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Year 5 - Paediatrics > Paeds GASTRO > Flashcards

Paeds GASTRO Flashcards

1
Q

What is the cause of GOR in babies?

A

Inappropriate relaxation of the LOS (functional immaturity)

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2
Q

By when does GOR usuallly resolve?

A

12 months: if persistent, may be due to GORD

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3
Q

How is GOR diagnosed?

A

Clinical dx
24 hour LOS pH monitoring (it should remain > 4)
OGD

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4
Q

Recall the factors affecting choice to refer for GOR

A

Same day referral if haematemesis, melaena or dysphagia

Assess by paediatrician if there are:
1. Red flags (eg faltering growth)
2. Unexplained IDA
3. No improvement after 1 y/o
4. Feeding aversion
5. Suspected Sandifer’s syndrome

Refer if there are complications

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5
Q

Recall the management options for GOR

A
  1. Reassure: it’s v common!
  2. Must sleep on back
  3. If breast fed: assess breast-feeding, consider alginate for 1-2 weeks, if not: pharmacology

If formula-fed: review feeding hx, try a smaller, more frequent feed + thickened formula, if doesn’t work, try alginate

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6
Q

What safety net should you watch out for when assessing GORD?

A

Monitor vomit: if bloody or green seek medical attention

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7
Q

At what age does pyloric stenosis present?

A

2-8 weeks

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8
Q

Is pyloric stenosis more common in girls or boys?

A

Boys (4 x more common)

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9
Q

Recall a genetic association of pyloric stenosis

A

Turner’s syndrome

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10
Q

What is the main symptom of pyloric stenosis?

A

Projectile, non-billious vomiting

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11
Q

Recall 3 symptoms of pyloric stenosis other than vomiting

A

Weight loss
Depressed fontanelle from dehydration
Loss of interest in food

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12
Q

Recall some signs of pyloric stenosis

A

Palpable ‘olive’ mass
Visible peristalsis in upper abdomen

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13
Q

What will be the acid-base profile in pyloric stenosis?

A

Hypochloraemic, hypokalaemic metabolic alkalosis may progress to a dehydrated lactic acidosis (opposite biochemial picture)

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14
Q

What is the best investigation for pyloric stenosis?

A

USS: shows target lesion of >3mm thickness
Do ABG to guide management

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15
Q

How should pyloric stenosis be managed?

A
  1. IV slow fluid resuscitation + correct any disturbances:
    1.5 x maintenance rate
    5% dextrose
    0.45% saline
  2. Laparoscopic Ramstedt pyloromyotomy
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16
Q

What are the symptoms of colic?

A

Inconsolable crying + drawing up of the hands + feet: child remains distressed between episodes

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17
Q

What should be considered if the colic is persistent?

A

Cow’s milk protein allergy or reflux
Try:
2 week trial of hydrosylate formula followed by
2 week trial of anti-reflux tx

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18
Q

In what age group is appendicitis less common, and what is a more likely cause of similar symptoms in this age group?

A

Rare in under 3s, then it’s more likely to be faecolith (stony mass of impacted faeces)

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19
Q

Recall the management of appendicitis in children

A

GAME
G: group + save
A: Abx IV
M: MRSA screen
E: eat + drink NBM

Then laparoscopic appendectomy

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20
Q

What is intussusception?

A

Invagination of proximal bowel into distant component (telescoping distally)

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21
Q

What is the most common site of intussusception?

A

Ileum through to caecum through ileocaecal valve (ileo-colic) - 90% cases

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22
Q

Recall the appearance of stool in intussusception, and the pathophysiology of how this happens

A

Red-currant jelly (blood + mucus) due to venous obstruction + compression –> oedema + mucosal bleeding
This is a LATE sign

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23
Q

What are the causes of intussusception?

A

Idiopathic
Physiological lead point: Peyer’s patch
Pathological lead point: malignancy, Meckel’s diverticulum, Henoch-Schonlein purpura

Thought to have a seasonal occurrence with viral illness with inflammatory processes triggering abdominal inflammation.

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24
Q

What are the symptoms of intussusception?

