peds #3 Flashcards
paroxysmal abdominal pain or cramping
colic
S/Sx of colic
sudden, dibilitating pain, cries, pulls legs up, red faced, fist clenched
usually lasts 3 hours at least 3 times a week
management of colic
antiflatulent, parental support
passive transfer of gastric contents into the esophagus, starts witin the 1st week of birth
gastroesophageal reflux
patho of gastroesophageal refulx
neurimuscular distrubance
(kids at risk: CP, neuro involvement
S/Sx of gastroesophageal reflux
passive regurgitation or emesis, poor weight gain, irritability, gagging
Dx for gastroesophageal reflux
h&p, barium swallow, upper GI, pH monitoring
Rx for gastroesophageal reflux
antacids (decrease acid production)
H2 blockers
nissen fundoplication
tightens esophagus for gas. reflux
hardening or thickening of pyloric
pyloric stenosis
S/sx of pyloric stenosis
forceful vomiting, sour smelling, hungry, dehydration, visible peristalsis
Dx of pyloric stenosis
h&p, u/s, barium swallow
pyloromyotomy
surgical tx for pyloric stenosis, RUQ incision, post op clear liquids, hear bowel sounds (4-6 hours)
telescoping of one portion of the intestines into another
intussusception (MEDICAL EMERGENCY)
complication of intussusception
ischemia
S.Sx of intussusception
heatlhy child who suddenly has episode of acute colicky, abdominal pain, N/V, jelly like stool
how will you know if the intussusception is fixed
you will have normal stools
remnant of fetal omphalomesenteric duct that conntects yolk sac with primitive mid-gut during fetal lifecan lead to intussusception
meckel diverticulum
S/sx of meckel diverticulum
abdominal pain, bloody stool, anemia (possible)
Dx of meckel diverticulum
history, radionucleotide scintigraphy (meckle scan)
Tx for meckel diverticulum
surgical removal,
if left untx hemorrhage and bowel obstruction
absence of hanglionic innervation to the muscle of a section of the bowel, usually the sigmoid colon, abnormal gene on chromosome 10
hirsprung disease
s/sx hirsprung disease
newborn: failure to pass meconium within 24-48 hours after birth, infant: constipation, distention, childhood: constipation, impaction
what will a child with hirsprung disease die from
interocolitis
Dx of hirsprung disease
history, digital rectal exam, barium enema, rectal biopsy, anorectal menometry
Tx for hirsprung
surgery
post op: assess for abdominal distention
when is surgery done for hernias
age 2-5
S/sx for hernias
lump in groin, asymptomatic, pain
intolerance for gluten, causes malnutrition in children
celiac disease
when is celiac disease first noted
after several months after introduction of cereals (usually age 1-5)
S.sx of celiac disease
fatty stool, impaired fat absorption, N/V, watery stools
Dx of celiac disase
jejunal biopsy, gluten free diet, d-xylose absorption test
complication of celic disease
malignant lymphoma of small intestine (or other GI malignancies)
forceful ejection of gastric contents through the mouth
vomiting
Tx for vomiting
NPO for short time (3-8 hours)
ice chips, water/clear liquids in small amounts
most pathogens are spread by fecal oral route through contaminated food or water or spread from person to person
etiology of diarrhea
what is the most common pathogen in diarrhea
rotavirus
acute diarrhea lasts for
7-14 days
chronic diarrhea (IBS) lasts how long
beyond 2-3 weeks
Tx for diarrhea
BRAT diet
water and sodium lost in proportin to each other
isotonic
water loss in excess of electrolyte loss
hypertonic
MOST dangerous type
total output exceeds input
dehydration
S/Sx of isotonic dehydration
turgor poor, membranes dry, rapid pulse, irritable or lethargic
S.sx of hypotonic dehydration
very poor skin turgor, clammy, slightly moist membranes, very rapid pulse, lethargic, convulsions possible
s/sx of hypertonic
fair turgor, membranes parched, moderatly rapid pulse, marked lethargy, extreme hyperirritability on stimulation
mild dehydration
3-5% weight loss, cap refil more than 2 seconds, urine specific gravity less 1.020
moderate dehydration
6-10% weight loss, cap refill 2-4 seconds, urine specific gravity less 1.020 or oliguria
severe dehydration
10-15 % weight loss, cap refill more 4 seconds, tenting, oliguria or anuria, sunken anterior fontanel
alteration in freqency consistency or ease of passing stool
constipation
reasons for constipation
structural, systemic, medications (opids, iron)
Tx for constipation
increase fiber and fluids CRAP diet (cherries, raisins, apricots, prunes)
child takes or has bottle of milk to bed for prolonged times
night bottle syndrome
