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3a Paediatrics > Paeds GI, nutrition and genitourinary (ILA 4) > Flashcards

Paeds GI, nutrition and genitourinary (ILA 4) Flashcards

1
Q

Define possetting

A

non forceful return of small amounts of milk which is often accompanied by the return of swallowed air “wind”

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2
Q

Define regurgitation

A

non forceful return of large amounts

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3
Q

Define vomiting

A

forceful ejection of gastric contents

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4
Q

List the differentials for vomiting in an infant

A

colic **
GORD **
feeding problems
gastroenteritis or any infection
dietary problems e.g. cows milk protein intolerance
intestinal obstruction - pyloric stenosis, atresia, intussusception, volvulus, Hirschprungs

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5
Q

List the differentials for vomiting in a pre school child

A 
gastroenteritis 
infection e.g. UTI, meningitis 
coeliac disease
appendicitis 
intestinal obstruction
torsion of testes 
renal failure
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6
Q

List the differentials for vomiting in a school age/ adolescent child

A 
gastroenteritis
infection e.g pyelonephritis, sepsis, meningitis
crohns, ulcerative colitis
coeliac disease
appendicitis 
bulimia/ anorexia 
pregnancy 
migraine
renal failure
DKA
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7
Q

Outline the red flags to identify in a vomiting child

A

signs of dehydration

weight loss / faltering growth

bile stained

haematemesis

abdominal tenderness and distension

blood in stool

bulging fontanelle, seizures

projectile vomiting

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8
Q

List the signs of dehydration

A 
tachycardia
tachypnoea 
dry mucuous membranes 
reduced skin turgor
decreased urine output 
irritable, lethargic 
sunken eyes
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9
Q

List the signs of hypernatraemic dehydration

A 
jitteriness 
increased muscle tone
hyper reflex
drowsiness
convulsions
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10
Q

How is dehydration managed?

A

50 ml/kg of low osmolarity rehydration solution over 4 hours

plus ORS solution for maintenance

continue breastfeeding

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11
Q

What is the normal frequency of defection in a child depending on their age?

A

first few weeks of life -> 4 stools per day

1 year old -> 2 per day

breast fed infants -> common not to pass stools for several days

> 3 y/o -> same as adults -> 3 stools per day to 3 stools a week

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12
Q

List the causes of constipation

A

idiopathic constipation **

dehydration
low fibre in diet 
drugs e.g. opiates 
problems with toilet training 
stress

babies… hirschprungs disease, anorectal abnormalities, hypothyroidism, hypercalcaemia

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13
Q

How can constipation present and what would you look for in the history?

A
  1. STOOL PATTERN
    <3 complete stools per week
  2. SYMPTOMS WITH DEFAECATION
    distress, straining, blood with stool, pain, poor appetite that improves on passing stool
  3. HISTORY
    previous constipation, previous anal fissure
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14
Q

identify the red flag clinical features of constipation

A

failure to pass meconium in first 24 hours of life -> Hirschsprungs
faltering growth -> hypothyroidism, coeliac
abdo distension -> Hirschsprungs
abnormal lower limb neurology

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15
Q

How is constipation managed?

A
  1. behavioural - toileting routine, star charts, bowel habit diary
  2. diet and lifestyle - increase fluid intake and fibre intake
  3. laxatives 1st line = Movicol paediatric plain (if fails to work after 2 weeks, add Senna a stimulant)
  4. maintenance laxatives until regular bowel movements 1st line = Movicol
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16
Q

List the surgical causes for acute abdominal pain

A 
acute appendicitis 
inguinal hernia
meckel diverticulum 
pancreatitis
trauma
interssusception
intestinal obstruction
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17
Q

List the medical causes for acute abdominal pain

A 
gastroenteritis 
UTI
hence schonlein purport
DKA
hepatitis
constipation
inflammatory bowel disease
psychological
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18
Q

Define recurrent abdominal pain?

