Paeds Differential Presentations Flashcards
1
Q
What is toddler diarrhoea?
A
- Most frequent cause of chronic diarrhoea in children aged 1-5
- Children DO NOT appear unwell
- Does not affect their ability to thrive
- Usually resolves by school age
- Theories of cause inc fast gut transit time
2
Q
Conservative management for toddler diarrhoea
A
Four F’s
* Fat
* Fibre
* No fruit juices
* Fluids
3
Q
Differentials for toddler diarrhoea
A
- Infection
- IBD
- Coeliac
- Dietary intolerance
4
Q
Toddler diarrhoea vs infection
A
- Infection is acute, TD chronic
- Fever
- Abdominal pain
- Vomitting
- Other close contacts unwell
- Can have bloody stool
- Stool culture shows organism causing infection
5
Q
TD vs dietary intolerance
A
- DI has pattern - associated with specific food triggers
- Abdominal cramps
- Increased flatulence
- Sometimes get skin reactions
- Elimination diets help - try lactose first as most common
6
Q
TD vs IBD
A
- IBD abdominal pain
- Blood/mucus in stool
- Both chronic
- Faecal calprotectin for IBD and biopsy needed for diagnosis
- Weight loss/deficiencies?
7
Q
TD vs Coeliac disease
A
- Coeliac abdo pain and distension
- N+V sometimes
- Failure to thrive, malnourished so anaemic, short stature, wasted gluteal muscle bulk, easy bruising (vit K)
- Serology needed for Anti-TTG
- OGD with biopsy
8
Q
GORD in younger children presents with
A
- Refusing feeds
- Gagging/choking
- Faltering growth
- Recurrent otitis media or sometimes dental erosions
- Typically occurs under 8 weeks
9
Q
Posseting vs GORD
A
- Possetting is normal, occurs after big feeds or if jiggled around following feeds
- Just some regurge of milk
- Child will not be distressed - will be distressed with GORD
10
Q
RF for GORD
A
- Premature
- Neurological disorders
11
Q
Conservative management of GORD
A
- Lie at 30 least at degrees following feeds
- Don’t lie down 30-45 mins after feeds
- Burping- try different positions, try to get 2nd burp
- Feed little and often - avoid large feeds
12
Q
Medication management of GORD
A
- Thickening agents eg cornstarch, rice starch, carob bean gum, locust bean gum
- Gaviscon in milk/supplement alongside milk with hotwater
- Metoclopramide
- Children aged 1-2 can do trial of omeprazole/H2 receptor antagonist, if symptoms persist –> specialist
13
Q
Differentials for GORD
A
- Psychological - bulimia in older children
- Abdominal migraine
- Mesenteric adenitis
14
Q
Bulimia vs GORD
A
- Mood changes
- Critical of weight
- More severe reflux symptoms as acid goes further up oesophagus
- Both will have vomitting/sore throat
15
Q
Abdominal migraine vs GORD
A
- In children migraines primarily affect abdomen
- Both have central abdominal pain, N&V
- Migraines can have associated headaches, photophobia, migraine triggers (eg food, stress), episodic pain, aura
16
Q
What is mesenteric adenitis?
A
- Inflamed abdominal lymph nodes
- Common in under 16s
- Secondary to viral infection
- Self limiting
17
Q
Mesenteric adentitis vs GORD
A
- Associated URTI
- Abdo pain often RIF
- Fever, diarrhoea
- Enlarged lymph nodes on USS
28
Q
OS vs Perthes
A
- Perthes = referred pain from hip
- Get associated hip pain and restricted movements of hip - gives strained muscle like pain in hip
- Caused by avascular necrosis of femoral head epiphysis - femoral head disintegrates
- Tender to palpate hip too
29
Q
OS vs SUFE
A
- Referred pain from hip
- Due to femoral head slipping on femoral epiphysis (growth plate)
- Still have smooth hip joint but shaft has come away from femoral head
- Strained muscle like pain in hip similar to Perthes