deficiency of protein with an adequate supply of calories
kwashiorkor
S/sx of kwashiorkor
thin wasted eextremities, ascites, scaly skin, blindness
results from general malnutrition of both calories and proteins
marasmus
S.sx of marasmus
starts at age 6-18 months, no sub q tissue, look old,
deficit in vit D
rickets
deficit in vit C
scurvvey
Dx of parasites
stool specimens, string test
Tx for parasites
quinacrine, furozone, flagyl
deficit in vit A
blindness
deficit in vit B
beri beri, constipation, alcoholics
Prevention of parasites
hand washing
what is the most common parasite int he US
protozoa (guardisasis)
protozoa
transmission: person to person
S/sx: abd cramps, diarrhea, constipation
tx of protozoa
furoxone, most infections resolve on on in 4-6 weeks
caused by a nematode, most common helminthic infection in US, small thread like worm that live in the cecum
pinworms (enterobiasis)
Pinworms
transmission: touch, inhalation
Dx: flashlight, tape
Tx for pinworms
mebendazole or vermox, anti itch cream for anal area, wash all bed clothes, keep nails short, wash hands
prevalent in southen warm climates, lives in the intestines
roundworm
roundworm
mild Gi sx to obstruction,
transmission: fecal oral
lives in warm soil
hook worm
hookworm
transmission: skin contact with soil, S/sx: erythema papular erruptions, itching, burning
results from ingestion of worm larvae living in inadequately cooked beef for pork
tapeworm
Tx for tapeworm
antihelminthics (destroys worm)
renal malignancy that may involve one or both kidneys, most common malignant neoplasm of the kidney
wilm’s tumor (nephroblastoma)
wilm’s tumor
S/sx: mass appears overnight, abdominal pain, vomit, fever, hematuria
Tx for wilms tumor
DO NOT PALPATE, surgery, chemo, radiation
failure of one or both testes to descnd fromthe abdominal cavity to the scrotum
cryptorchidism
occurs more in preterm males
have higher risk for testes cancer
true undescended
can palpate, just hasnt dropped yet
ectopic
cant palpate, in abdomen
Tx cryptorchidism
if persists after one year, refer to surgeon, if ectopic test kidney function
orchiopexy
surgery done for cryptorchidism
involuntary voiding of urine beyond the expected age at which voluntary control should not be achieved after successful toilet training
enuresis (wetting bed)
classifications of enuresis
primary: never achieved a peiod of dryness
secondary: dry for 3-6 months and then resumes wetting
diurnal: wetting occurs only during day
nocturnal: wetting occurs only at night
VCUG
voiding cystourethrogram, xray visualize childs urinary tract and bladder
Tx for enuresis
oxybutyin chloride, desmopressin, imipramine ydrocholoride
passing of stools into underwear or Pjs past the normal time of toliet training
encopuresis
Tx for encopuresis
increase fluids, fiber, decrease dairy, enemas, MOM, schedule
clinical manifestation of a large # of distinct glomerular disorder (fluid shift)
nephrotic syndrome
damage to the basement membrane
S.sx of nephrotic syndrome
proteinuria, edema, low serum albumin, increased blood lipid level, decrease output, weight losspuffiness
Dx nephrotic syndrome
UA, serum, renal biopsy
Tx for nephrotic syndrome
diet, prednisone, diuretics, I&O, daily weight, abdominal girth, rest, skin breakdown, no tight clothing
complication of nephrotic syndrome
peritonitis
inflammation of glomeruli
acute glomerulonehritis, by product of strep
S/sx of acute glomerulonehritis
decrease of glomerular filtration rate, puffiness, dark colored urine, edema, pale, lethargy, HA
Tx acute glomerulonehritis
abx, diretics, bed rest, limit competitive activity until normal kidney function, dont add electrolytes until after 1st void (dont want excess of potassium)
hemolytic anemia, thrombocytopenia, acute renal failure
hemolytic uremic syndrome (HUS)
S/Sx of HUS
hemorrhagic manifestations, oliguria or anuria, decreased renal function, CNS involvement (sezires)
prevention of HUS
cook temp of meat to 160, no unpasterurized milk, wash raw veggies, dont swim where water can be contaminated
acute encephalitis with accompanying fatty infiltration of the liver, brain, kidney, heart, lung, skeletal muscle. Viral illness (flu, varicella)
reyes syndrome
when is reyes syndrome more likely to occur
Jan, Feb, March
S/sx reye’s syndrome
anorexia, lethargy, vomiting, combativeness, normal to low grade fever (can look like drug intoxication)
Dx of reye’s syndrome
liver enzymes, liver biopsy, WBC, CSF
Prevention of Reye’s syndrome
no ASA, tylenol, no Peptobismal
