc
EXAMINATION OF COLLAPSE
- what could brady cardia indicate in this setting? 1
- what could tachy cardia indicate in this setting? 3
- what should you be searching for to rule in/out one group of causes?
- what examination to do? which ‘add on’ part of this examination should you always do?
BRADY
- could mean raised ICP
TACHY
- infection
- ingestion of drugs
- anaphylaxis (or other cause of shock)
look for SOURCE OF INFECTION
NEURO EXAM
- must include looking at PUPILS (PEARL)
also:
- abnormal posture (decordiate or decerebrte posture)
- GCS
possible investigations for ‘collapse’ and when you would use them:
- bedside? 5
- bloods? 5
- imaging? 3
BEDSIDE
- capillary glucose (always)
- urine dip (if suspect infection)
- LP (if suspect infection, not if non-blanching rash though)
- ECG (if cardiac syncope possible)
- opthalmascope (if any neuro/raised ICP signs)
BLOODS
- blood glucose
- blood gases (metabolic or resp acidosis)
- FBC (infection, acute blood loss)
- blood culture (if suspect infection)
- U+E (dehydration incl DKA, ingestion of drugs)
IMAGING
- CXR (infection)
- CT/MRI (focal pathology: tumour, haemorrhage, abscess)
- skeletal survey (if suspect NAI)
Two definitions of failure to thrive?
main intervention used in diagnosing FTT?
what important to differentiate it from? how to prevent this?
FAILURE TO THRIVE (FTT)
1) Drop in at least 2 centiles
2) less than 0.4th centile
plot GROWTH CHARTS!
differentiate from child who is constitutionally small / short
- use personalised growth charts which take into account parents height + weight
DDx of failure to thrive:
what are the three main groups of causes?
other main two groups of causes that doesn’t fit into any of these 3?
what is the commonest cause of FTT? describe it
- Inadequate caloric intake
- Inadequate nutrient absorption
- Increased metabolism
DON’T FORGET
- genetic abnormalities, eg Turner’s syndrome
- medications (eg steroids)
COMMONEST CAUSE = environmental / psychological
- weight nor affected first, then head circum + height
- eating difficuolties are common
- disturbed maternal-child interaction may be present
- maternal depression/mental health problem may be present
- neglect may be a factor
DDx OF FAILURE TO THRIVE due to:
- Inadequate caloric intake? (4 infants, 4 any age)
by ‘infants’ I mean either only happens in infants or is normally present from birth/early infancy
INADEQUATE CALORIC INTAKE:
- inadequate breast milk supply or poor latching
- incorrect formula preparation
- mechanical feeding difficulties (eg cleft lip/palate)
- reflux
- poor oral neuromotor coordination
- poor eating habits (‘fussy’)
- neglect or abuse
- mental health conditions (in parent or child)
DDx OF FAILURE TO THRIVE due to:
- Inadequate nutrient absorption? (4 infant, 3 any age)
by ‘infants’ I mean either only happens in infants or is normally present from birth/early infancy
INADEQUATE NUTRIENT ABSORPTION
- biliary atresia
- cystic fibrosis
- inborn errors of metabolism
- milk protein allergy
- coeliac disease (growth chart shows fall off in growth when gluten introduced into diet)
- chronic GI conditions (eg IBD)
- anaemia / iron deficiency
DDx OF FAILURE TO THRIVE due to:
- Increased metabolism? (2 infant, 5 any age)
nb some of these may be groups of causes
by ‘infants’ I mean either only happens in infants or is normally present from birth/early infancy
INCREASED METABOLISM
- chronic lung disease of immaturity
- congenital heart disease
- chronic infection (eg HIV, TB)
- chronic inflammation (eg asthma, IBD)
- hyperthyroidism
- renal failure
- malignancy
RED FLAGS FOR FAILURE TO THRIVE? 8 (ie when to suspect a medical cause)
nb 2 are hx, 6 are exam findings
- cardiac findings suggesting congenital heart disease (eg murmur, oedema, jugular venous distension)
- developmental delay
- dysmorphic features
- failure to gain weight despite adequate caloric intake
- organomegaly
- lymphadenopathy
- recurrent or severe resp or urinary infection
- recurrent vomiting, diarrhoea or dehydration
What specific questions to raise in a child presenting with FTT:
- review of systems? 7
- Birth Hx? 3
- nutritional Hx? 2
- developmental Hx? 2
- FHx? 2
- SHx? 2
REVIEW OF SYSTEMS
- vomiting
- diarhoea
- colic
- irritability
- fatigue
- chronic cough
- SOB when feeding (think cardiac)
BIRTH Hx
- prenatal probs
- birth WEIGHT (+ gestation)
- postnatal probs / stays in NICU
also ask if any recurrent or chronic conditions
