Pediatric Medical Disorders Flashcards
(36 cards)
infants double their birth weight in how many months? triple?
how much weight do children gain between 2 years and puberty?
infants double their birth weight by 4mo and triple their birth weight in one year.
children gain 2kg/years between 2 years and puberty.
Pyloric Stenosis
- occurs at what age?
- clinical presentation
- PE
- labs/evaluation
- Tx
Occurs at 3-5weeks
Clinical Presentation:
- projectile nonbilious vomitting*
- infant immediately hungry (Hungry vomitter)*
- dehydrated
- jaundice
PE:
- check hydration status
- check for jaundice
- palpate abdomen for “olive”* (50-90%)
Labs: CMP, Bilirubin
Eval: US
Tx: Pyloramyotamy (insicion and cut pylorus)
differential diagnosis of a newborn infant with vomiting can be divided into what two categories? WHat are the etiologies of these?
Bilious:
- partial or complete bowel obstruction
- malrotation, volvulus, Hirschsprung dz, incarcerated hernia, intussusception, intestinal atresia
Nonbilious:
- GERD
- cow or soy milk protein intolerance
- pyloric stenosis
- gastritis
WHat is the MC etiology behind persistent emesis in newborns?
Which age group MC presents with intussusception?
What age range does pyloric stenosis often present?
Newborns with persistent emesis often have intestinal atresia
Toddlers comprise the age group that most commonly presents with intussusception
Pyloric stenosis often presents around 3-6weeks of age.
MC etiology behind abdominal pain in:
- newborn
- infancy to 2yrs
Newborn:
- GERD
- Necrotizing colitis
- vovulus
Infancy to 2 years;
- intussusception
- Meckels diverticulum
- bacterial enteritis
Necrotizing enterocolitis:
- what is this?
- who gets this?
What: inflamed & infected bowel d/t poor immune system of baby.
Pneumatosis intestinalis is pathopneumonic for this dz. (gas cysts in bowel wall from bacteria)
Who: complication after premature birth.
What is vovulus? seen up to what age? sx? Tx?
twisting of the gut, presents with bloody stools, bile, vomiting. Seen up to 1 year of age.
Tx: surgery to untwist the bowel
What is meckels diverticulum? Sx? Tx?
slight bulge in the small intestine present at birth.
Sx: painless rectal bleeding
Tx: surgical removal.
What is Hirschsprungs dz?
- aka
- Tx
what: occurs when part or all of the large intestine has no ganglion cells and therefore cannot function. The affected segment cannot contract or relax to pass stool through the colon leading to an obstruction
aka: congenital megacolon
Tx: if just one segment they can sometimes remove it, possible colostomy.
GERD:
- infants aka
- warning signs of underlying pathology
happy spitters
Warning signs:
- GI: bilious vomiting, GI bleeding, forceful vomiting, prolong consstipation, diarrhea, or abd distention
- Neurologic: bulging fontanelle, seizures, micro/macrocephaly, hyper/hypotonia,
- nonspecific: fever, pneumonia, lethargy, failure to thrive.
GERD:
- if warning signs are absent and the infant has any of the following sx then you consider GI specialist to do work up, what are theses sx?
- work up
- tx
- indications for pharmocotherapy
poor weight gain, irritability, feeding refusal, gross blood in stool
Work up:
- esophageal pH monitoring
- endoscopy
Tx:
- lifestyle changes; avoid ALL exposure to tobacco smoke, smaller feedings, trial of a diet where ALL cows milk is removed**
- positioning therapy: keep infant upright for 10-20mins after feed
- PPI
Indications for pharm:
- infant with mild esophagitis on endoscopic bx
- infant w/ significant sx AND whom conservative measures have failed then do 3-6mo of therapy w/ repeat endoscopy
- PPI
Colic:
- what are important questions to ask?
- what is the rule of threes?
- what age does this usually occur? stop?
Questions:
-feeding habits, when do they cry, how long do they cry, how long do they sleep?