A

pain sufficient to interrupt normal activities and lasts for >3 months

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19
Q

List the differentials for recurrent abdominal pain

A

UNKNOWN

GI - crohns, ulcerative colitis, constipation, gastritis, peptic ulcer, IBS, malrotation

GYNAE- endometriosis, dysmenorrhoea, PID, ovarian cysts

PSYCHOLOGICAL- stress, bullying, abuse

URINARY TRACT- UTI, hepatitis, gall stones, pancreatitis

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20
Q

How is recurrent abdominal pain managed?

A
  1. identify any serious causes without multiple investigations e.g. urine microscopy, ultrasound
  2. full history and examination
  3. reassure parents
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21
Q

What is Gastro-Oesophageal reflux disease?

A

involuntary passage of gastric contents into the oesophagus

caused by inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity

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22
Q

How does GORD present?

A

recurrent regurgitation ** = non forceful regurgitation of large volumes of milk
well child
dry cough
unhappy lying flat , crying after feeds

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23
Q

Who does GORD most commonly affect?

A

very common in infancy, usually resolved by 12 months old

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24
Q

Outline the possible complications of GORD

A

failure to thrive
oesophagitis
pulmonary aspiration
dystonic neck posturing

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25
Q

How is GORD managed conservatively, medically and surgically?

A
  1. add thickening agent e.g. Nestargel to feeds
  2. add 1-2 trial of Gaviscon (alginate therapy) to feeds + smaller more frequent feeds, position head up after feeds
  3. add PPI or H2 receptor antagonist to feeds
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26
Q

How is pyloric stenosis caused?

A

hypertrophy of the pyloric muscle causing gastric outlet obstruction and impaired gastric emptying

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27
Q

Describe the classic presentation of pyloric stenosis

A 
present at 2-7 weeks of age 
most commonly boys
projectile vomiting (non bilious)
hunger after vomiting
weight loss 
dehydration
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28
Q

Which metabolic changes would you expect to see in a child with pyloric stenosis?

A

metabolic alkalosis
hypokalaemia
hyponatraemia
hypochloraemia

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29
Q

Which investigation confirms a diagnosis of pyloric stenosis?

A

ultrasound

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30
Q

How is a baby with pyloric stenosis assessed?

A
  1. gastric peristalsis
  2. pyloric mass felt - like an “olive”
  3. ultrasound** - confirm diagnosis
  4. dehydration
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31
Q

How is pyloric stenosis managed?

A
  1. IV fluids, correct electrolyte imbalance

2. pyloromyotomy “ramstedts procedure”

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32
Q

What are the symptoms and signs of acute appendicitis?

A 
abdominal pain - initially central/colicky and then localises to RIF (Mcburneys point)
fever
vomiting
anorexia
persistent tenderness
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33
Q

Outline the necessary investigations for acute appendicitis

A
  1. raised CRP and raised WCC

2. ultrasound

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34
Q

How is acute appendicitis managed?

A

appendicectomy!!!1

if suspect perforation, IV fluids and IV antibiotics

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35
Q

What is interssusception?

A

“telescopic bowel”

invagination of the proximal bowel into a distal segment

most common is ileum passing into caecum through the ileocaecal valve

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36
Q

Describe the common presentation of interssusception

A

age 3 months - 2 years old , more common in boys

few days history of severe colicky pain - draw knees in and pale
intermittent screaming with lethargy in between
**red currant jelly stool **
billious vomiting

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37
Q

What would you expect to find on examination of a child with interssusception?

A

sausage shaped mass palpable in RLQ**

abdominal distension

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38
Q

How is interssusception diagnosed?

A

ultrasound * - doughnut, target sign , “alternating echogenic and hypoechogenic rings”

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39
Q

How is interssusception managed?

A
  1. ABC
  2. fluid resus and alert HDU
  3. surgery - rectal air insufflation
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40
Q

What is meckels diverticulum?

A

ill remnant of the vitello intestinal duct

can contain ectopic gastric mucosa or pancreatic tissue

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41
Q

How is meckels diverticulum remembered?

A

RULE OF 2…

2 feet from ileo-caecal valve
2% of population
2cm long

(presents with rectal bleeding and anaemia)

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42
Q

How is meckels diverticulum managed?