A

Intermittent colicky pain
Vomit - depending on type: may be bile-stained or not
Bloody stools (may be a late sign)

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25
Q

What are the signs of intussusception?

A

Abdominal distention with sausage shaped mass in RUQ
Emptiness on palpation in RLQ (Dance’s sign)
Red-currant jelly stool is a late sign
Signs of peritonitis if intussusception has been present a long time

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26
Q

What are the appropriate investigations for intussusception?

A
  1. Abdo USS: may show donut sign (think: intUSSusception)
  2. AXR (may be normal)
  3. Barium/ gastrogaffin enema if have 1 of 3 Ps: Perforation, Peritonitis, Pale complexion
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27
Q

What would be a contraindication for an air contrast enema?

A

Signs of peritonitis or free fluid (perforation) on USS - requires urgent surgery
HSP present

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28
Q

How should intussusception be managed?

A

It’s an emergency

If stable:
- Fluid resuscitation
- Enema: pneumatic - forces bowel to un-telescope - take x rays throughout

If unstable:
- Don’t mess about with contrast, go in with open surgery
- Remove any non-viable bowel

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29
Q

Is intussusception more commonly seen in males or females?

A

Males (2:1 ratio)

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30
Q

What age is intussusception most commonly seen?

A

Between 5 and 12 months

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31
Q

What should be done if there is recurrent intussusception?

A

Investigate for a lead point

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32
Q

When are intussusceptions with lead points commonly seen?

A

In patients with:
HSP (intestinal wall haematoma)
CF (hypertrophied intestinal mucosal glands)
Lymphoma
Peyer’s patches (enlarged mesenteric lymph nodes) - seen in younger infants following respiratory or GI infection

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33
Q

What is Meckel’s diverticulum?

A

Ileal remnant of vitello-intestinal duct on anti-mesenteric border containing ectopic gastric mucosa or pancreatic tissue

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34
Q

What is the rule used to remember all you need to know about Meckel’s diverticulum?

A

Rule of twos
2 years old
2 x more common in boys
2 feet from ileocaecal valve
2 inches long
2 different mucosae (gastric + pancreatic)

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35
Q

What are the signs and symptoms of meckel’s diverticulum?

A

Mostly asymptomatic
Painless massive PR bleeding if it bleeds
May show billious vomiting, dehydration + intractable constipation

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36
Q

How should meckel’s diverticulum be investigated?

A

Technetium scan indicates increased uptake by gastric mucosa
AXR or USS + laparoscopy

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37
Q

How should meckel’s diverticulum be managed?

A

If asymptomatic, leave it alone!

If symptomatic:
Bleeding: excise diverticulum with blood transfusion
Obstruction: excise diverticulum + lyse adhesions
Perforation/ peritonitis: Excise with perioperative Abx

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38
Q

How may volvulus present?

A
  1. At any age, after lying quiescent for ages
  2. In first few days of life, with obstruction + possible compromised blood supply –> abdo pain, billious vomiting, peritonism etc
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39
Q

What is the main sign of volvulus on abdo examination?

A

Scaphoid abdomen

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40
Q

How should volvulus be investigated?

A
  1. Upper GI contrast study (urgently) to assess patency if billious vomiting
  2. USS
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41
Q

How should volvulus be managed?

A

Urgent laparotomy
Untwist volvulus, mobilise the duodenum, place bowel in a good position + remove any necrotic bowel

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42
Q

What is the first thing to exclude in suspected IBS?

A

Coeliac

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43
Q

Recall the signs and symptoms of IBS

A

Abdo pain: often worse before or relieved by defaecation
Explosive loose or mucus stools
Bloating
Tenesmus
Constipation

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44
Q

Recall the 3 most common causes of paediatric gastroenteritis in decreasing prevalence

A
  1. Rotavirus
  2. Campylobacter
  3. Shigella/ salmonella
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45
Q

If there is bloody diarrhoea in gastroenteritis, which microbes should be considered first?

A

CHESS organisms:
Campylobacter
Hemorrhagic E coli
Entamoeba histolytica
Salmonella
Shigella

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46
Q

What investigations should be done in a case of gastroenteritis?

