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A3 ME3034 SPECIALTIES > W07 - PAEDS: Allergies (Paeds); Paed Nephrology; Paed Sx; Paed Urology > Flashcards

W07 - PAEDS: Allergies (Paeds); Paed Nephrology; Paed Sx; Paed Urology Flashcards

1
Q

Describe the pathophysiological mechanisms of IgE mediated allergy

A

Histamine , Tryptase, Hydrolase

Later biphasic reaction: Secreted inflammatory mediators – Prostaglandins, Leukotrienes, PAF, Cytokines

HISTAMINE:
Bronchial smooth muscle contraction
Vasodilation
Separation of endothelial cells (responsible for hives)
Pain and itching

TRIGGERS:
Food
Environmental Allergen
Drug
Sting / Bite
Idiopathic

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2
Q

Recognise the presenting features suggestive of IgE medicated food allergy and be able to elicit an allergy focussed history

A

Mild/moderate

Severe: +airway, bronchispasm, hypoT

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3
Q

Formulate and justify a diagnosis of IgE Mediated allergy

A
  • previous reactions
  • atopy
  • FHx
  • Response to Tx
  • Co-existing asthma? - bronchospasm exacerbation
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4
Q

Be able to identify and select appropriate investigations to aid diagnosis of suspected food allergy

A

SKIN PRICK TESTING
- strong negative predictor

SPECIFIC IgE
- no risk of reaction,
- unreliable in eczema
- delay

ORAL FOOD CHALLENGE
GOLD STANDARD
daycase procedure, double blind controlled.

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5
Q

Identify and describe the management for the prevention and treatment of food allergy

A

Avoidance of triggers

H1- Antihistamine (2nd or 3rd generation)
- PYRITON
- CHLORPHENAMINE
(1st gen sedating)
(2nd or 3rd are non-sedating)

High Dose Antihistamines +/- second antihistamine

Leukotriene Antagonist

Corticosteroids (3-5 days)

Tranexamic Acid

Anti IgE Monoclonal antibody (Omalizumab) in children over 7 years of age

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6
Q

Hereditary angioedema

A

C4 and C1 Esterase Inhibitor Dysfunction

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7
Q

Signs of anaphylaxis

A

Laryngeal Oedema
Hypotension/collapse
Bronchospasm
Feeling of impending doom
Onset usually in minutes

  • onset around 60mins, faster = worse prognosis
  • 20% have biphasic reaction 1-8 hrs later therefore need steroids and hospital admission
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8
Q

RF for anaphylaxis

A

Asthma (poorly controlled)
Stress
Exercise
Viral infection
Alcohol

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9
Q

Mgmt for Anaphylaxis

A

EPIPEN
Adult 0.3mg / 0.5mg, Junior 0.15mg

Education on use home/school

1st line treatment of anaphylaxis

Early use is associated with better outcomes

Potential interaction with B-blockers and tricyclics

ACTIONS:
Reverses peripheral vasodilation
Increases peripheral vascular resistance
Improves BP and coronary perfusion
Decreases angiooedema
Causes bronchodilation
Decreases release of inflammatory mediators

  • hx of severe reaction, trace amounts
  • cvd, resp, co-existing asthma comorbidities
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10
Q

Food Allergies

A

RF: existing allergies, atopy

Peanut:
> avoid
> immuno rx?, Palforzia

Egg:
67% grow out of it by 5yo
> promote re-introduction, egg ladder

Milk:
D&V, confusion, infants = histamine
D&V, eczema, bloating bleeding, irritability = non-histamine, non-IgE MOST COMMON

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11
Q

Fruit & Veg Allergy

A

Oral Allergy Syndrome

Cross reactivity of tree/plant pollens and foods
Causes mainly oral symptoms - itching, mouth swelling, tongue discomfort etc…
Birch - kiwi, apple, pear, nectarines
Alder - celery, pear, apple, cherry
Ragweed - watermelon, banana, cucumber

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12
Q

NEPHROTIC SYNDROME in paeds

A

*proteinuria, intravascular depletion,
* glomerular disease
* Interaction between lymphocytes (T and B cells) and podocytes

  • hypoalbuminemia = oedema
  • frothy urine
  • minimal change most prevalent
  • followed by Focal segmental glomerulosclerosis (FSGS)

> PREDNISOLONE
!cushings

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13
Q

Investigating glomerular disease

A

i. DIPSTIC

ii. PROTEIN:CREATININE

iii. 24hr urine (gold standard)

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14
Q

NEPHRITIC SYNDROME in paeds

A
  • haematuria, intravascular overload
  • glomerular disease
  • fluid overload, JVP, oedema
  • increased creatinine
  • hyponatremia, hyperk.
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15
Q

