Medicine Phase 3a > PAEDIATRICS - 5 > Flashcards

PAEDIATRICS - 5 Flashcards

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1
Q

Advantages of breastfeeding for infant

A 
Provides ideal nutrition
Reduces risk of:
- GI infection
- Resp infection
- Otitis media
- Necrotizing enterocolitis
Enhances mother-child relationship
Reduces risk of insulin-dependent diabetes, HTN and obesity
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2
Q

Advantages of breastfeeding for mother

A

Promotes close attachment between mother and baby
Reduces risk of breast and ovarian cancer
Reduces risk of DMT2

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3
Q

Most abundant Ig in breast milk

A

IgA

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4
Q

Physiology of breast feeding

A

Baby used rooting, sucking and swallowing reflexes

Tactile receptors in nipple activated

Hypothalamus –> anterior (prolactin) and posterior (oxytocin) pituitary

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5
Q

Function of prolactin in breast feeding

A

AP –> prolactin –> milk secretion by cuboidal cells

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6
Q

Function of oxytocin in breast feeding

A

PP –> oxytocin secretion –> contraction of myoepithelial cells in alveoli –> forces milk into larger ducts (let-down reflex)

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7
Q

Define weight faltering

A

Sustained drop down by 2 gentile spaces

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8
Q

Aetiology of weight faltering

A 
Inadequate availability of food
Psychosocial deprivation
Neglect
Impaired suck/swallow
Chronic illness

Inadequate retention

Malabsorption

Failure to utilise nutrients

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9
Q

Causes pf impaired suck/ swallow

A 
Oro-motor dysfunction
Neurological disorder (cerebral palsy)
Cleft palate
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10
Q

Causes of malabsorption

A

Coeliac disease
CF
Cow’s milk protein allergy
Short gut syndrome

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11
Q

Causes of inadequate retention

A

Vomiting

Severe GORD

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12
Q

Causes of failure to utilise nutrients

A

Syndromes

Chromosomal disorders

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13
Q

Causes of increased requirements

A

Thyrotoxicosis
CF
Malignancy

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14
Q

Most common cause of faltering growth

A

Inadequate food intake

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15
Q

Define posseting

A

Small amounts of milk that accompany the return of swallowed air

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16
Q

Define regurgitation

A

Large amounts of milk that accompany the return of swallows air

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17
Q

Define vomiting

A

Forceful ejection of gastric contents

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18
Q

Red flag in a vomiting child condition: bile-stained vomit

A

Intestinal obstruction

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19
Q

Red flag in a vomiting child condition: haematemesis

A

Oesophagitis
Peptic ulcer
Oral/ nasal bleeding
Varices

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20
Q

Red flag condition in a vomiting child: projectile vomiting in first few weeks of life