A

AXR to exclude other causes
Stool sample analysis
for viruses = stool electron microscopy
for bacteria = stool culture

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47
Q

How should paediatric gastroeneteritis be managed?

A

Rehydration

Learn maintenance fluid volumes:
0-10 kg = 100mls/kg

10-20kgs = 1000mls + 50ml/kg for each kg over 10kg

20+ kgs = 1500mls + 20 mls/kg for each kg over 20kgs

If <5 use IV fluids + maintain with oral rehydration solution

If >5, give 200mls after each

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48
Q

What is the safety netting for how long vomiting and diarrhoea should last?

A

Vomiting: usually 1-2 days, must stop within 3 days

Diarrhoea: 5-7 days, must stop within 2 weeks

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49
Q

What is the most accurate marker of dehydration in children?

A

Weight loss

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50
Q

What is the threshold marker of dehydration for clinical dehydration and shock?

A

5-10% weight loss = clinical dehydration
>10% weight loss = shock

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51
Q

Recall the symptoms of hypernatraemia

A

Mnemonic: f(ull) of salt
Flushing

Oedema
Fever

Seizures
Agitation
Low urine output
Thirst

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52
Q

Recall the symptoms of hyponatraemia

A

SALT LOSS
Stupor
Anorexia
Limp tone
Tendon reflexes reduced

Lethargy
Orthostatic hypotension
Seizures
Stomach cramps

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53
Q

When are IV fluids (rather than ORS) indicated?

A

Shock
Deterioration
Persistent vomiting

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54
Q

What are the bolus fluids given in shock?

A

20mls/kg 0.9% saline over 15 mins (most situations)

10mls/kg 0.9% saline over 60 mins (trauma, fluid overload, heart failure)

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55
Q

Recall the day 1, 2, 3, 4, and 5 fluid resucitation requirements in neonates

A

Day 1: 50-60mls/kg/day

Day 2: 70-80mls/kg/day

Day 3: 80-100mls/kg/day

Day 4: 100-120mls/kg/day

Day 5: 120-150mls/kg/day

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56
Q

Which type of fluid should be used in fluid resus for term neonates?

A

Isotonic crystalloids with 10% dextrose

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57
Q

If giving IV fluids to a hypernatraemic child, what should be the biggest caution?

A

Take care with cerebral oedema
Rapid reduction in plasma sodium concentration + osmolality will lead to a shift of water into cerebral cells
May result in seizures + cerebral oedema

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58
Q

When should Abx be used in gastroenteritis?

A

Not even indicated when cause is bacterial

Use when:
- SEPSIS
- salmonella < 6 months
- C difficile with pseudomembranous colitis

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59
Q

What is the post-gastroenteritis syndrome and how can it be treated?

A

Introduction of a normal diet results in a return of watery diarrhoea

Treat with oral rehydration therapy

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60
Q

What would be seen on biopsy in Crohn’s?

A

Non-caseating epitheloid cell granulomata

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61
Q

Recall some important investigations to do for Crohn’s disease

A
  1. FBC including iron, folate and B12
  2. Faecal calprotectin
  3. Colonoscopy + biopsy (cobblestones)
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62
Q

How should Crohn’s be treated?

A

Induce remission:
Nutritional management
Replace diet with whole protein modular diet: excessively liquid, for 6-8 weeks.
The products are easily-digested and replace lost weight

Pharmacological management: steroids (prednisolone)

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63
Q

What is the classical presentation of UC?

A

Rectal bleeding
Diarrhoea
Abdo pain

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64
Q

What are the appropriate investigations to do in ulcerative colitis?

A

Same as Crohn’s

  1. FBC including iron, folate + B12
  2. Faecal calprotectin
  3. Colonoscopy + biopsy
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65
Q

What does histology reveal in UC?

A

Mucosal inflammation/ ulceration
Crypt damage

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66
Q

What scores can be used to score paediatric UC?

A

Paediatric UC Activity Index
Truelove + Witts

67
Q

What is one coexisting condition that it’s important to be aware of in ulcerative colitis?