neurological condition resulting from damage to the motor cortex and resulting in impaired muscular control
cerebral palsy
1 cause of Cp is
cerebral anoxia (head trauma, decrease of birth weight)
spastic
hypertonicity
dyskinetic
abnormal involuntary movement (jerky)
athetosis
slow wormlike writhing movements
atatic
awkward wide based gait
primary goal of CP
early recognition and promote optimum development
Tx for CP
braces, wheeled scooter boards, orthopedic surgery, Rx to decrease spasticity dantrolene, baclofen, robaxin, valium
premature closing of one or more cranial sutures
craniosynotosis
Tx for craniosynotosis
surgery to decrease pressure, correct deformity
recovery: assess nero, watch bleeding & infection
inherited disorder, abnormal precollagen, bone has large areas of osseous tissue with no architectural pattern
osteogenesis imperfecta
“briddle bone”
Type 1
MOST COMMON, blue sclera, after puberty femur fx
type II
most severe, death occurs before infancy
avascular necrosis of the femoral head (no blood supply), degenerative changes, flattening of upper surface of femoral head
legg-calve-perthes disease
4 stages of legg-calves-perthes disease
avascular stage (degenerative changes)
fragmentation/revascularazation: mottled appearacnce on xray
reparative stage: trying to repair itsself
regenerative stage
S/sx of legg-calves-perthes disease
intermittent appearacnce of limp on affected side, pain (increases in AM), limited ROM
Tx of legg-calves-perthes disease
surgery
slipping of the femur head posteriorly and inferiorly, occurs in pre-adolescence, obese or very tall & thin rapid growth
slipped femoral capital epiphysis
lateral curvature of spine
scoliosis
no pain until severe, occurs around age 10
Tx for scoliosis
observe, surgical, braces (slow progression of curve, boston brace & thoracic lumbar sacral orthotic TLSO)
posterior wires are threaded beneath laminae of each vertebrae and tightened around rods resting along transverse processes so that spinal column is stabilized by transverse traction on each vertebrae
luque segmental spinal instrumentation (scoliosis)
exaggeration of lumbar curvature
lordosis
humpback
kyphosis
chronic inflammation of synovium and joint effusion, S.Sx must begin before age of 16 and last longer than 6 weeks and in more thatn one joint
juvenile rheumatoid arthritis
S.sx of juvenile rheumatoid arthritis
swelling, contractures, warm to touch, not red, stiffness increases in AM or with decrease of motion
Rx for juvenile rheumatoid arthritis
ASA, NSAIDS, SAARDS, cytotozics, corticosteroids
ability to spread to others
communicability
time between the invasion of an organism and the onset of Sx of infection
incubation period
time btwn the beginning of nonspecific Sx and specific Sx
prodromal period
stage during which the specific Sx are evidnet
illness
interval btwn when sx begin to fade and the return to full wellness
convalescent period
how pathogen enters the body
portal of entry
how organisms leave the body
portal of exit
method by which the organisms are spread and enter a new individual to cause disease
chain of infection
rash
exanthem
how to relieve a itch or rash
dress in light cotton clothing, maintain hydration, fingernails short, press on itchy areas dont scratch, analgesics for comfort, antihistamines
roseola infantum
human herpesvirus 6, high fever then rash, period of communicability is during febrile period
rubella (german measles)
rash starts at face and goes down, joint stiffness, tx: Sx, transmission: droplet
Measles (rubeola)
sore throat, enlarged lymph nodes, droplet transmission, classic sign: kopliks spots on mouth (bright red with blue center)
chicken pox (varicella)
contagious one day before the rash
erythema infectiosum (5th disease)
rash on cheek then goes to extremites “slap cheek”, droplet transmission, tx Sx
poliomyelitis
encourage bed rest, direct and indirect contact
mumps
ear ache, soft foods, direct and indirect contact
scarlet fever
Tx PCN 7-10 days, large droplets and direct contact, fast progressivebeta hemolytic streptococci, group A
diphtheria
bull neck, conjunctivitis, direct and indirect contact, ABx
whooping cough (pertussis)
bordetella pertussis, direct and indirect contact, DtaP vaccine
Type 1 DM
usually thin build, must inject exogenous insulin to survive, autoimmune destructive process, hyperglycemia progress to ketoacidosis, weight loss
S.sx of type 1 dm
polyphagia, polydipsia, polyuria
Tx for type 1
3 meals, 3 snacks, carb counting, insluin (long acting, fast acting)
somogyi
rebound
dawn phenm.