A

Pyloric stenosis

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21
Q

Red flag condition in a vomiting child: vomiting at end of paroxysmal coughing

A

Whooping cough

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22
Q

Red flag condition in a vomiting child: abdominal distension

A

Intesintal obstruction e.g. strangulated inguinal hernia

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23
Q

Red flag condition in a vomiting child: hepatosplenomegaly

A

Chronic liver disease

Inborn error of metabolism

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24
Q

Red flag condition in a vomiting child: blood in stool

A

Intussusception

Bacterial gastroenteritis

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25
Red flag condition in a vomiting child: severe dehydration/ shock
Severe gastroenteritis Systemic infection (UTI, meningitis) DKA
26
Red flag condition in a vomiting child: bulging fontanelle or seizures
Raised ICP
27
Red flag condition in a vomiting child: faltering growth
GORD | Coeliac disease
28
Pathology of GORin infancy
Inappropriate relaxation of lower oesophageal sphincter due to functional immaturity
29
Complications of GOR
GORD Oesophagitis Recurrent pulmonary aspiration Dystonic neck posturing (Sandifer syndrome)
30
GOR investigations
- Usually a clinical diagnosis | - 24 hour oesophageal pH monitoring
31
GOR management
1. ) Reassurance 2. ) Adding inert thickening agents to feeds (Carobel) 3. ) Smaller, more frequent feeds 4. ) H2 receptor antagonists or PPI
32
Define pyloric stenosis
Hypertrophy of pyloric muscle --> gastric outlet obstruction
33
Pyloric stenosis clinical features
Vomiting Hunger after vomiting Weight loss Hypochloraemic metabolic alkalosis
34
Pyloric stenosis diagnosis
Test feed - observe for gastric peristalsis Olive mass palpable in RUQ US abdomen
35
Pyloric stenosis management
1. ) Fluid + electrolyte replacement 2. ) Pyloromyotomy 3. ) Child can be fed within 6 hours post surgery and discharged within 2 days
36
Pyloric stenosis epidemiology
More common in boys (4:1) More common if FH More common with first born child
37
Pyloric stenosis biochemical results
Hyponatraemia Hypokalaemia Hypochloraemic alkalosis
38
Define intussusception
Invagination of proximal bowel into a distal segment
39
Intussusception most common location
Ileum --> caecum through ileocaecal valve
40
Intussusception peak presentation
3 months - 2 years
41
Intussusception potential complications
Stretching and constricting mesentery --> venous obstruction --> engorgement and bleeding --> bowel perforation --> peritonitis
42
Intussusception clinical presentation
``` Paroxysmal severe colicky pain Pallor Refusal of feeds/ vomiting Sausage-shaped mass Redcurrant jelly stool (blood stained mucous) Abdominal distention + shock ```
43
Intussusception predisposing factors
Viral infection --> enlargement o Peyer's patches --> may form point of intussusception
44
Intussusception investigations
X-ray abdomen - distended bowel - absence of gas US abdomen - target/ donut sign
45
Intussusception treatment
1. ) Rectal air insufflation (by radiologist) | 2. ) If fails, operative reduction
46
Define Meckel diverticulum
Ileal remnant of Vitelli-intestinal duct
47
Meckel diverticulum clinical features
Severe rectal bleeding
48
Meckel diverticulum investigation
``` Technetium scan (Tc-99m) - increased uptake of ectopic gastric mucosa ```
49
Meckel diverticulum treatment
Surgical resection
50
Investigation for child with dark green vomiting
Urgent upper GI contrast study | - to assess intestinal rotation
51
Malrotation clinical presentation
Obstruction with bilious vomiting in the first few days of life Abdominal pain
52
Malrotation treatment
1.) Surgical correction/ untwisting of volvulus
53
Define recurrent abdominal pain
Pain sufficient to interrupt normal activities, lasting for at least 3 months
54
Recurrent abdominal pain - GI causes
IBS Constipation Abdominal migraine IBD
55
Recurrent abdominal pain - GU causes
``` Dysmenorrhoea Ovarian cysts PID UTI PUJ obstruction (pelvic-ureteric junction) ```
56
Recurrent abdominal pain - psychosocial
Bullying Abuse Stress
57
Recurrent abdominal pain - liver + friends
Hepatitis Gall stones Pancreatitis
58
Recurrent abdominal pain investigations
1. ) Full examination 2. ) Urine microscopy and culture 3. ) Abdo US
59
Define abdominal migraine
Abdominal pain and headaches occurring simultaneously
60
Abdominal migraine clinical features
Midline abdo pain Vomiting Facial pallor Migraine history
61
Abdominal migraine
Treat migraines
62
IBS clinical features
``` Non-specific abdominal pain Relieved by defection Explosive, loose or mucousy stools Bloating Constipation ```
63
H.pyloric eradication therapy
PPI + amoxicillin + metronidazole (or clarithromycin)
64
Most common cause of gastroenteritis in children
Adenoviruses | Campylobacter jejuni
65
Gastroenteritis: campylobacter jejuni - clinical presentation
Severe abdominal pain
66