A

Depression

68
Q

How should UC be managed?

A

1st line = oral aminosalicylates: may also be used to maintain remission
2nd line - oral corticosteroid
3rd line = oral tacrolimus
Surgery in resistant disease

69
Q

When does UC become an emergency?

A

In severe fulminating disease

70
Q

What is the usual cause of toddler diarrhoea?

A

Underlying maturational delay in intestinal mobility

71
Q

Recall some signs and symptoms of toddler diarrhoea

A

Varying consistency stools: well-formed to explosive + loose, may have bits of undigested vegetable
Child will be well + thriving

72
Q

How is toddler diarrhoea managed?

A

Increase fibre + fat in diet (whole milk, yoghurts, cheese)
Avoid fruit juice + squash

73
Q

What is the first-line management of constipation?

A

All first line:
1. Advise behavioural interventions (eg schedueled toileting, bowel habit diary, reward system)
2. Advise diet + lifestyle (adequate fluid intake)
3. Medication:
step 1 = movicol paediatric plan (dose escalates for 2 weeks)
Step 2: maintain for 6 months

74
Q

Recall some important things to remember in PACES counselling for constipation

A

Explain movicol takes some time to work (dose increases over 2 weeks)
Encourage child sitting on loo after mealtimes to use reflex
Advise a star chart to aid motivation

75
Q

What is Hirschprung’s?

A

An absence of ganglion cells from the myenteric (Auerbach) + submucosal (Meissner’s) plexuses

76
Q

Is there are gender predominance associated with Hirschprung’s?

A

Male 4:1 ratio

77
Q

Recall 2 risk factors for Hirschprung’s

A

Down’s
Men2a

78
Q

Recall some signs and symptoms of Hirschprung’s

A

Failure to pass meconium in first 24 hours
Explosive passage of liquid/ foul stools

79
Q

If Hirschprung’s doesn’t present in first few days of life, what may happen?

A

May then present in a week or two with life-threatening Hirschprung’s enterocolitis (C diff)

80
Q

How should Hirschprung’s be investigated?

A
  1. AXR (if obstruction)
  2. Contrast enema (showing dilated distal + narrowed proximal segments)
  3. Definitive diagnosis is via suction-assisted full-thickness rectal biopsy showing absence of ganglion cells
81
Q

When would an an enema be contraindicated in Hirschsprung’s?

A

If there are signs of perforation or peritonitis

82
Q

What is the aetiology of Hirschsprung’s enterocolitis?

A

Proximal colonic dilatation secondary to obstruction (functional) with thinning of the colonic wall, bacterial overgrowth and translocation of the gut bacteria into the blood.

83
Q

What is the management of Hirschprungs?

A

1st line: bowel irrigation
Also 1st line: endorectal pullthrough (colostomy followed by anastomosing normally innervated bowel)

84
Q

What is the management of Hirschsprung’s enterocolitis?

A

Supportive fluid resuscitation
Decompression with NG tube (and rectal tube if needed)
Broad-spectrum Abx (with anaerobic coverage)
Surgery - definitive treatment

85
Q

Recall the principles of management for anal fissure

A

Ensure stools are soft + easy to pass (conservative)
Increase dietary fibre + fluid intake
Anal hygeine
Safety net: seek further help if not healed within 2 weeks

86
Q

Recall all the principles of management for threadworm

A

Single dose of an anti-helminth (mebendazole) for the whole household

Advise rigorous hygeine for 2 weeks if on mebendazole, or 6 weeks if using hygeine measures alone

Exclusion from school/ nursery is not required

87
Q

What can cause a temporary lactase deficiency?

A

Gastroenteritis
Crohn’s
Coeliac
Alcoholism

88
Q

What should be excluded in suspected lactose intolerance?

A

Gastroenteritis (stool sample)
Crohn’s (faecal calprotectin)
Coeliac (anti-tTG/EMA)

89
Q

How is a diagnosis of lactose intolerance made?

A

It’s a clinical diagnosis
trial a 2 week lactose-free diet + see how Sx are
Breath hydrogen test: early rise in H2 following CHO ingestion

90
Q

How is secondary lactose intolerance managed?

