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Flashcards in CYSTIC FIBROSIS Deck (16):
1

What is the carrier rate of cystic fibrosis?

1 in 25

2

What is the incidence of live births with cystic fibrosis?

1 in 2500

3

On what chromosome is the affected cystic fibrosis gene found?

Chromosome 7

4

What is the name of the protein that is affected in cystic fibrosis?

Cystic fibrosis transmembrane regulator (CFTR)

5

What is the result of the mutation of the gene encoding the CFTR protein in cystic fibrosis?

Defective c-AMP dependent chloride channel across epithelial cells. This leads to increased viscosity of secretions

6

Which organs are most affected by cystic fibrosis?

Respiratory system - recurrent chest infections

Exocrine pancreas - insufficiency

7

What is the most useful test for diagnosing cystic fibrosis?

Sweat test using pilocarpine iontophoresis to induce sweating and then show abnormal quantities of chloride ions in the sweat.

8

Infection by which organisms does cystic fibrosis predispose the patient to?

S. aureus

H. influenzae

Pseudomonas

9

What are the long term complications of repeated infections in a cystic fibrosis patient?

Bronchiectasis

Abscess formation

10

What are the features of cystic fibrosis?

Chest hyperinflation

Crackles

Wheeze

Finger clubbing

Malabsorption and failure to thrive

Steatorrhea

10-20% present in neonatal period with meconium ileus.

11

What are the features of meconium ileus?

Failure to pass meconium

Bilious vomiting

Distension of the abdomen


Caused by thickened meconium which is secondary to cystic fibrosis

12

How is cystic fibrosis usually diagnosed?

Screening is part of newborn blood spot using immunoreactive trypsinogen (Guthrie test).

Gold standard diagnostic test is the sweat test - failure of the normal reabsorption of sodium and chloride leads to abnormally salty sweat. Two sweat tests showing a chloride of >60 mmol/L confirms CF.

Genetic testing of most common mutations will also help diagnosis.

13

What are the non-pulmonary aspects of cystic fibrosis?

Airway - nasal polyps

GI - Distal ileal obstruction syndrome

Pancreas/endocrine - Diabetes, poor growth, osteoporosis

Reproductive - infertility in males due to absent vas deferens

Joints - arthropathy

Vascular - vasculitis

Hepatic - portal hypertension

14

How are patients with cystic fibrosis managed with regard to the respiratory system?

MDT

Physiotherapy - chest percussion with postural drainage, breathing exercises, positive expiratory pressure masks.

Many centres recommend continuous flucloxacillin therapy in first 2 years of life.

Use of in-dwelling vascular devices (Port-A-Cath) aid regular intravenous antibiotic courses.

Mucolytics such as nebulised hypotonic saline can help mucous clearance

15

How are patients with cystic fibrosis managed with regard to nutrition?

MDT

High calorie diet

Vitamin supplements (especially fat soluble vitamins)

Pancreatic enzyme supplementation using enteric-coated microspheres which contain amylase, lipase and protease.

16

What is the prognosis of someone diagnosed with cystic fibrosis?

50% live beyond 40 but life expectancy remains in the 40s

Lung transplantation can help increase life expectancy