11 Flashcards
(57 cards)
conjunctiva appears red and swollen, with some mild lid edema +/- drainage
conjunctivitis
Causes of conjunctivitis
Allergies
Chemical irritation, or
Infection
ddx for periorbital swelling, fatigue and poor appetite
hepatic failure, CHF, nephrotic syndromic, glomerular nephritis
Why abdominal distension glomerulonephritis, nephrotic syndrome, and hepatic failure?
hypoalbuminema
First sign of hypoalbuminemia in nephrotic syndrome?
periorbital edema
How is HTN defined in a child?
systolic or diastolic blood pressure at or above the 95th percentile measured on three or more occasions,
What cardiac finding supports high fluid volume?
S4 gallop, if present, would indicate an overloaded left ventricle, and would suggest congestive heart failure
A little boy comes in with periorbital edema. What all can you do to assess fluid status?
Lungs - dullness or crackles Cardiac - S4 Abdomen - fluid wave Extremities - pitting edema GU - scrotal edema
ascites, edema, hypertension and hematuria
acute glomerulonephritis
ascites, edema, tachycardia, murmur, a gallop, hepatomegaly.
CHF
ascites, edema, jaundice
hepatic failure
four criteria for nephrotic syndrome
nephrotic range proteinuria, hypoalbuminemia, edema, and hyperlipidemia.
How does edema occur in nephrotic syndrome
Decreased serum oncotic pressure from hypoalbuminemia results in interstitial fluid accumulation and resultant edema (the excess fluid is in the interstitial space, and not necessarily in the vascular space; patients may actually be hypovolemic. This is why patients with nephrotic syndrome do not necessarily become hypertensive
Why hyperlipidemia in nephrotic syndrome?
Body is attempting to increase oncotic pressure through biosynthesis
Primary cause of nephrotic syndrome?
Minimal change disease
Child comes in with gross hematuria (usually tea or cola colored), hypertension, edema. What recent history should you ask about?
Patient likely has PSGN. Recent pharyngitis or skin infection with strep pyogenes
golden honey-colored crust, under nose and around wounds/insect bites,
Impetigo - either strep pyogenes or staph
You suspect PSGN in child with swelling. What labs to check?
ASO titers (elevated)
Streptozyme test (positive)
Anti-DNAase B antibodies (elevated)
C3 (low)
What is a nephrotic range protein:creatinine?
> 2
How to treat children with nephrotic syndrome
corticosteroids, salt restriction (1500-2000mg) +/- furosemide and albumin (save for children with symptomatic fluid overload)
Why not give albumin alone to child with nephrotic syndrome?
Quick volume redistribution into vessels, which could lead to CHF and pulmonary edema
Common infectious complications of nephrotic syndrome
Spontaneous bacterial peritonitis
Pneumonia
Cellulitis
UTI
What health preventative measures should a child in nephrotic syndrome remission take?
Polyvalent pneumococcal vaccine
Two doses of varicella vaccine (if not already immunized)
An annual influenza vaccine
Name secondary lesions (occur later in the course of a lesion or rash)
Scale, crust, fissure, erosion, ulcer, excoriation
