Paeds gastro Flashcards
What’s IV fluid resus in children/infants?
Bolus of 20ml kg of 0.9% NaCl over less than 10 minutes. For DKA, make this 10ml/kg to reduce risk of cerebral oedema.
Features of hyernatremic dehydration
Muscle contraction: activation of nAchR triggers influx of Na and Ca = membrane depolarisation.
So hypernatraemia causes increased tone, jittery movements and hyperreflexia. Can have seizures/coma.
How do you differentiate early (compensated) and late (decompensated) shock in children?
b.pressure: normal vs.hypotension heart rate: tachycardia vs.bradycardia respiration: tachypnoea vs.acidotic (Kussmaul) extremities: pale or mottled vs.blue urine output: reduced vs.absent
Which IBD produced perianal features? (skin tags etc)
Chron’s
Features of Hirschsprung’s disease
Delayed passage of meconium (over 48h),
abdominal distension.
Pathology: lack of ganglion cells in sigmoid colon/rectum, above dilates.
When is jaundice pathological in a new born?
First 24 hours, beyond 14 days.
Causes of jaundice in first 24 hours
Haemolytic disease (ABO or rh), hereditary spherocytosis, G6PDD inborn error of metabolism- breakdown of rbc
Cause of prolonged jaundice (occurring after common 2-14 day period)
Hypothyroid.
Infection: UTI or CMV
Biliary atresia (narrow or absent)
Components of a prolonged jaundice screen in neonates
FBC, blood film, Coombs tests for autoimmune haemolytic anaemia
Us and Es
LFTs, conjugated and unconjugated bilirubin (raised conj can = biliary atresia, requiring urgent surgery)
TFTs
Urine MCS.
Assessing faecal impaction in children
- Sx of severe constipation
- Overflow soiling
- Palpable mass
Mx of faecal impaction/severe constipation
Laxative ladder + advice on diet/fluids
1) Macrogols (movicol), osmotic agents that draw water into lumen of bowel
2) Stimulants like Senna, activate myenteric plexus
Inform that disimpaction therapy can initially worsen pain/soiling.
Maintenance therapy is similar, once several weeks of bowel habits have been established, slowly wean down.