A
  1. technetium scan

2. surgical resection

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43
Q

What is the most common viral cause of gastroenteritis?

A

rotavirus infection (60%)

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44
Q

List the bacterial causes of gastroenteritis?

A

campylobacter jejuni infection - abdo pain, most common
shigella - blood in stool, tenesmus
salmonella - blood in stool, tenesmus
cholera - profuse, watery, rapidly deteriorating
E.coli - profuse, rapidly deteriorating, most common cause of traveller diarrhoea
staph aureus- cause acute food poisoning, resolves in 2 days

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45
Q

How might gastroenteritis present?

A 
loose/watery stools
vomiting
abdominal pain (Campylobacter)
dehydration 
history of travel abroad/ contact with someone with diarrhoea
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46
Q

Which symptoms would suggest a shigella or salmonella cause of gastroenteritis?

A

blood and pus in stool
high fever
tenesmus

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47
Q

How is dehydration measured during diarrhoeal illness?

A

dehydration measured by degree of weight loss..
<5% weight loss = no dehydration clinically
5-10% weight loss= clinically dehydrated
>10% weight loss= shock

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48
Q

How is gastroenteritis managed?

A
  1. no investigations necessary - stool culture if blood/ septic child
  2. fluids and rehydration solutions
  3. monitor nutrition
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49
Q

What is Hirschprungs disease?

A

absence of ganglionic cells from myenteric plexus of large bowel

due to developmental failure of the parasympathetic Auerbach and Meissner plexuses

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50
Q

How does Hirschsprungs disease present?

A

failure to pass meconium within 48 hrs of life
constipation
abdominal distension
bilious vomiting later

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51
Q

How is hirschsprungs disease diagnosed?

A

suction rectal biopsy

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52
Q

How is hirschsprungs disease managed?

A
  1. rectal washout and enema

2. surgical resection

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53
Q

What is intestinal malrotation?

A

obstruction of the small bowel

congenital anomaly of rotation of the midgut

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54
Q

if a few day old child presents with billious vomiting, what must be ruled out?

A

INTESTINAL MALROTATION

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55
Q

How does intestinal malrotation present?

A

billious vomiting
1-7 days old child
abdominal pain
(if this is presentation, must rule this out!)

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56
Q

How is intestinal malrotation diagnosed?

A

upper GI contrast study =1st line and diagnostic

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57
Q

How is intestinal malrotation treated?

A

surgical correction by Ladds procedure

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58
Q

When is chronic diarrhoea (Toddlers diarrhoea) suspected?

A

stools varying in consistency e.g. explosive, loose or formed
children well and thriving
no precipitating dietary factors
grow out of symptoms by 5 y/o

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59
Q

How is coeliac disease caused?

A

gliadin in gluten causes a immunological response in the proximal small intestine to cause shorter villi and flat mucosa

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60
Q

What is associated with coeliac disease?

A

family history

autoimmune diseases e.g. type 1 diabetes, hypothyroidism, graves, psoriasis, SLE

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61
Q

Which gastrointestinal symptoms are seen with coeliac disease and when do they present?

A

present at 8-24 months of age AFTER introduction of wheat containing food…

diarrhoea/ malabsorptive stools
abdominal distension and bloating
failure to thrive
buttock wasting

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62
Q

Outline other multi system symptoms and signs of coeliac disease

A 
anaemia - iron or folate deficiency 
growth failure
dermatitis herpetiformis 
hyposplenism 
osteomalacia 
mouth ulcers
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63
Q

What is the diagnostic sign of coeliac disease?

A

IgA tissue transglutaminase antibodies

64
Q

How is coeliac disease managed?