NUTRITIONAL Hx
- dietary hx (ideally a food diary)
- any feeding difficulties (when start: birth, weening, toddler - think about whether these are a cause or result of FTT)
DEVELOPMENTAL Hx
- any concerns? (esp loss of acquired skills)
- ask about age-relevant milestones for each of 4 domains
FHx
- any FHx of genetic problems / short stature / FTT
- any maternal/paternal mental health problems
SHx
- any problems at home? incl financial difficulties
- ever had any involvement with social care
What potential underlying cause of failure to thrive might each of these exam findings suggest:
- poor parent-child interaction 1
- mental status change 2
- pale 1
- dysmorphic changes 1
- hair colour / texture change 1
- wasting 2
- rash, skin changes, bruising 2
- heart murmur 1
- respiratory compromise 1
- hepatomegaly 3
- peripheral oedema 2
poor parent-child interaction
- depression / social stress
mental status change
- cerebral palsy
- poor social bonding
pale
- iron deficiency anaemia
dysmorphic changes
- genetic abnormality / undiagnosed syndrome
hair colour / texture change
- zinc deficiency
wasting
- cerebral palsy
- cancer
rash, skin changes, bruising
- cow’s milk allergy
- abuse
heart murmur
- anatomical cardiac defect
respiratory compromise
- cystic fibrosis
hepatomegaly
- infection
- chronic illness
- malnutrition
peripheral oedema
- renal disease
- liver disease
INVESTIGATIONS FOR FTT:
- first thing to do?
- what documentation to always look at?
- when to do investigations?
- bedside test to consider? 2
- bloods to consider? 7
- imaging to consider? 1
PLOT INDIVIDUALISED GROWTH CHART
SEE RED BOOK!!!
- loads of info in there from health visitor about living conditions etc
LET HX + EXAM GUIDE INVESTIGATIONS
- probs do a FBC in everyone for anaemia but apart from that only do investogations which match with hx/exam
- urine dipstick / culture
- sweat test (if suspect CF)
- FBC
- U+E
- LFT
- ESR/CRP
- TFTs
- coeliac antibodies
- chromosomes (in girls, for turners)
- echo (if suspect cardiac cause)
Causes of short stature:
- steady but poor growth? (3 common, 2 rare)
- fall-off in growth across centiles? (3 common, 2 rare)
describe features which may indicate each
STEADY BUT POOR GROWTH
CONSTITUTIONAL
- short parents
- normal hx + exam
- no delay in bone age
MATURATIONAL DELAY
- delayed onset of puberty
- FH x of delay
- delayed bone age
IUGR
- low birth weight
- the underlying reason for IUGR (eg maternal alcohol, genetic syndrome) may be evident
TURNER’S (rare)
- features of turner’s (not always present)
- XO karyotype
- no pubertal signs
- no delay in bone age
SKELETAL DYSPLASIAS (rare)
- body disproportion with shortened limbs
- achondroplasia is most common cause
FALL OFF IN GROWTH ACROSS CENTILES
PSYCHOSOCIAL
- neglected appearance
- behavioural problems
- catch-up growth occurs when child removed from home
CHRONIC ILLNESS
- usually identified on hx + exam
- crohns andf kidney disease may be occult
- some delay in bone age occurs
ACQUIRED HYPOTHYROIDISM
- clinical features of hypothyroidism
- goitre may be present
- low T4, high TSH + thyroid antibodies
- delayed bone age
CUSHING’S (rare)
- cushingoid features
- usually iatrogenic dt prescribed steroids
- delayed bone age
GROWTH HORMONE DEFICIENCY (rare)
- congenital or acquired
- may occur with other hormone deficiencies
- delayed bone age
DDx for fatigue/lethargy in an acute presentation:
- infective? 5
- non-infective? 4
INFECTIVE
- viral URTI infection
- UTI
- gastroenteritis
- meningitis
- septicaemia
NON-INFECTIVE
- DKA
- hypoglycaemia
- brain tuymour
- hypothyroid
nb viral URTI is by far the most common cause, but exclude others
DDx for fatigue/lethargy in a chronic/insidious presentation:
- psychosocial? 4
- infections? 3
- metabolic/endocrine? 3
- other chronic diseases? 7
ones with = sign are most common
PSYCHOSOCIAL = depression/anxiety = sleep problems (incl sleep apnoea if obese) = neglect / difficulties at home/school - chronic fatigue
INFECTIONS
= post-viral fatigue
- EBV infection
- TB or other occult infection
METABOLIC / ENDOCRINE
= iron-deficiency anaemia (incl from periods)
= diabetes
- hypothyroidism
OTHER CHRONIC DISEASES
- coeliac disease
- crohns
- liver disease
- cardiac disease
- renal failure
- leukaemia
- solid malignancies
(also other rarer chronic diseases such as JIA, SLE, addisons etc)
also always consider pregnancy in adolescent girl!