increase of BS in am due to hormones
Type 2 Dm
strong genetic predispostion, overwight, inactive, HTN, hyperlipidemia, diet, excercise
S.sx of type 2
3 p’s without weight loss, yeast infection, increase sleep, fatigue, dark mark on back of neck
tx for type 2
educate, 3 meals, 1 snack, decrease carb intake/sodium/fat/calories, diet exercise, oral Rx or insulin
chronic complications of DM
microvascular (eyes, kidneys) type 1
macrovascular (heart) type 2
trisomy 21 defect
down syndrome
S.sx of down syndrome
broad flat nose, asian appearance, brushfileds spots, back of head flat, congenital heart defects
what issues can you have with feeding
large tounge, feed slowly
missing portion of chormosome 5
cri-du-chat syndrome
S.sx of cri-du-chat syndrome
distinctive weak high pitched cry (cat), microcephaly, eyes far apart, severe mental retardation
presence of one or more X chromosomes
klinefelters syndrome
clinical manifestations of klinefelters syndrome
no distinctive physical characteristics before onset of puberty, infertility, decreased 2ndary sex characteristics, mental impairment
Tx for klinefelters syndrome
none, can give testosterone to increase male characteristics
only one functional X chromosome
turners syndrome
99% females die inutero
Tx for turners syndrome
growth hormone, estrogen
lacks HexA enzyme necessary for lipid metabolism
tay sach’s disease
found in jewish population
S/sx tay sach’s disease
normal for 1st 6 months, then regress, loss of head control, exaggerated moro, severe mental retardation, blind, seizures, live to 3-5 years die r/t cachezia, pneumonia
disease of metabolism, phenylalanine is an essential amino acid necessary for growth and repair of body cells
PKU phenylketonuria
PKU
increased phenylanlanine (builds up in brain tissue) tyrosine (fair blond hair, blue eyes
S.sx of PKU
seizure, exzema
Dx for PKU
heal stick after 2 full days of mild feeding, then test again
Tx for PKU
keep blood level below 8 (2-8)
stay away from milk, nuts, meats, eggs, cheese, bread, rice, corn, pasta
inborn error of metabolism, autosomal recessive, child is deficient in the liver enzyme galactose 1 phostphate uridyl transferase
galactosemia
(build up of galactose in brain liver eyes)
cataracts seizure, lethargy
S.sx of galactosemia
appear normal at birth, after start of feedings, vomit & have weight loss, E coli sepsis,
Tx for galactosemia
NO BREAST FEEDINGs, formula feedings (lactose free),
group of inherited blood disorders characterized by deficienceies in the rate of production of specific globin chains of Hgb
thalassemia
increase of incidence in ppl live near mediterranean sea
S/sx
dont show until 6 months (fetal Hgb is replaced by adult Hgb), pale, tired, anorexia, Hgb less 5 g/100ml, epistaxis is common, bronzed skin
tx for thalassemia
prevent heart failure, transfuse RBC every 2-4 weeks, iron chelating agent (removes excess iron stores), spleenectomy, cure is possible with bone marrow transplant, but usually die in adolesence due to cardiac failure
gene level defect sex linked, deficiency of both T & B cells, unable to fight infection
severe combined immunodeficiency disorder (SCID)
Dx of severe combined immunodeficiency disorder (SCID)
hx of infection, family hx, lymphocytopenia
Tx for severe combined immunodeficiency disorder (SCID)
bone marrow transplant, gene therapy, if untx DIE
BUBBLE BOY
group of muscle diseases in childhood lack of protein needed for muscle contraction, progressive weakness and wasting of skeletal muscle
muscular dystrophy
usually only live 20 years
S.sx of muscular dystrophy
waddling gait, gowers sign (get up very slowly), progressive weakness and wasting of skeletal muscle
Dx of muscluar dystrophy
muscle biopsy, EMG, serum CPK (elevated in skeletal muscle injury)
groups of bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of the blood, sex linked X recessive
hemophila
female is carrier, males have disease
which factor is the intrinsic factor of coagulation
factor VIII
Dx of hemophillia
platelet cound WNL, prothrombin time WNL, thromboplastin abnormal, PTT abnormal
S/sx of hemophilia
painful/swelling at joints, GI bleeds, nose bleeds,
Tx for hemophilia
control bleeding, administer factor VIII, prevention is key
if injury occurs
IV factor VIII, immpbilize joint, ice, avoid sutures
NO ASA!!!