A

remove gluten from the diet!!

avoid wheat, barley, rye and symptoms will resolve

65
Q

Describe the pathology of crohns disease

A

granulomatous inflammation of the distal ileum and proximal colon

transmural
normal bowel areas in between areas of diseased areas
‘cobblestone appearance”

66
Q

Describe the classic presentation of crohns disease

A 
abdominal pain
diarrhoea 
lethargy and fatigue
weight loss 
growth failure/ delayed puberty
67
Q

List the extra intestinal manifestations of crohns disease

A 
erythema nodosum 
iron deficiency anaemia 
uveitis 
perianal skin tags 
arthralgia 
conjunctivitis 
clubbing
mouth ulcers
68
Q

How is crohns disease investigated?

A
  1. endoscopy and biopsy
  2. raised CRP and ESR
  3. small bowel imaging
69
Q

How is crohns disease managed medically?

A
  1. immunosuppressant medication e.g. aziothioprine, methotrexate - to maintain remission
  2. long term supplemental enteral nutrition

if treatment fails, anti-tif agents e.g. infliximab or surgery

70
Q

What is ulcerative colitis?

A

recurrent inflammation and ulceration of the mucosa of the colon

extends from rectum proximal
continuous diseases
crypt damage - abscess, loss of crypts

71
Q

How does ulcerative colitis present?

A 
colicky pain
diarrhoea
weight loss
rectal bleeding 
growth failure
72
Q

In ulcerative colitis, what are you at increased risk of?

A

adenocarcinoma of the colon

so need regular colonoscopic screening

73
Q

How is UC investigated?

A

endoscopy and colonoscopy and biopsy

widespread ulceration, pseudopolyps, crypt abscesses

74
Q

How is UC managed depending on severity of disease?

A

mild = aminosalicylates e.g. mesalazine

aggressive = systemic steroids for acute attacks and immunomodulatory therapy for remission (azathioprine)

severe = colectomy with ileostomy

75
Q

List of the causes of nutrient malabsorption

A 
biliary atresia 
lymphatic leakage 
short bowel syndrome - necrotising enterocolitis 
crohns / UC 
cystic fibrosis 
coeliac disease
lactose intolerance
76
Q

What is cows milk protein allergy associated with?

A

atopy

IgA and IgG deficiency

77
Q

What are the symptoms of cows milk protein allergy?

A 
loose stools
vomiting
failure to thrive
atopic history 
GORD
78
Q

If the stools are bloody with cows milk protein allergy, what would be suspected?

A

cows milk protein colitis

79
Q

How is cows milk protein allergy managed?

A
  1. eliminate from diet - if symptoms improve then diagnose
  2. hydrolysed feeds
  3. amino acid based feeds
80
Q

what is the difference between hydrolysed feeds and amino acid based feeds?

A

hydrolysed feeds = break the milk protein up into pieces

amino acid based feeds = made with individual amino acids so well tolerated

81
Q

How does lactose intolerance present and who it is associated with?

A

associated with oriental backgrounds

explosive watery stools
abdominal distension
audible bowel sounds
flatulence

82
Q

How is lactose intolerance diagnosed?

A
  1. lactose hydrogen breath test

2. eliminate from diet

83
Q

How is lactose intolerance managed?

A
  1. eliminate lactose from diet
  2. lactose free formula and milk free diet
  3. calcium and vitamin D supplements
84
Q

How long does WHO recommend mothers breast feed for?

A

6 months

85
Q

What are the advantages of breastfeeding?

A

reduces incidence of necrotising enterocolitis in preterm babies

helps with bonding/ loving relationship

reduces breast cancer risk in women

reduced incidence of obesity, diabetes and hypertension in babies

passive immunity

86
Q

What are the limitations of breastfeeding?

A

puts pressure on mother if fail to establish feeds

restrictive for mother

cannot tell how much a baby is taking from breast

difficult for preterm babies

transmission of infection and drugs e.g. HIV, hep B, CMV

vitamin K deficiency

87
Q

Describe the physiology of breast feeding

A
  1. baby uses rooting, sucking and swallowing reflexes to feed
  2. hypothalamus sends impulses to pituitary gland
  3. anterior pituitary secretes prolactin which stimulates milk production in acini of breast
  4. posterior pituitary secretes oxytocin which contracts myoepithelial cells in alveoli, forcing milk into larger ducts
88
Q

List some of the properties of breast milk

A 
IgA
bifidus factor
lysozyme
lactoferrin
macrophages 
lymphocytes 
protein 
calcium phosphorus
89
Q

When is pasteurised cows milk given to a child?

