Paeds crib notes

Question 1

Colic definition

Answer 1

RULE OF THREES

3 hours/3 days/3 weeks

Question 2

Colic key Qs

Answer 2

Feeding, weight gain, obstetric, bowels, waterworks, vomiting, crying (timing and duration)

Question 3

Colic examination

Answer 3

General exam

Abdo exam - include hernial orifices and testicles!

Question 4

Key ddx in colic

Answer 4

Acute

• intusscueption
• Volvulus
• Nappy rash
• Corneal abrasion

Chronic

• GORD
• Cow’s milk allergy

Question 5

Gord definition

Answer 5

frequent regurgitation of feeds

Question 6

When is GORD expected?

Answer 6

8 weeks - 1 year

Question 7

Give symptoms for GORD

Answer 7

RESP

• Apnoeas
• Cough
• Wheeze

GI

• Regurg/vomiting
• Failure to thrive
• Poor eating

Question 8

How to diagnose GORD?

Answer 8

Clinical

Oesophageal PH studies if complex

Question 9

Red flags for GORD

Answer 9

• Projectile vomiting
• Blood in stool (intussusception, cow milk protein allergy)
• Blood in vomit

Question 10

Management of GORD

Answer 10

1) Reassurance it becomes less of a problems as get older
2) Smaller, frequent feeds and get Breast feeding teaching
3) Pharmacological -> omeprazole if complex

Question 11

When to come back in GORD?

Answer 11

• Projectile vomiting
• Failure to thrive
• New blood

Question 12

Constipation red flags

Answer 12

1) Symptoms commence from birth
2) Failure or delay (>48 hours) in passing meconium
3) SBO symptoms
4) Abnormal examination (position of anus, poor reflexes)

Question 13

Management of functional constipation

Answer 13

1) Disimpaction - movicol paediatric plan (macrogol)

2) Maintenance - High fibre diet, hydration, stool diary linked to reward system

Question 14

Referral criteria for constipation?

Answer 14

1) An organic cause is suspected or there are any red flags (see NICE guidance table, above).
2) Treatment is unsuccessful (ie no response in four weeks for a child aged under 1 year)]
3) Management is complex.
4) Child abuse is suspected.

Question 15

How much weight loss is acceptable in first 10 days of life?

Answer 15

10% of body weight

Question 16

Failure to thrive history

Answer 16

• Pregnancy
• > smoking
• > Alcohol
• > use of medication
• > Illness
• Infant feeding
• Wet & dirty nappies
• illness of child
• Nature of stool
• Maternal interaction

Question 17

Investigations failure to thrive

Answer 17

• Bloods: FBC, U&Es, LFTs
• Other fluids: Urinalysis & culture
• Stuff: Coeliac screen

Question 18

Management functional failure to thrive

Answer 18

1) Treat cause

2) Encourage oral intake

Question 19

How to investigate cow’s milk protein allergy

Answer 19

Exclusion of cow’s milk from diet
Skin prick
Total IgE

Question 20

Management of cow’s milk protein

Answer 20

Extensively hydrolysed formula feed
OR
Continue breast feeding, mother eliminates cow’s milk from diet

Question 21

Most common cause of paediatric gastroenteritis

Answer 21

Rotavirus

Question 22

Onset of diarrhoea in gastroenteritis

Answer 22

1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

Question 23

MANAGEMENT OF PAEDIATRIC DIARRHOEA

Answer 23

• ORS if dehydrated
• Hand washing
• Should not attend school until diarrhoea stopped for 48 hours

Question 24

Investigations of paediatric diarrhoea

Answer 24

1) Stool culture
- bloody diarrhoea
- Mucus in stool
- Septicaemia
- Immunocompromised
2) FBC, U&Es
3) Perform a blood culture
4) E.coli infection should be investigated for infection

Question 25

Management of child patients with dehydration & gastroenteritis

Answer 25

1) Continue breast feeding 2) Exclude fruit juices 3) Offer ORS

Question 26

What to avoid in management of children with diarrhoea & dehydration

Answer 26

1) Abx unless absolutely indicated - For suspected or confirmed septicaemia. - With extra-intestinal spread of bacterial infection. - When younger than 6 months with salmonella gastroenteritis. - In those who are malnourished or immunocompromised with salmonella gastroenteritis. 2) Solid foods 3) Anti-diarrhoeals

Question 27

Outline Haemolytic Uraemic Syndrome

Answer 27

2* to ecoli infection, triad of: Microangiopathic haemolytic anaemia (Coombs' test negative). Thrombocytopenia. Acute kidney injury (acute renal failure).

Question 28

Classic presentation of HUS

Answer 28

Profuse diarrhoea that turns blood 2-3 days later

Question 29

Investigations HUS

Answer 29

FBC, film, U&Es, CRP, stool culture

Question 30

GI complications of HUS

Answer 30

Complications 1) Intussusception 2) Volvulus

Question 31

Pharmacological

Answer 31

Racecadotril | - antidiarrhoeal

Question 32

Outline toddlers diarrhoea

Answer 32

Toddler's diarrhoea typically occurs in the second year of life and is associated with undigested food such as peas and carrots in the stools. The child is well and growing normally. It is thought to relate to a rapid intestinal transit time. It resolves by the age of 4 years.

Question 33

COELIACS DISEASE PRESENTATION

Answer 33

``` failure to thrive diarrhoea abdominal distension older children may present with anaemia many cases are not diagnosed to adulthood DEFICIENCY - Iron, B12, folate ```

Question 34

COELIAC DISEASE COMPLICATIONS

Answer 34

- AUTOIMMUNE: Dermatitis herpetiformis, T1 diabetes, autoimmune hepatitis - Hyposplenism

Question 35

COELIAC DISEASE INVESTIGATIONS

Answer 35

Reintroduce gluten for 6-weeks 1) Anti-ttg, anti-ejndomysal, anti-gliadin antibodies 2) Jejunal biopsy - Subtotal villous atrophy - Crypt hyperplasia - Inflitration of lymphocytes in lamina propria

Question 36

COELIAC DISEASE MANAGEMENT

Answer 36

``` avoid wheat: bread, pasta, pastry barley*: beer rye oats**§ ```

Question 37

Hirchprung's disease definition

Answer 37

Hirschsprung's disease is caused by an aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses

Question 38

Definitive hisrchprung's diagnosis

Answer 38

rectal biopsy

Question 39

Mesenteric adenitis cause

Answer 39

Adenoviruses, Epstein Barr virus, beta-haemolytic streptococcus, Staphylococcus spp., Escherichia coli, Streptococcus viridans

Question 40

Intussucpetion features

Answer 40

1) Bile stained vomit 2) Acute abdominal pain 3) sausage shaped mass 4) absence of bowel in RLQ 5) red currant stool

Question 41

lead point intussuception

Answer 41

``` Viral - Adenovirus, rotavirus Pathological - meckel's diverticulum - Petuz-jeghers syndrome - hence schonlein purpura ```

Question 42

intussusception investigations

Answer 42

FBC, U&Es, abdominal x-ray, ultrasound

Question 43

Intussusception management

Answer 43

Drip & suck Redution w/ air enema Laparotomy if peritonitis