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explain why children have a higher HR than adults
child
= lower blood volume
= lower stroke volume
= higher HR required for same amount of cardiac output
**high yield
what percentage of blood loss predisposes a child to hypovolemic shock?
mild hypovolemia: 15% –> early signs like increase HR
moderate hypovolemia: 15-30% –> decrease urine output, mild HYPOtension
severe hypovolemia: 30-40% –> significant HYPOtension, rapid pulse, confusion, lethargy
life threatening: >40%
do children or adults compensate for blood loss more effectively?
children compensate more effectively
= mask early signs of shock
= early monitoring and rapid intervention is crucial
for CVS… what are the 2 normal foetal structures
- patent ductus arteriosus
- patent ductus venosus
**high yield (can MEQ)
what happens if the PDA does not close soon after birth… what are the LT side effects?
PDA
**high yield (NEED TO REVISE CVS AGAIN)
what is the most common type f congenital heat defects
- tetraology of fallot
- cyanotic heart vs non cyanotic heart
**high yield CVS embryology
when do congenital heart defects usually arise?
in the FIRST TRIMESTER (when the heart tube starts to fold)
in second/ third trimester (if there are viral infections that occur here)
**impt big concept
children have a narrower airway compared to adults… what does that predispose them to?
respiratory distress
**high yield MEQ
how does a childn’s lung capcity differ from that of an adult? and what are the LT effects
- smaller size and volume
- smaller tidal volume
- higher respiratory rate = higher metabolic rate
- smaller number and size of aveoli
**HIGH YIELD ENDOCRINE
in children, which hormones are most important for growth? vs puberty?
growth: GH
puberty: estrogen and testosterone (sex hormones)
what is the significance of a child having to drink breast milk instead of solid food? (4 points)
- newborn immature digestive systems
= stomach produce lower level of digestive enzymes
= not capable of processing solid foods + intestine cannot handle digestion and absorption of nutrients from solid foods - breast milk produces necessary nutrients newborns need for growth and development
- lack of oral motor skills required to move solid food around their mouths & chew & swallow
- lack of swallowing reflexes
= increased risk of choking
what are some of the main killers of young children in their first months of life
- prematurity
- neonataal factors
why does prematurity cause neonatal death?
underdeveloped organs (list examples)
= nutritional, gastrointestinal, and immature immune system challenges
- BRAIN
= apnea
2/ LUNGS
- HEART
= PDA does not close
= shunting and heart failure - POOR TEMP REGULATION
= due to insufficient body fat
= - underdeveloped
**high yield microbiology
what are the main types of serious bacterial infections in a neonate?
vs viral infections
BACTERIAL
1. listeria
2. GBS
3. ecoli
VIRAL
1. influenza
2. RSV (respiratory syncytical virus)
3. enterovirus (HAND FOOT MOUTH DISEASE, rash on palms and soles, ulcers in the mouth)
4. Hep B and C (from maternal transmission)
hep B increases risk of liver cancer by 300X
5. varicella zoster (if mom catches primary infection within 2 weeks of giving birth)
in terms of percentage, what is the risk of serious bacterial infections when neonates have a fever?
15%
**high yield MEQ
what hakes a neonate more susceptible to infections?
SOCIOECOLOGICAL FACTORS
1. increase exposure to pathogens
- eg. putting soil on umbilical cord to dry it up
- a lot of people visiting the baby
2.
**high yield immunology
what are the different types of immunity
- maternal immunity
= newborns recieve passive immunity from maternal antibodies - innate and adaptive immunity
= innate immune system is developed at birth, but ADAPTIVE IMMUNITY IS UNDEVELOPED
**
newborns recieve passive immunity from mothers (via placenta & breast milk)
= recieve maternal Ab
=
what are the 3 conditions to look out for in neonataes that have jaundice lasting >2 weeks
- biliary atresia
- choledochal cyst
- alagille syndrome
- Biliary Atresia
Definition:
A rare, life-threatening condition where the bile ducts (intrahepatic and/or extrahepatic) are absent, underdeveloped, or scarred.