A

at 1 years old

90
Q

When should specialised formula be used?

A

cows milk protein allergy
lactose intolerance
cystic fibrosis
neonatal cholestatic liver disease

91
Q

When should weaning start?

A

solid foods recommended to be introduced at 6 months of age

start with pureed fruit, root vegetables or rice

92
Q

Define “faltering growth”

A

“dropping centiles” - either growth faltering or weight faltering

fall across 1+ centiles if <9th gentile at birth OR
fall across 2+ centiles if 9th-91st centile at birth OR
weight under 2nd gentile regardless of birth weight

93
Q

Outline the possible causes of failure to thrive

A

FEEDING PROBLEMS
ineffective suckling in breast fed infants
ineffective bottle feeding
post natal depression
insufficient food/ quantities of milk offered

NON ORGANIC
neglect/ abuse
psychosocial deprivation

ORGANIC
suckling - cleft palate, cerebral palsy
vomiting - GORD
malabsorption - coeliac, cystic fibrosis
increased requirements - HIV, congenital heart disease, thyrotoxicosis

94
Q

How is faltering growth assessed?

A
  1. growth and weight chart
  2. examination for any organic illness
  3. history of diet, feeding, development
95
Q

What are the possible causes of diarrhoea in children?

A 
inflammatory bowel e.g. crohns, UC
coeliac disease
chronic constipation 
side effects of antibiotics
gastroenteritis 
bowel obstruction 
toddler diarrhoea 
cows milk intolerance
hyperthyroidism
96
Q

List the anomalies of the urinary tract detectable during antenatal ultrasound screening

A 
renal genesis 
multicystic dysplastic kidneys 
polycystic kidney disease
horseshoe kidney / pelvic kidney 
duplex system
bladder extrophy 
urine flow obstruction
97
Q

How is polycystic kidney disease inherited?

A

autosomal dominant

98
Q

What complications can polycystic kidney disease cause?

A 
haematuria
renal failure
hypertension
cysts in the liver and pancreas
cerebral aneurysms 
mitral valve prolapse
99
Q

Where can urine flow obstruction occur?

A

pelvicouteric or vesicoureteric junction
bladder neck
posterior urethra

100
Q

What are the consequences of urine flow obstruction?

A

thickened bladder wall
hydronephrosis
bladder neck obstruction

101
Q

What does Potter syndrome result from?

A

multi cystic dysplastic kidneys

bilateral renal genesis

102
Q

How does potter syndrome manifest?

A

primary problem is kidney failure causing reduced fetal urine excretion and oligohydramnios

causes facial features of low seat ears, beaked nose and lung hypoplasia

103
Q

Which investigations are carried out to assess renal function

A
  1. plasma creatinine concentration
  2. estimated glomerular filtration rate - good measure of renal function
  3. EDTA GFR
  4. creatinine clearance
  5. plasma urea concentration - raised levels are symptomatic
104
Q

Which radiological investigation if preferred to assess renal anatomy?

A

ultrasound

shows anatomy, urinary tract dilatation, stones, nephrocalcinosis

105
Q

What are the most common causative organisms of an UTI?

A

E.coli ***
Pseudomonas
Proteus
Klebsiella

106
Q

What are the risk factors for an UTI?

A

urinary tract abnormality

incomplete bladder emptying e.g. infrequent voiding, incomplete micturition, constipation

vesicoureteric reflux

107
Q

What is vesicoureteric reflux and how is it caused?

A

developmental abnormality of vesicoureteric junction

reflux can cause ureteric dilatation which causes incomplete bladder emptying, renal damage and pyloneprhitis

Causes: family history, after an UTI, bladder pathology

108
Q

How might an infant with an UTI present?

A 
fever
vomiting
poor feeding
irritable
lethargic 
sepsis !!!!
109
Q

How might an older child with an UTI present?