A

Cut out dairy to allow time to heal

May need calcium + vit D supplements

Digestive enzymes can be taken in a capsule before eating lactose until gut matures/ heals

91
Q

Recall 2 genetic associations with Coeliac’s?

A

HLA DQ2 (95%), DQ8 (80%)

92
Q

Recall the symptoms of coeliac in children

A

Failure to thrive
Abdo distention
Bloating
Irritability

93
Q

When does coeliac disease first present in children?

A

8-24 months after introduction to wheat foods

94
Q

How is coeliac disease diagnosed?

A

Most sensitive = IgA TTG
Or (less sensitive) = IgA anti-EMA

95
Q

What other investigations are useful in coeliac disease?

A

FBC + blood smear to look for anaemia
In older children/ adults: OJD + biopsy can confirm dx
In younger kids: no histopathological confirmation

96
Q

How should coeliac disease be managed?

A

Cut out all wheat, rye + barley
Dietician referral + annual review
Support sources: Coeliac UK

97
Q

What might be the consequences of non-adherence to diet in coeliac disease?

A

Micronutrient deficiency, osteoporosis, EATK, hyposplenism

98
Q

What is mesenteric adenitis?

A

Swollen lymph glands that cause temporary abdo pain following infection

99
Q

What are the signs and symptoms of mesenteric adenitis?

A

Abdo pain
Nausea + diarrhoea, leading to reduced appetite
Infectious picture
Often preceded by UTI

100
Q

How should mesenteric adenitis be diagnosed?

A

Definitive dx= laparoscopy showing large mesenteric lymph nodes + normal appendix
More often dx of exclusion (exclude appendicitis with bloods, urine, MC+S)

101
Q

How should mesenteric adenitis be managed?

A

Simple analgesia
Maybe Abx (but not routine)
Safety net for increased pain, deterioration

102
Q

What is the pathophysiology of an indirect inguinal hernia?

A

Towards end of pregnancy the process vaginalis allows passage of testicles from abdomen to scrotum
When this passage fails to close, abdo lining/ bowel can protrude through defect

103
Q

Recall the signs and symptoms of hernia

A

Scrotal sac enlarged, contains palpable loops of bowel, fluid (does not always transilluminate)
Swelling or bulge may be intermittent + can appear on crying or straining

104
Q

How is hernia diagnosed?

A

Clinical diagnosis
Examine supine + standing + try to reduce in order to determine type of hernia

105
Q

Recall 3 risk factors for umbilical hernia

A

Afro-caribbean
Down’s
Mucopolysaccharide diseases

106
Q

How should hernia be managed?

A

Correct urgently
1. If < 6 weeks old, correct <2 days
2. If < 6 months old, correct <2 weeks
3. If <6 year old, correct <2 months

107
Q

How does an umbilical granuloma appear?

A

Leaks + is watery

108
Q

How is umbilical granuloma treated?

A

With salt

109
Q

Where are femoral hernias located?

A

Beneath inguinal canal

110
Q

What is femoral hernia most similar to?

A

Indirect inguinal hernia

111
Q

What is gastroschisis?

A

Paraumbilical wall defect: abdominal contents outside body without a peritoneal covering
Needs immediate surgery

112
Q

What is omphalocele?

A

Bowel protruding out of the body with a peritoneal covering

113
Q

How should omphalocele be managed?

A

Closure starting immediately, finishing at 6-12 months

114
Q

What is encoparesis?

A

Soiling of underwear with stool in children who are past the age of toilet training

115
Q

What is the usual cause of encoparesis?

A

Constipation with overflow

116
Q

How should encopresis be managed?

A

Enquire about stressors, changes in medication, food intolerances etc

117
Q

What are the 2 most likely causes of liver failure in children <2 y/o?

A

HSV infection
Metabolic disease

118
Q

What is the most likely cause of acute liver failure in children >2 y/o?

A

Paracetamol OD

119
Q

What are the signs and symptoms of acute liver failure?

