Paeds crib notes Flashcards
Colic definition
RULE OF THREES
3 hours/3 days/3 weeks
Colic key Qs
Feeding, weight gain, obstetric, bowels, waterworks, vomiting, crying (timing and duration)
Colic examination
General exam
Abdo exam - include hernial orifices and testicles!
Key ddx in colic
Acute
- intusscueption
- Volvulus
- Nappy rash
- Corneal abrasion
Chronic
- GORD
- Cow’s milk allergy
Gord definition
frequent regurgitation of feeds
When is GORD expected?
8 weeks - 1 year
Give symptoms for GORD
RESP
- Apnoeas
- Cough
- Wheeze
GI
- Regurg/vomiting
- Failure to thrive
- Poor eating
How to diagnose GORD?
Clinical
Oesophageal PH studies if complex
Red flags for GORD
- Projectile vomiting
- Blood in stool (intussusception, cow milk protein allergy)
- Blood in vomit
Management of GORD
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
When to come back in GORD?
- Projectile vomiting
- Failure to thrive
- New blood
Constipation red flags
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)
Management of functional constipation
1) Disimpaction - movicol paediatric plan (macrogol)
2) Maintenance - High fibre diet, hydration, stool diary linked to reward system
Referral criteria for constipation?
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.
How much weight loss is acceptable in first 10 days of life?
10% of body weight
Failure to thrive history
- Pregnancy
- > smoking
- > Alcohol
- > use of medication
- > Illness
- Infant feeding
- Wet & dirty nappies
- illness of child
- Nature of stool
- Maternal interaction
Investigations failure to thrive
- Bloods: FBC, U&Es, LFTs
- Other fluids: Urinalysis & culture
- Stuff: Coeliac screen
Management functional failure to thrive
1) Treat cause
2) Encourage oral intake
How to investigate cow’s milk protein allergy
Exclusion of cow’s milk from diet
Skin prick
Total IgE
Management of cow’s milk protein
Extensively hydrolysed formula feed
OR
Continue breast feeding, mother eliminates cow’s milk from diet
Most common cause of paediatric gastroenteritis
Rotavirus
Onset of diarrhoea in gastroenteritis
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
MANAGEMENT OF PAEDIATRIC DIARRHOEA
- ORS if dehydrated
- Hand washing
- Should not attend school until diarrhoea stopped for 48 hours
Investigations of paediatric diarrhoea
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
Management of child patients with dehydration & gastroenteritis
1) Continue breast feeding
2) Exclude fruit juices
3) Offer ORS
What to avoid in management of children with diarrhoea & dehydration
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
Outline Haemolytic Uraemic Syndrome
2* to ecoli infection, triad of:
Microangiopathic haemolytic anaemia (Coombs’ test negative).
Thrombocytopenia.
Acute kidney injury (acute renal failure).
Classic presentation of HUS
Profuse diarrhoea that turns blood 2-3 days later
Investigations HUS
FBC, film, U&Es, CRP, stool culture
GI complications of HUS
Complications
1) Intussusception
2) Volvulus
Pharmacological
Racecadotril
- antidiarrhoeal
Outline toddlers diarrhoea
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.
COELIACS DISEASE PRESENTATION
failure to thrive diarrhoea abdominal distension older children may present with anaemia many cases are not diagnosed to adulthood DEFICIENCY - Iron, B12, folate
COELIAC DISEASE COMPLICATIONS
- AUTOIMMUNE: Dermatitis herpetiformis, T1 diabetes, autoimmune hepatitis
- Hyposplenism
COELIAC DISEASE INVESTIGATIONS
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
COELIAC DISEASE MANAGEMENT
avoid wheat: bread, pasta, pastry barley*: beer rye oats**§
Hirchprung’s disease definition
Hirschsprung’s disease is caused by an aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses
Definitive hisrchprung’s diagnosis
rectal biopsy
Mesenteric adenitis cause
Adenoviruses, Epstein Barr virus, beta-haemolytic streptococcus, Staphylococcus spp., Escherichia coli, Streptococcus viridans
Intussucpetion features
1) Bile stained vomit
2) Acute abdominal pain
3) sausage shaped mass
4) absence of bowel in RLQ
5) red currant stool
lead point intussuception
Viral - Adenovirus, rotavirus Pathological - meckel's diverticulum - Petuz-jeghers syndrome - hence schonlein purpura
intussusception investigations
FBC, U&Es, abdominal x-ray, ultrasound
Intussusception management
Drip & suck
Redution w/ air enema
Laparotomy if peritonitis