A 
dysuria 
increased frequency of urination
abdominal pain/ loin tenderness
fever
vomiting 
haematuria
cloudy, offensive urine
110
Q

How is an UTI first diagnosed?

A

1st line = urine dipstick -> screening test, +ve leucocytes or nitrates

if +ve = clean catch urine sample MC&S

111
Q

Which investigation should be done routinely in all children with an UTI?

A

ultrasound within 6 weeks
to identify structural abnormalities, obstruction or scarring

DMSA (for renal scarring) after 3 months if USS atypical or under 3 y/o OR micturating cystourethrogram if <1y/o

112
Q

Outline the conservative advice given for children with an UTI

A 
high fluid intake
regular voiding 
ensure complete bladder emptying training
good perineal hygiene 
prevent constipation
probiotics encouraged
113
Q

Who should you refer to the hospital with an UTI?

A

<3 months old
children at high of serious illness
suspect sepsis

114
Q

Which antibiotic should be prescribed for a child <3 months with an UTI?

A

IV cefotaxime

115
Q

Which antibiotic should be prescribed for children >3 months with upper UTI/ pyelonephritis ?

A

oral co-amoxiclav for 7-10 days
OR
IV cefotaxime for 2-4 days and then oral for up to 7-10 days in total

116
Q

Which antibiotic should be prescribed for children with a lower UTI or cystitis?

A

trimethoprim

nitrofurantoin

117
Q

what are the features of an upper UTI or acute pyelonephritis?

A

temp >38 degrees
loin pain
loin tenderness
bacteriuria

118
Q

What are the two types of haematuria?

A
  1. glomerular haematuria

2. lower urinary tract haematuria

119
Q

What is the difference between glomerular and lower urinary tract haematuria?

A

glomerular haematuria = brown coloured, with proteinuria

lower urinary tract haematuria = bright red colour, no proteinuria

120
Q

List the non glomerular causes of haematuria

A 
infection e.g. schistomiasis, TB
trauma 
stones
sickle cell disease 
bleeding disorders
renal vein thrombosis 
HSP
121
Q

list the glomerular causes of haematuria

A

acute/ chronic glomerulonephritis
familial nephritis
IgA nephropathy
nephritic syndrome

122
Q

If the urine is red in colour/ +ve haemoglobin on dipsticks, which tests should be done?

A

urine microscopy and culture

ultrasound

FBC, U&E, clotting screen, creatinine

123
Q

When is a renal biopsy indicated?

A

persistent proteinuria
recurrent macroscopic haematuria
renal function abnormal

124
Q

What are the 2 types of proteinuria?

A
  1. transient proteinuria

2. persistent proteinuria

125
Q

What is the difference between transient and persistent proteinuria?

A

transient can occur during febrile illness or after exercise

persistent is significant and need to measure urine protein: creatinine in early morning

126
Q

What are the possible causes of proteinuria?

A 
orthostatic proteinuria
nephrotic syndrome 
increased glomerular filtration pressure
hypertension
henoch schlonlein purpura
UTI
chronic renal disease
127
Q

What is the triad for nephrotic syndrome?

A
  1. proteinuria
    >1g/m^2/24 hours
  2. hypoalbuminaemia
    <25g/L
  3. peripheral oedema
    e. g. scrotal, periorbital, ascites, ankle
128
Q

What is the aetiology of nephrotic syndrome?

A

Minimal change disease ** (80%)

focal segmental glomerulonephritis

membranous glomerulonephritis

infections

HSP

129
Q

What can cause minimal change disease?

A

hodgkins lymphoma
NSAIDs
HIV, hepatitis, syphilis

130
Q

What are the 3 types of nephrotic syndrome and their differences?

A
  1. steroid sensitive nephrotic syndrome **
    precipitated by resp infection
  2. steroid resistant nephrotic syndorme
    can’t treat with steroids, treat oedema with diuretics, salt restriction
  3. congenital nephrotic syndrome
    rare, first 3 months of life, need nephrectomy or dialysis and renal transplant
131
Q

How is nephrotic syndrome investigated?

