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Obs & Gyny - Risk Factors > Paeds crib notes > Flashcards

Paeds crib notes Flashcards

1
Q

Colic definition

A

RULE OF THREES

3 hours/3 days/3 weeks

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2
Q

Colic key Qs

A

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

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3
Q

Colic examination

A

General exam

Abdo exam - include hernial orifices and testicles!

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4
Q

Key ddx in colic

A

Acute

  • intusscueption
  • Volvulus
  • Nappy rash
  • Corneal abrasion

Chronic

  • GORD
  • Cow’s milk allergy
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5
Q

Gord definition

A

frequent regurgitation of feeds

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6
Q

When is GORD expected?

A

8 weeks - 1 year

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7
Q

Give symptoms for GORD

A

RESP

  • Apnoeas
  • Cough
  • Wheeze

GI

  • Regurg/vomiting
  • Failure to thrive
  • Poor eating
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8
Q

How to diagnose GORD?

A

Clinical

Oesophageal PH studies if complex

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9
Q

Red flags for GORD

A
  • Projectile vomiting
  • Blood in stool (intussusception, cow milk protein allergy)
  • Blood in vomit
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10
Q

Management of GORD

A

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

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11
Q

When to come back in GORD?

A
  • Projectile vomiting
  • Failure to thrive
  • New blood
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12
Q

Constipation red flags

A

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)

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13
Q

Management of functional constipation

A

1) Disimpaction - movicol paediatric plan (macrogol)

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

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14
Q

Referral criteria for constipation?

A

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.

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15
Q

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

A

10% of body weight

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16
Q

Failure to thrive history

A
  • Pregnancy
  • > smoking
  • > Alcohol
  • > use of medication
  • > Illness
  • Infant feeding
  • Wet & dirty nappies
  • illness of child
  • Nature of stool
  • Maternal interaction
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17
Q

Investigations failure to thrive

A
  • Bloods: FBC, U&Es, LFTs
  • Other fluids: Urinalysis & culture
  • Stuff: Coeliac screen
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18
Q

Management functional failure to thrive

A

1) Treat cause

2) Encourage oral intake

19
Q

How to investigate cow’s milk protein allergy

A

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

20
Q

Management of cow’s milk protein

A

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

21
Q

Most common cause of paediatric gastroenteritis

A

Rotavirus

22
Q

Onset of diarrhoea in gastroenteritis

A

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

23
Q

MANAGEMENT OF PAEDIATRIC DIARRHOEA

A
  • ORS if dehydrated
  • Hand washing
  • Should not attend school until diarrhoea stopped for 48 hours
24
Q

Investigations of paediatric diarrhoea

A

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

25
Q

Management of child patients with dehydration & gastroenteritis

A

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

26
Q

What to avoid in management of children with diarrhoea & dehydration

A

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

27
Q

Outline Haemolytic Uraemic Syndrome

A

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

28
Q

Classic presentation of HUS

A

Profuse diarrhoea that turns blood 2-3 days later

29
Q

Investigations HUS

A

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

30
Q

GI complications of HUS

A

Complications

1) Intussusception
2) Volvulus

31
Q

Pharmacological

A

Racecadotril

- antidiarrhoeal

32
Q

Outline toddlers diarrhoea

A

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.

33
Q

COELIACS DISEASE PRESENTATION

A 
failure to thrive
diarrhoea
abdominal distension
older children may present with anaemia
many cases are not diagnosed to adulthood
DEFICIENCY - Iron, B12, folate
34
Q

COELIAC DISEASE COMPLICATIONS

A
  • AUTOIMMUNE: Dermatitis herpetiformis, T1 diabetes, autoimmune hepatitis
  • Hyposplenism
35
Q

COELIAC DISEASE INVESTIGATIONS

A

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

36
Q

COELIAC DISEASE MANAGEMENT

A 
avoid 
wheat: bread, pasta, pastry
barley*: beer
rye
oats**§
37
Q

Hirchprung’s disease definition

A

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

38
Q

Definitive hisrchprung’s diagnosis

A

rectal biopsy

39
Q

Mesenteric adenitis cause

A

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

40
Q

Intussucpetion features

A

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

41
Q

lead point intussuception

A 
Viral 
- Adenovirus, rotavirus
Pathological 
- meckel's diverticulum
- Petuz-jeghers syndrome
- hence schonlein purpura
42
Q

intussusception investigations

A

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

43
Q

Intussusception management

A

Drip & suck
Redution w/ air enema
Laparotomy if peritonitis

Obs & Gyny - Risk Factors (18 decks)

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