Acquired Glomreulopathy in paeds

A

PODOCYTE implicated in Minimal Change Disease

BASEMENT MEMBRANE implicated in Post Infectious Glomerulonephritis

ENDOTHELIAL CELL implicated in PIGN, Haemolkytic Uremic Syndrome

MESANGIAL CELL implicated in
IgA Vasculitis
* common in children

+STEROID RESISTANT NEPHROTIC SYNDROME: genetic factor, podocyte loss, progressive inflammation and sclerosis

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16
Q

Congenital Glomerulopathy

A

*rare, layer involved

PODOCYTE DYSFUNCTION
BASEMENT MEMBRANE PROTEIN DYSFUNCTION
ENDOTHELIAL VASCULAR DYSFUNCTION

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17
Q

Considerations for steroid therapy in paeds

A

Behaviour
Mood lability
Sleep disturbance

*infection risk: varicella status, pneumococcal vax, abx prophylaxis

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18
Q

Acute post-infectious glomerulonephritis

A

Group Strep A, beta hemolytic
throat, skin

  • ag mimicry produces Ab-Ag complexes = TYPE 3 HYPERSENSITIVITY
    = AKI

*self-limiting
* bacterial culture!

> Abx
Support renal functions
Diuretics

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19
Q

IgA Nephropathy

A

Most common glomerulonephritis
1-2 days after URTI
Usually older children and adults

Recurrent macroscopic haematuria
Chronic microscopic haematuria
Varying degree of proteinuria

  • biopsy confirms: IgA, IgG, C3 deposits

> ACEi - mild disease, proteinuria
imm suppr.

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20
Q

Mesangial Deposits of IgA, IgG, and C3 on immunostaining are suggestive of which glomerular disease?

A

IgA Nephropathy

21
Q

HSP IgA Vasculitis

A

HENOCH SCHONLEIN PURPURA
* VASCULITIS (most common childhood vasculitis): palpable purpura
+ abdo pain
+ renal involvement
+ arthritis
+ BIOPSY

5-15yrs

associated with sensitivity vs nephrotic/nephritic IgAN, but still nephritic in picture

post viral trigger or drug trigger
4-6w duration

> symptomtic
glucocorticoid rx: improve GI involvement
imm suppr.
LT hypertension and proteinuria screening

22
Q

PSGN Vs IgAN

A

Latency
Imm complexes in PSGN biopsy
* both nephritic

In addition, PSGN classically presents with hypocomplementemia, and if the patient undergoes a renal biopsy there is evidence of an immune complex-mediated process. In contrast, IgA Nephropathy shows normal serologic values (though IgA levels may be elevated in about a third of patients) and the renal biopsy will show mesangial IgA deposition.

One of the most important distinctions can be made in taking a good history: In PSGN, glomerulonephritis typically does not set in until several weeks after the initial infection. In contrast, IgA Nephropathy may present with so-called “synpharyngitic glomerulonephritis”–pharyngitis and glomerulonephritis at the same time.

23
Q

AKI Hallmarks & Approach

A

hallmarks:
Anuria/oliguria (<0.5ml/kg/hr) - havent pissed for more than 8hrs

Hypertension with fluid overload

Rapid rise in plasma creatinine - 1.5x+ rise

injury resulting in retention and failure to filter

> MONITOR: BP, urine, wt
MAINTAIN: hydration, electrolytes, balance
MINIMISE: drugs

24
Q

Pre-Renal AKI Causes

A

Perfusion

25
Q

Intrinsic renal causes AKI

A

Glomerular disease
- haemolytic
- glomerulonephritis

Tubular injury
- necrosis dt hypoperfusion
- drugs

IInterstitial nephritis
- NSAID, AuImm

26
Q

Post-Renal causes AKI

A

obstructive

27
Q

HUS

A

1) haemolysis
- packed cell volume less than 30%

2) thrombocytopenia
* typically post-diarrhoea dt e coli toxin or shiga toxin = vascular dmg = pro-thrombotic state
bloody diarrhoea emergency in children

3) AKI
-serum creatinine raised

> early volume expansion

28
Q

CKD in paeds

A

55% dt congenital anomalies of the kidneys and urinary tract =
- reflux nephropathy
- dysplasia
- obstructive

17% genetic, can be confounding to congenital abn
+ turner
+ trisomy21
+ prune belly syndrome
+ branchio-oto renal

29
Q

CKD Stages

A

CKD 2 - 60-89

CKD3a - 45 - 59
CKD3b - 30 - 44

CKD 4 - 15 - 29

CKD 5 / ESRD - 0 - 15

30
Q

UTI in paeds

A

neonates
- fever, vom, lethargy, irritability
- poor feeding

child
+abdo pain / loin pain / tenderness

+ malaise

*fever = pyelonephritis

  • urine specimen
  • dipstix unreliable <2yo
  • microscopy = pyuria, bacturia
  • culture