A

urine dipstick
urine microscopy and culture
UandE, FBC, ESR, creatinine, albumin
hepatitis B and C screen

132
Q

How is nephritic syndrome managed?

A

high dose of oral corticosteroids (prednisolone)

+ fluid balance, manage electrolytes, penicillin prophylaxis (as lose immunoglobulins so at risk of infection), pneumococcal vaccination

133
Q

How is steroid resistant nephrotic syndrome managed?

A

TREAT THE OEDEMA

  1. diuretics
  2. salt restriction
  3. ACE-I
  4. NSAIDs
134
Q

What is nephritic syndrome?

A

inflammation of the kidneys causing…

  1. haematuria
  2. hypertension
  3. proteinuria

+ oliguria, blurred vision, uraemia

135
Q

What is nephritic syndrome commonly caused by in children?

A

Alport syndrome

IgA nephropathy “bergers disease”
often following an URTI

post streptococcal glomerulonephritis

Henoch Schonlein Purpura

Haemolytic Uraemic syndrome

136
Q

What is henoch schonlein purpura?

A

IgA mediated small vessel vasculitis

137
Q

What is the triad for henoch schonlein purpura?

A
  1. purpura - raised like sandpaper, over buttocks and extensor surfaces
  2. arthritis - knees and ankles
  3. abdominal pain
138
Q

What is henoch schonlein purpura associated with?

A

IgA nephropathy

following a URTI

139
Q

What would you expect to see on the urine dipstick of someone with HSP?

A

proteinuria

haematuria

140
Q

How is HSP managed?

A

oral prednisolone

complications: HTN, abnormal kidney function

141
Q

What is the classical triad for haemolytic uraemic syndrome?

A
  1. acute renal failure (decreased urine output, abdo pain)
  2. thrombocytopenia
  3. microangiopathic haemolytic anaemia
142
Q

What are the complications of haemolytic uraemic syndrome?

A

hypertension

chronic renal failure

143
Q

What can cause haemolytic uraemic syndrome?

A 
bloody diarrhoea- E.coli ***
tumours
pregnancy 
SLE
HIV
144
Q

How is haemolytic uraemic syndrome managed?

A

supportive
fluids
plasma exchange if severe

145
Q

How is dehydration managed fluids wise?

A

10-20ml/kg of 0.9% saline bolus stat

146
Q

What is the rate of maintenance fluids?

A

Rate (ml/hour) = total daily requirement / 24

147
Q

Which fluids are used for maintenance fluids?

A

0.9% saline + 5% dextrose + 10mmol KCl

148
Q

How is total daily fluid requirements (24hr) calculated)?

A

1st 10kg body weight = 100ml/kg/day

2nd 10kg body eight = 50ml/kg/day

remainder body weight= 20ml/kg/day

149
Q

How is vesico ureteric reflux diagnosed?

A

** micturating cystourethrogram **

then do DSMA to look for renal scarring

150
Q

list the signs of shock

A 
decreased LOC
cold extremities 
mottled
weak peripheral pulse 
hypotension 
prolonged cap refill time
151
Q

Describe the pathological features of coeliac in the small intestine?

A

villous atrophy
epithelial cell hyperplasia
mucosal inflammation
increase depth of crypts

152
Q

what is biliary atresia?

A

destruction or absence of the extra hepatic biliary tree and intrahepatic biliary ducts leading to chronic liver failure

153
Q

How does biliary atresia present?

A 
neonatal jaundice
faltering growth
pale stools 
dark urine
hepatomegaly
154
Q

How is biliary atresia diagnosed?

A

laparotomy by operative cholangiography **
ultrasound
conjugated bilirubin high

155
Q

How is biliary atresia managed?

A

must be operated on within 60 days of life (surgical bypass of fibrotic ducts / Kasai procedure)

complications of surgery: cholangitis, malabsorption of fats, cirrhosis, liver transplant if unsuccessful

3a Paediatrics (9 decks)

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