Gastroenteritis: shigella/ salmonella - clinical presentation
Blood and pus in stool Pain Tenesmus (cramp)
67
Gastroenteritis: cholera and E coli - clinical presentation
Rapidly dehydrating diarrhoea
68
Potential complication of gastroenteritis
Dehydration leading to shock
69
General clinical features of gastroenteritis
Sudden change to loose or watery stools | Vomiting
70
Red flags in a dehydrated child
``` Deteriorating Altered consciousness Sunken eyes Tachycardia Tachypnoea Reduced skin turgor ```
71
Red flag condition in child with constipation - failure to pass meconium within 24 hours of life
Hirschsprung disease
72
Red flag condition in child with constipation - gross abdominal distension
Hirschsprung disease
73
Red flag condition in child with constipation - abnormal neurological findings
Lumbosacral pathology
74
Red flag condition in child with constipation - sacral dimple above natal cleft
Spina bifida occulta
75
Spina bifida occulta clinical features
``` Sacral dimple above natal cleft Over spine: - Naevus - Hairy patch - Central pit - Discoloured skin ```
76
Red flag condition in child with constipation - perianal bruising or multiple fissures
Sexual abuse
77
Red flag condition in child with constipation - perianal fistulae abscesses or fissures
Perianal crohn's disease
78
Constipation - treatment
Disimpaction regime - Stool softener (macrogol laxative) - Electrolytes (movicol paediatric plain) - -> given for 1-2 weeks If unsuccessful: - Stimulant laxative (senna) Maintenance treatment: - Polyethylene glycol
79
Define Hirschsprung disease
Absence of ganglion cells from myenteric and submucosal plexuses of large bowel
80
Hirschsprung disease clinical presentation
First 24 hours of life: - Intestinal obstructio - Abdominal distension - Bile-stained vomiting Later life: - Chronic constipation - Abdominal distension
81
Hirschsprung disease investigations + results
Suction rectal biopsy - Absence of ganglion cells - Large ACh-positive nerve trunks on a
82
Hirschsprung disease management
Surgery - initial colostomy - anatomising normally innervated bowel --> anus
83
Toddler's diarrhoea clinical features
Varying consistency of stools | Undigested vegetables in stools
84
UTI clinical presentation - infants
``` Fever Vomiting Lethargy/ irritability Poor feeding Faltering growth Jaundice Septicaemia Offensive urine Febrile seizure (>6 months) ```
85
UTI clinical presentation - children
``` Dysuria, frequency and urgency Abdo pain Fever + rigors Lethargy Vomiting Offensive/ cloudy urine ```
86
Most common causative organisms of UTI
``` E coli Klebsiella Proteus Pseudomonas Strep faecalis ```
87
Features of an atypical UTI
``` Seriously ill/ sepsis Poor urine flow Abdominal or bladder mass Raised CK Failure to respond to Abx within 48 hours ```
88
UTI investigations
1.) Urine dipstick 2.) US kidneys and urinary tract 3.) <1 year = MCUG and DMSA 1-3 years = DMSA >3 years = no further investigations
89
UTI treatment - <3 months
1. ) Refer immediately to hospital 2. ) IV co-amoxiclav for 5-7 days 3. ) Oral prophylactic Abx
90
UTI treatment - >3 months
Oral trimethoprim 7 days for upper UTI (pyelonephritis) 3 days for lower UTI (cystitis)
91
Causes of proteinuria
``` Orthostatic proteinuria Glomerular abnormalities: - minimal change disease - glomerulonephritis - abnormal glomerular basement membrane Increased glomerular filtration pressure Reduced renal mass in CKD Hypertension Tubular proteinuria Nephrotic syndrome ```
92
Nephrotic syndrome - predisposing conditions
Henoch-Schonlein purpura | SLE
93
Define nephrotic syndrome
Heavy proteinuria, resulting in low plasma albumin and oedema
94
Nephrotic syndrome - clinical features
``` Periorbital oedema Scrotal/ vulval, leg and ankle oedema Ascites Breathlessness (pleural effusions) Infection (loss of Ig in urine) ```
95
Nephrotic syndrome - treatment
``` Oral corticosteroids (prednisolone) for 4 weeks After this, tapered down ```
96
Nephrotic syndrome - investigation if unresponsive to treatment
Renal biopsy
97
Potential complications of nephrotic syndrome
Hypovolaemia Thrombosis (hypercoagulable state) Infection Hypercholesterolaemia
98
Prognosis of steroid-sensitive nephrotic syndrome
``` 1/3 = resolves 1/3 = infrequent relapses 1/3 = frequent relapses --> steroid dependent ```
99
Glomerular haematuria biochemical results
Brown urine Deformed red cells Casts
100
Causes of haematuria - nonglomerular
``` Infection Trauma to genitalia Stones Tumours Sickle cell disease ```
101
Causes of haematuria - glomerular
Acute glomerulonephritis | IgA nephropathy
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Investigation for haematuria
``` Urine microscopy Protein and calcium excretion Kidney and urinary tract US U&E's FBC Coagulation screen ```
103
Renal biopsy indications
Significant persistent proteinuria Recurrent macroscopic haematuria Abnormal renal function Abnormal complement levels
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