Red flags for lethargy/fatigue? 9
- weight loss/FTT
- non-blanching rash
- easy bruising
- fever with no identifiable infection focus
- night sweats
- swollen joints or MSK pain
- widespread and/or concerning lymphadenopathy
- hepatosplenomegaly
- any palpable non-tender lumps (eg kidney, bone)
Initial investigation if chronic presentation of fatigue / lethargy? 1
FBC
- can reveal iron deficiency anaemia
- can show high WCC if ongoing infection
- can show abnormalities in leukaemia
then do whatever investigations are indicated by
DDx for acute dyspnoea in children:
- resp non-infective? 2
- resp infective? 6
- cardiac? 1
- other? 4
RESP
= asthma attack
- inhaled foreign body
= viral URTI (incl viral-induced wheeze)
= croup
= bronchiolitis
= pneumonia
- TB
- whooping cough
CARDIAC
- heart failure
OTHER
- DKA
- sepsis
- ingestion of toxins
- panic attack
BREATHLESSNESS Hx:
- associated symptoms to ask about in HPC? 8
- important conditions to ask about in PMHx? 3
- important conditions to ask about in FHx? 3
nb also ask about onset and, if really uddne ask about likelihood of foreign body or panic attack
ASSOCIATED SYMPTOMS
- cough (productive or not)
- wheeze
- any stridor or whooping
- fever
- lethargy / behaviour change (DKA, sepsis, dehydration)
- rashes or sign changes (sepsis)
- eating + drinking?
- wet nappies / urinating?
PMHx
- any atopic conditions
- any underlying conditions (esp heart disease
- prematurity?
FHx
- any atopic conditions
- TB
- CF
What two clinical signs make pneumonia more likely in bronchiolitis?
- high-grade fever (>38.5)
- persistent focal crackles on auscultation
RESP EXAM FOR CHILD WHO IS SOB:
- noises to listen for? 4
- signs of resp distress to look for? 8
- sign indicative of epiglottitis?
- possible findings on persussion / auscultation?
- what else to always examine in child with resp symptoms? 6
NOISES
- grunting
- stridor
- wheeze
- whooping
RESP DISTRESS
- high RR (for age)
- grunting
- nasal flaring
- inter/subcostal recession
- tracheal tug
- central cyanosis
- child can’t talk in full sentences
- restlessness or reduced GCS
new drooling = epiglotittis until proven otherwise
AUSCULTATION (nb tend not to do percussion - though do in osce)
- reduced air entry
- crackles
- wheeze
nb signs are often not focal in young children
ALWAYS EXAMINE
- ears
- nose
- throat
- heart
- abdomen
- skin for rashes
INVESTIGATIONS FOR SOB
- first line blood? (and finding)
- bloods if very unwell? 2
- first line imaging?
- three types of resp swab and what each looks for?
- bedside test if suspect asthma?
- test if suspect TB?
obvs always keep an eye on obs too (esp O2 + temp)
FBC
- high neutrophils in bacterial pneumonia
- high lymphocytes in pertussis
if ill
- blood culture
- blood gases
SWABS
- sputum culture (causative organisms, incl acid fast bacilli in TB)
- nasopharyngeal aspirate (viral immunoflurescence for bronchiolitis)
- per nasal swab (for bordella pertussis)
PEFR for asthma
Mantoux test if suspect TB
two main indications for doing a bronchoscopy for SOB child?
- inhaled foreign body likely
- diagnostic bronchioalvelar lavage
DDx for chronic cough without breathlessness? 9
- GOR
- post nasal drip
- tracheo-oesophageal fistula (‘TOF cough’)
- passive smoking
- cystic fibrosis
- retained or recurrent aspirations
- variant asthma
- pertussis
(also post-viral cough) - tic / habit cough
also may just be recurrent infections, normal for age group (if REALLY frequent then may be immunocompromised but kids do just get a LOT of infections!)