!risk of vescico-ureteric reflux
! in combination = risk of scarring

31
Q

Stages of vescico-ureteric reflux

A

1-ureter only
2-ureter, pelvis, calyces
3-dilatation ureter
4-Moderate dilatation of ureter
± pelvis ±tortuous ureter, obliteration of fornices
5-gross dilatation/tortuosity,
no papillary impression in calyces

32
Q

Investigating urinary scarring for paeds

A

USS

DMSA - isotope: scarring/function

MAG3 scan: dynamic

33
Q

Mgmt of urinary tract infections in paeds

A

lower tract
> 3d oral abx

upper tract / pyelonephritis
> 7-10d abx

  • fluids, hygiene, constipation
  • manage voiding issues
34
Q

CKD assessment & considerations

A

BP
- doppler goldtandard under 5yo
* ramipril common for CKD4 for 3-18yo

Bladder size

Metabolic Bone Disease
low activation of D3
> phosphate binders
> vitamin d suppl.
> growth hormone

Atherosclerosis RF

Anemia

35
Q

WHO Pain Ladder

A

paracetamol

ibuprofen

weak opiod

strong opiod

36
Q

mesenteric lymphadenitis

A

viral intestinal infection is the usual cause of mesenteric lymphadenitis, also known as mesenteric adenitis. It mainly affects children and teens

high temperature
URTI often
not “unwell”

37
Q

Malrotation

A

Malrotation is an abnormality of the bowel, which happens while the baby is developing in the womb. Volvulus is a complication of malrotation and occurs when the bowel twists so the blood supply to that part of the bowel is cut off. This can be a life threatening problem.

*fairy liquid green vomit

> sx emergency

38
Q

Intrussuscepton

A

the inversion of one portion of the intestine within another.
“intussusception is the most common cause of bowel obstruction in those 3 months to 6 years of age”

*bilious vomiting
bloody mucous PR, red currant jelly stool
*colic and dying spells, 4s caap refill

*USS target sign

> pneumostatic reduction
laparatomy

39
Q

Umbillical hernia

A
  • umbillical swelling
  • worse w/ crying
  • easily reducible

*spont. closure by 4yrs

repair w/ compl.

40
Q

Abdo Wall Defects

A

GASTROSCHISIS
* expsure of gut, assoc. w/ atresia
> delayed closure
> total parenteral nutrition

EXOMPHALOS
umbilical defect w/ covered viscera
associated anomalies
> 1º / delayed closure

41
Q

Hernias in Paeds

A

inguinal = lump/groin swelling that goes away, overall happy child and feeding
m>f, common in prems.

*incarcerated = bulge remains w/ relaxation: organs

<1yr = urgent, repair
1yr+ = elective repair

42
Q

Hydrocele in Paeds

A

scrotal swelling, bluish colour, painless
*common in newborns, strain/crying/evening

> conservative until 5yrs

43
Q

Cryptorchidism

A

testis cannot be manipulated into the bottom half of the scrotum
* true undescended
* retractile testis / ascending

> orchidopexy

44
Q

Non-rectractile foreskin

A

reucrrent balanitis, pinhole meatus
* struggling to pass urine
* lichen sclerosus

> circumcision

45
Q

Testicular Torsion

A

testicular pain, red scrotum,asymmetry, acute

> surgical correction
(6-8 hr to recover scrotum)

Vs
TORSION APPENDIX TESTIS: scrotum red, NO ASYMMETRY, blue spot seen, tender

> pain mgmt

46
Q

UTI

A

must prevent renal scarring => HT = tx!
*screen all <6mos, atypical, recurrent
pyuria, systemic upset

USS, renography: MAG3 (drainage, function), DMSA (scarring), micturating cystourethrogram (MCUG)

47
Q

What grade of VUR is the following on scan and what is the mgmt of VUR:
tortuous ureter with moderate dilatation
blunting of fornices but preserved papillary impressions

A

Grade 4 out of 5

grade 1: reflux limited to the ureter
grade 2: reflux up to the renal pelvis
grade 3: mild dilatation of ureter and pelvicalyceal system
5 = severe dilation, loss of fornices and papillary impressions

> conservative
abx prophylaxis until toilet trained
- TRIMETHOPRIM
STING: injection = reduction of ureteric orifice size
ureteric reimplantation

48
Q

Hypospadias

A

MEatus on the ventral aspect of the penis
- anterior
- middle
-posterior

  • US, karyotype

> surgical repositioning

A3 ME3034 SPECIALTIES (27 decks)

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