A

Jaundice
Coagulopathy
Hypoglycaemia
Electrolyte disturbance
Encephalopathy

120
Q

How should Acute liver failure be managed?

A

Referral to a national paediatric liver centre
To stabilise the child:
- IV dextrose (due to hypoglycaemia)
- broad spectrum Abx + anti-fungals to prevent sepsis
- IV vit K + PPIs to prevent haemorrhage
- Fluid restriction + mannitol

121
Q

Recall some features of poor liver prognosis

A

Shrinking liver
Falling transaminases
Rising bilirubin
Worsening coagulopathy

122
Q

How should hepatic encephalopathy be managed?

A

Reduce nitrogen with lactulose

123
Q

How should AI hepatitis be managed?

A

Prednisolone/ azothioprine

124
Q

How should sclerosing cholangitis be managed?

A

Ursodeoxycholic acid (aids bile flow)

125
Q

How should Wilson’s disease be managed?

A

Zinc (blocks intestinal Cu resorption)

Trientine/ penicillinamine (increases urinary Cu excretion)

Pyridoxine (vit B6, prevents peripheral neuropathy)

Symptomatic tx for tremor, dystonia + speech impediment

126
Q

How is non-alcoholic fatty liver disease managed in children?

A

Weight loss
Statins
Treatment of diabetes
Vit E + C
Ursodeoxycholic acid to improve bile flow

127
Q

How should paracetamol OD be managed?

A

<1 hour: activated charchoal, do paracetamol level 4 hours post ingestion, NAC if indicated

> 1 hour: do a paracetamol level, NAC if indicated

128
Q

Is pyloric stenosis more common in girls or boys?

A

Boys (4 x more common)

129
Q

What is the inheritance pattern of pyloric stenosis?

A

Polygenic

130
Q

What is the incidence of pyloric stenosis?

A

0.3%

131
Q

What is the race predilection of pyloric stenosis?

A

More common in Caucasian babies

132
Q

What is a Ramstedt pyloromyotomy?

A

The procedure of choice for pyloric stenosis where the pyloric muscle is split longitudinally down to the mucosa. It is easily performed with minimal complications.

133
Q

What is the classical triad of HUS?

A

Thrombocytopenia
Microangiopathic haemolytic uraemia
Acute renal failure

134
Q

What is the most common cause of HUS in children?

A

E.coli 0157:H7 - causes bloody diarrhoea

135
Q

What investigations should be done for HUS?

A

FBC
Blood film
Renal function and serum electrolytes
Stool specimens for culture - as commonly caused by gastroenteritis in children

136
Q

What are the 5 main causes of dysentry?

A

CHESS Y
Campylobacter
Haemolytic E.coli (0157:H7)
Entamoeba (protozoa)
Shigella
Salmonella

Yersinia enterocolitica

137
Q

Give some reasons for physiological jaundice at birth

A
  1. Hb release from RBCs as there is high [Hb] at birth
  2. RBC lifespan being 70 days rather than 120 days
  3. Breast milk jaundice (but not until after >24 hours)
  4. BR metabolism being less efficient in first few days of life
138
Q

What is the main danger of uBR buildup in neonates?

A

Kernicterus - a form of encephalopathy

139
Q

What is kernicterus?

A

A form of encephalopathy caused by a deposit of uBR in the basal ganglia
May develop into dyskinetic CP, LD + sensorineural deafness

140
Q

How can uBR buildup in neonates be treated before any damage is done?

A

Phototherapy +/- IvIG and exchange transfusion

141
Q

What would be the difference in clinical presentation between uBR buildup and cBR buildup?

A

uBR buildup –> kernicterus
cBR buildup –> dark urine + pale stools

142
Q

In what situations should phototherapy be stopped?

A

If bronzing occurs - means the child has a buildup of cBR, rather than uBR, which cannot be treated using phototherapy

143
Q

How should investigations begin in neonatal jaundice?