DDx for wheeze in children:
- widespread? 3
- focal? 2
WIDESPREAD
- asthma
- viral-induced wheeze
- bronchiolitis
FOCAL
- pneumonia
- foreign body
(see essential core condition flaschards for how to differentiate between viral-induced wheeze + asthma)
DDx for cyanosis:
- peripheral? 4
- central? 5
nb acronym for this, two words - 1st word is causes of peripheral, 2nd word is central
also one other cause that isn’t in this pneumonic!
COLD PALMS
PERIPHERAL
C = Cold O = Obstruction L = LVF and shock D = Decreased cardiac output
CENTRAL
P = Polycythaemia A = Altitude L = Lung disease M = Methemoglobinaemia (see on blood gas) S = Shunt (R -> L - ie cyanotic heart disease)
Also DON’T FORGET breath holding spells too!!!
Lung diseases include basically anything but especially:
- asthma
- pneumonia
- inhaled foreign body
- meconium aspioration at birth
- congenital lung conditions / prematurity
INNOCENT MURMUR:
- eight features? (all start with the same letter)
- what often triggers or exacerbates them?
- safety net?
8 S’s
- Soft (also quiet)
- Short
- Systolic
- Site - heard over small area (left Sternal edge)
- Sitting + standing - Change with movement or position (decreases in intensity when stand)
- symptom-free
- Signs - none present (incl no FTT and no thrills)
- Special tests normal (radiograph, ECG normal)
tend to get / exacerbate in:
- febrile / intercurrent illness
- anaemia
also because heart is small there is just more turbulence
- can be heard in 30% of children at some point
If child is acutely unwell and has a murmur then wait until they are better again to listen for murmur again - normally it’s gone when they’re well again
nb, on the other hand, pathological murmurs are:
- pansystolic or diastolic (or may be systolic)
- harsh or long
- loud
- may radiate + have palpable thrill
- may involve cardiac sympotms (esp fatigue, cyanosis)
Differential diagnosis for murmur:
- innocent? 3
- pathological? 7 (basically most of thecongenital heart conditions)
describe features / location of each? 7
INNOCENT
VENOUS HUM
- blowing continuous murmur in systole + diastole
- heard below the clavicles
- disappears on lying down
PULMONARY FLOW MURMUR
- brief high-pitched murmur at second left intercostal space
- best heard with child lying down
SYSTOLIC EJECTION MURMUR
- short systolic murmur at left sternal edge or apex
- musical sound
- changes with child’s position
- intensified by fever, exercise and emotion
PATHOLOGICAL
AORTIC STENOSIS
- soft systolic ejection murmur at right upper sternal border
- radiates to neck and down left sternal border
- causes dizziness + LOC in older children
PULMONARY STENOSIS
- short systolic ejection murmur in upper left chest
- conducted / radiated to back
- thrill in pulmonary area
ATRIAL SEPTAL DEFECT
- soft systolic murmur at 2nd left intercostal space
- wide fixed splitting of second sound
- may first be detected at school entry
VENTRICULAR SEPTAL DEFECT
- harsh pan systolic murmur at lower left sternal border
- radiates all over chest
- signs of heart failure may be present
TETROLOGY OF FALLOT
- ejection systolic murmur
- cyanotic
PATENT DUCTUS ARTERIOSUS
- continuous ‘machinery’ murmur
- below left clavicle
- also get collapsing pulses
- especially common in premature infants
COARACTATION OF AORTA
- systolic murmur on left side of chest
- heard in the back
- absent / weak / delayed femoral pulses
- nb murmur sometimes not heard, change in femoral pulses is more sensitive sign
nb transposition of arteries don’t tend to have a murmur
ACUTE ABDO PAIN in children:
- three most common causes? (nb all GI)
- other GI causes? 5
- urinary system? 2
- other important? 3
- other important in teenagers? 4
MOST COMMON
- constipation
- mesenteric adenitis
- gastroenteritis
OTHER GI
- appendicitis
- intusssuception
- bowel obstruction (incl volvulus in neonates, also meckel’s)
- peptic ulcer (pain at night, relief with milk)
- inflammatory bowel disease
(also cholecystitis + pancreatitis are rare but can happen)
URINARY
- pyelonephritis / UTI
- henoch schonlein purpura
OTHER - lower-lobe pneumonia - DKA - anxiety / stress / migraine (- sickle cell)
TEENS
- ectopic pregnancy
- ovarian cyst
- pelvic inflam disease
- ovarian / testicular torsion
nb could also be an acute presentation of a chronic problem - always ask if had before!