Results in obstruction of bile flow from the liver to the intestines.
Cause:
The exact cause is unknown, but it is believed to involve:
Congenital malformations.
Postnatal inflammatory or infectious damage.
Types:
Perinatal/Acquired: Most common, appearing after birth (2-8 weeks).
Embryonic/Fetal: Less common, associated with other anomalies (e.g., heart defects).
Symptoms:
Persistent jaundice beyond 2 weeks of life.
Pale or clay-colored stools (lack of bile pigments).
Dark urine.
Enlarged liver (hepatomegaly).
Poor weight gain or growth.
Diagnosis:
Blood Tests: Elevated conjugated bilirubin.
Ultrasound: Absence of bile ducts or abnormal bile flow.
HIDA Scan: No bile excretion into the intestines.
Liver Biopsy: Confirms absence or scarring of bile ducts.
Treatment:
Kasai Procedure (Hepatoportoenterostomy):
A surgical bypass that connects the liver directly to the small intestine.
Best results if done before 2 months of age.
Liver Transplant:
Required if the Kasai procedure fails or liver damage progresses.
2. Choledochal Cyst
Definition:
Congenital dilatation of the bile ducts, which can lead to bile flow obstruction, infection, and liver damage.
Cause:
Likely due to an abnormality in the pancreaticobiliary junction, allowing reflux of pancreatic enzymes into the bile ducts.
Types (Todani Classification):
Type I: Fusiform dilatation of the common bile duct (most common).
Type II: Diverticulum-like outpouching.
Type III: Cystic dilatation near the duodenal opening (choledochocele).
Types IV and V: Involve multiple intrahepatic or extrahepatic cysts.
Symptoms:
Jaundice (intermittent or persistent).
Abdominal pain or a palpable mass.
Dark urine and pale stools.
Recurrent cholangitis (bile duct infections).
Diagnosis:
Ultrasound: Detects cystic dilatations.
MRCP (Magnetic Resonance Cholangiopancreatography): Detailed visualization of the biliary tree.
ERCP (Endoscopic Retrograde Cholangiopancreatography): Diagnostic and sometimes therapeutic.
Treatment:
Surgical Removal of the Cyst:
Complete excision of the cyst to prevent complications like infection, stone formation, or cancer.
Biliary Reconstruction:
Roux-en-Y hepaticojejunostomy (reconstruction of bile flow).
3. Alagille Syndrome
Definition:
A rare genetic disorder characterized by abnormalities in the bile ducts, as well as multi-system involvement (liver, heart, eyes, skeleton).
Cause:
Mutations in the JAG1 or NOTCH2 genes, which are critical for bile duct development.
Autosomal dominant inheritance.
Symptoms:
Liver:
Reduced or absent intrahepatic bile ducts leading to cholestasis (bile flow obstruction).
Jaundice, pale stools, dark urine, and pruritus (itching).
Heart:
Congenital heart defects (e.g., pulmonary artery stenosis).
Skeletal:
Butterfly-shaped vertebrae.
Eyes:
Posterior embryotoxon (a specific corneal abnormality).
Facial Features:
Prominent forehead, deep-set eyes, and a pointed chin.
Diagnosis:
Liver Biopsy: Confirms paucity (reduction) of bile ducts.
Genetic Testing: Identifies JAG1 or NOTCH2 mutations.
Imaging and Echocardiography: Evaluate multi-organ involvement.
Treatment:
Symptom Management:
Cholestyramine or ursodeoxycholic acid for pruritus and cholestasis.
Supplementation with fat-soluble vitamins (A, D, E, K).
Liver Transplant:
For severe liver disease or cirrhosis.
Management of Heart and Other Systemic Issues:
Tailored based on the specific anomalies.
what is the approximate healing time for fractures