A
  1. Check transcutaneous or serum BR levels
  2. Do a split BR to check uBR/cBR
  3. May want to do a blood film analysis
144
Q

Recall some pathological causes of neonatal jaundice in babies <24 hours old

A

GRAPHIC DOG
- Gilbert’s
- Rhesus disease
- ABO incompatability (–> haemolysis)
- PK deficiency
- Hereditary spherocytosis
- Infection
- Crigler-Najjar
- Dubin-Johnson
- Other…
- G6PD deficiency

145
Q

Recall 3 physiological causes of jaundice in a 2 day to 2 week old baby

A

Physiological jaundice
- due to immature liver, peaks at 3-5 days

Breastfeeding jaundice
- less milk intake –> more enterohepatic recycling

Breastmilk jaundice
- Decreased UGT1A1 activity (occurs following physiological jaundice)

146
Q

What haemolytic and metabolic causes for jaundice might present in a 2 day to 2 week old baby?

A

Metabolic: Gilbert’s, Crigler-Najjar, Dubin-Johnson

Haemolytic: G6PDD, PK deficiency, hereditary spherocytosis (less likely to be ABO at this point)

147
Q

What may be the cause of jaundice in a 2 day to 2 week old baby that didn’t present in first 24 hours?

A

Congenital hypothyroidism
Dehydration
Bruising (cephalohematoma)
Polycythaemia

148
Q

How should jaundice be investigated in a baby over 2 weeks old?

A

Direct and indirect serum BR

149
Q

Which of the conditions that cause jaundice in a 2 day to 2 week old baby might continue to the >2 weeks stage?

A

All - but physiological + breastmilk is most common

150
Q

Recall 2 further causes of a buildup of uBR in a baby over 2 weeks old

A

Pyloric stenosis (presents at 2-4 weeks)

Congenital hypothyroidism*

151
Q

Systematically recall the causes of a raised cBR in the neonate (>2w old)

A

Endocrine: Congenital hypothyroidism

GI: Billiary atresia, ascending cholangitis (can be caused by lipids on TPN)

Metabolic: Gal-1-PUT, A1AT deficiency, Tyrosinaemia type 1, peroxisomal disease

Other: CF, idiopathic neonatal hepatitis

152
Q

Recall some investigations you might do to find the underlying cause of jaundice in a baby

A

TC/ serum BR within 6 hours of presentation

Haematocrit

DAT/ Coombs (haemolysis?)

G6PD levels (depending on ethnic origin)

TSH (hypothyroid?)

LFTs (ascending cholangitis? Biliary atresia?)

Blood group of M and B (ABO incompatible? Rhesus?)

Blood film + osmotic fragility (hereditary spherocytosis?)

MC&S of urine/ CSF (if ? infection cause)

153
Q

For how long does jaundice have to persist in order to be defined as ‘prolonged’?

A

> 14 days if term

154
Q

At what age should investigations include a split BR rather than just a total BR?

A

2 weeks

155
Q

What is a worrying BR in a baby >37w gestation (red flag for kernicterus)?

A

> 340

156
Q

Recall the clinical features of kernicterus

A

Poor feeding
Extreme lethargy
Hypotonia
High-pitched cry

157
Q

How is treatment of neonatal jaundice guided?

A

There are thresholds at which phototherapy/ exchange transfusion are indicated

158
Q

What are the options for treatment of neonatal jaundice?

A

Phototherapy +/- IV Ig
Exchange transfusion + phototherapy +/- IV Ig

159
Q

How does phototherapy work?

A

Converts uBR to a water-soluble pigment that is excreted in urine

160
Q

What important checks should be done during/ after phototherapy?

A

During: temperature, BR levels every 4-6 hours (with regular feed breaks)

After (12-18 hours post): check for a rebound hyperbilirubinaemia

161
Q

When should intensive phototherapy be given?

A
  1. Rapidly rising BR
  2. Serum BR within 50mmol of exchange tranfusion threshold (after 72 hours life)
  3. BR level doesn’t respond after 6 hours of therapy
162
Q

What are the 2 indications for exchange transfusion to treat neonatal jaundice?

A
  1. BR threshold reached
  2. Signs of kernicterus
163
Q

What is an important thing to remember when giving an exchange transfusion?

A

Give folic acid afterwards to prevent anaemia

Year 5 - Paediatrics (15 decks)

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