Qs to ask about acute abdo pain? 8
red flags to ask about? 5
associated symptoms to ask about:
- GI? 4
- urinary? 3
- other local? 3
- systemic? 7
what should you never forget to check in / simple test for:
- anyone with abdo pain?
- any teenage girl w abdo pain?
SOCRATES!
- site
- onset (incl any viral illness before)
- character
- radiation (incl to testes)
- associated symptoms
- timing (does it wake from sleep)
- exacerbating / relieving factors
- severity
RED FLAGS
- bilious vomiting
- blood in stool or vomit
- pain waking up child at night
- haemodynamic instability / shock
- peritonitis / guarding
GI
- nausea
- vomiting (blood? green?)
- diarrhoea / constipation (ask re freq + consistency)
- blood in stools
URINARY
- pain on urination
- new nocturnal enuresis (DM or UTI)
- blood in urine
- polyuria (also polydipsia)
OTHER
- girls: periods started? painful? heavy?
- vaginal / penile discharge (think STI)
- resp symptoms (incl SOB, cough)
- joint pain / swelling (HSP, IBD))
SYSTEMIC - AW FS FIN
- appetite loss (often get in appendicitis, or gain if DM)
- weight loss
- fatigue
- sleep
- fever
- itch (incl jaundice, RASH, skin probs)
- night sweats
ANY CHILD = check glucose
ANY TEENAGE GIRL = pregnancy test
Investigations for acute abdo pain:
- bedside? (2 always, 2 sometimes)
- bloods (2 always, 5 to consider)
- two main imaging used?
= urine dip
= capillary blood glucose
- urine culture
- pregnancy test
BLOODS = FBC = CRP - U+E (HSP, UTI, dehydration) - LFT (jaundice) - ESR (IBD) - blood gas (if unwell) - amylase (pancreatitis)
- abdo x-ray
- abdo USS
(see other flashcard for when use what)
What is 1st line imaging for suspected:
- appendicitis
- biliary atresia
- constipation / bowel obstruction
- duodenal atresia
- intussception
- malrotation + volvulus
- necerotising enterocolitis
- pyloric stenosis
way of remembering which is which?
- appendicitis = USS
- biliary atresia = USS
- constipation / bowel obstruction = X-RAY
- duodenal atresia = X-RAY (‘double bubble’ sign)
- intussception = USS
- malrotation + volvulus = X-RAY
- necerotising enterocolitis = X-RAY
- pyloric stenosis = USS
nb if obstruction / bile stained vomit then x-ray - generally the rest is USS
- nb duodenal atresia is only exception to this
CHRONIC/RECURRENT ABDO PAIN IN CHILDREN:
- non-organic causes? 4
- organic GI causes? 4
- other relatively common causes? 2
- rare causes? 18 (5 GI, 3 gynae, 2 urinary, 3 neuro, 5 other)
(don’t worry if don’t get all of these rare causes)
- RECURRENT ABDO PAIN OF CHILDHOOD
- Irritable bowel syndrome
- non-ulcer dyspepsia
- abdominal migraine
- constipation
- GORD / oesophagitis
- IBD
- coeliac disease
- recurrent UTIs (could be dt anatomical problem or ureteric reflux)
- dysmenorrhoea / endometriosis
RARE
- eosinophilic oesophagitis
- h. pylori infection / peptic ulcer disease
- hiatal hernia
- pancreatitis
- giardiasis
- mittelschmertz
- ovarian cyst
- pelvic inflammatory disease
- ureteropelvic junction obstruction
- kidney stones
- nerve entrapment
- spinal tumour
- transverse myelitis
- porphyria
- familial meditierranean fever
- lead posioning
- lymphoma
- sickle cell disease
What red flags should you always ask about for recurrent / chronic abdo pain to see if organic? 11
- red flag signs on exam? 3
RED FLAGS ON HX
- pain that is not-central
- wake child at night?
- any GROWTH FAILURE/weight loss?
- diarrhoea or vomiting?
- any GI blood loss?
- dysuria?
- secondary nocturnal enuresis
- unexplained fever
- joint inflammation
- skin rashes
- FHx of IBD
RED FLAGS ON EXAM
- any perianal or oral lesions
- palpable mass / organomegaly (incl kidneys)
- jaundice
