Pediatric Conditions Flashcards
Differentials for non-bilious vomiting
- Gastroenteritis
- Acute viral illness
- Food allergy
- Pyloric stenosis
- GERD
- Meconium ileus
Differentials for bilious vomiting
- Volvulus with rotation
- Intussusception
- Ileus (meconium, septic, etc)
- Meconium plug syndrome
- Bowel perforation
- Hirschsprung
- Intestinal atresia
- Necrotising enterocolitis
Clinical features of Meckel’s diverticulum
- Typically asymptomatic, incidental finding - most frequently symptomatic <2y
- Commonly presenting with painless GI bleeding (hematochezia or melena)
- Abdominal pain (usually RLQ)
- Intestinal obstructive symptoms (if herniated or twisted)
Diagnosis and management of Meckel’s diverticulum
- Diagnostic:
- Meckel’s scan (Technetium-99 scan)
- X-ray: limited but can be used for detecting obstruction or perforation
- Management:
- Asymptomatic:
- Resection indicated for all children or young adults
- Symptomatic: diverticulectomy or segmental resection
- Asymptomatic:
Clinical features of intussusception
- Most commonly in children between 3m - 5y old
- Initially non-bilious vomiting, bilious if becomes obstructive
- Abdominal pain: acute, cyclical, colicky
- Palpable abdominal mass - usually RUQ
- Bloody stools: “currant jelly”
- Lethargy, pallor, other sympoms of shock
Diagnostic and management of intussusception
- Abdominal ultrasound: target sign
- Air or barium enema
- Management:
- Initial steps: NG decompression and fluid resuscitation
- Non-surgical: air enema
- Surgical reduction
Clinical features of pyloric stenosis
- Forceful projectile vomiting after feeds
- Difficulty feeds and irritable
- Palpable, non-tender, epigastric mass
- Visible peristaltic waves
- Dehydration symptoms:
- Presenting around 2-7 weeks of life
Diagnostic and management of pyloric stenosis
- Definitive imaging: abdominal ultrasound or barium studies
- FBE: late signs include electrolyte derangements (hypochloremic metabolic alkalosis)
- Management:
- Correct any electrolyte derangment and fluid replacement
- NPO
- Surgical procedure: pyloromyotomy
Clinical features of Hirschsprung
- Initial presentation
- Meconium not passing in the first 48h of life
- Abdominal bloating and tenderness
- Bilious vomiting
- Late presentation
- Chronic presentation (in milder cases)
- Failure to thrive/poor feeds
DRE exam findings: tight anal spinchter, squirt sign (explosive stool release after finger removal)
Diagnosis and management of Hirschsprung
- Initial imaging: X-ray and barium enema
- Diagnostic imaging: rectal biopsy
- Management:
- Initial:
- correct fluid and electrolyte disturbance
- NG decompression and colonic irrigation
- screen for signs of enterocolitis
- Surgical resection of aganglionic region
- Initial:
Differential diagnosis of delayed passage of meconium
- Hirschsprung
- Meconium ileus
- IND
- Congenital hypothyroidism
Types of acyanotic congenital heart disease
VSD, ASD, PDA, coarctation of aorta
Types of cyanotic congenital heart diseases
- Tetralogy of Fallot
- Transposition of the great vessels
Difference between acyanotic and cyanotic lesions
- Acyanotic conditions (“pink babies”): Have left-to-right shunts in which oxygenated blood from the lungs is shunted back into the pulmonary circulation.
- Cyanotic conditions (“blue babies”): Have right-to-left shunts in which deoxygenated blood is shunted into the systemic circulation
Describe Eisenmenger syndrome
Reversal of left-right shunt to right-left shunting due to increased pulmonary pressures (pulmonary hypertension), leading to cyanosis.
Clinical features and auscultation findings of VSD
- Holosystolic murmur - best heard in the LLSE
- Louder in small defects
- Louder with maneuvers increasing afterload (e.g. handgrip)
- Presenting with recurrent chest infections, dyspnea, CHF, failure to thrive
Clinical features and auscultation findings of ASD
- Systolic ejection murmur over ULSE - widely fixed split S2
- Recurrent respiratory infection, easily fatigued, failure to thrive
Management of ASD/VSD
- Most septal defects close spontaneously
- Follow-up echo based on size
- If CHF developmnes: initial treatment includes diuretics + inotropes + ACEi
Clinical features and auscultation findings of PDA
- Typically asymptomatic; patients with large defects may present with FTT, recurrent lower respiratory tract infections, clubbing, and CHF.
- Continuous “machinery murmur” at the second left intercostal space at the sternal border
What do you give to close a PDA? When is this contraindicated?
- Indomethacin (NSAID)
- Contraindicated in cyanotic lesions that require PDA for survival (transposition of great vessels, tetralogy of Fallot, coarctation of aorta)
Clinical features of coractation of aorta
Narrowing of aorta at the aortic isthmus - in the descending or abdominal aorta
* Features:
* Differential cyanosis - affecting lower extremities
* Asymptomatic hypertension, lower extrimity claudication,
* Continous murmur may be heard diffusely over the torso
Management of coarctation of aorta
- Prostaglandin - reopen PDA
- Surgical repair or balloon dilatation