Rule of threes:
- greater than/= 3 hrs of day crying
- greater than/= 3days a week
- lasts at least 3 weeks
- infant less than 3mo old
Ususally starts 3-6weeks and ends at 3-4 mo.
Colic:
- associated characteristics
- soothing maneuvers
Characteristics:
- paroxysmal
- occurs more in evening
- qualitatively different from normal crying
- associated w/ hypertonia*
- inconsolability
- infant is normal when not colicky
- first few weeks of life are unremarkable.
Soothing maneuvers:
- pacifier
- car or stroller ride
- hold/rock infant
- change scenery/minimize visual stimuli
- place child in infant swing
- rub infant abd
- provide white noise or play CD of heartbeats
- sing to infant
- give baby quite time in crib for 5-10 minutes
Colic Tx
- trial of elemental formula for 1 week (predigested so they are easy to eat)
- if breast feeding try hypoallergenic diet
- trial of probiotic – Lactobacillus reuteri
NOT a trial of soy milk, simethacone, infant massage, homeopathic remedies
***most important to provide parenteral support
- never shake the baby
- ok to take break and let someone else take care of the baby**
- stay positive, dont feel guilty, colic is not a sign of bad parenting
Oral Rehydration Therapy
- what is this?
- first choice fluid?
- technique?
What: small amounts of liquid taken orally to replace fluids and electrolytes
-Pedialyte is first choice fluid
Technique: 5ml every 2-3 minutes, just enough to coat the esophagus WITHOUT causing a large enough bolus in the stomach to induce emesis.
WHat are the antiemetics approved in the pediatric patient?
Odansetrom (Zofran)
-available in oral dissolving tablets and IV
Physical findings of volume depletion in infants and children:
- mild
- moderate
- severe
- Pulse:
- SBP:
- Resp:
- Buccal mucosa:
- Anterior fontenelle:
- Eyes:
- skin turgor:
- skin:
- urine output:
- systemic sings:
Mild:
- Pulse: normal
- SBP: normal
- Resp: normal
- Buccal mucosa: tacky/slight dry
- Anterior fontenelle: normal
- Eyes: normal
- skin turgor: normal
- skin: normal
- urine output: normal/mild reduced
- systemic sings: increased thirst.
Moderate;
- Pulse: rapid
- SBP: normal to low
- Resp: deep, may be increased
- Buccal mucosa: dry
- Anterior fontenelle: sunken
- Eyes: sunken
- skin turgor: reduced
- skin: cool
- urine output: markedly reduced
- systemic signs: listlessness, irritability
Severe:
- Pulse: rapid & weak
- SBP: low
- Resp: deep, tachypnea
- Buccal mucosa: parched
- Anterior fontenelle: markedly sunken
- Eyes: markedly sunken
- skin turgor: tenting
- skin: cool, mottled, acrocyanosis
- urine output: anuria
- systemic sings: grunting, lethargy, coma
What is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration?
Tx of severe hypovolemia
Oral rehdyration therapy!!!
Severe:
-rapid infusion of isotonic saline & then oral rehydration therapy.
Constipation
- definition
- 3 main causes
def: a decrease in a persons normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard dry stool.
causes:
- lack of fiber
- inadequate consumption of fluids
- sedentary lifestyle
What is gastrocolic reflux?
peristalsis occurring 5-15mins after eating meal that stimulates you to have a BM.
What is encopresis?
paradoxical diarrhea…aka fecal leakage. :)
*this is basically diarrhea in the presence of constipation.
What are some causes of functional retention leading to constipation?
- traumatic events:
- -painful passage of hard stools
- -painful diarrhea
- physical or sexual abuse
- Psychosocial situations/environmental changes:
- difficulty with potty training
- -divorce.
Encopresis:
-often results from what?
often the result of functional retention causing stretching of rectum and decreased sensation to empty bowel. liquid stool leaks around a retained stool mass and is involuntarily passed.
Organic causes of constipation?
- hirschsprungs dz (aganglionic colon)
- anatomic abnormalities of anus or colon
- meds: antacids, opiates, phenobarbitol
- spinal cord abnormalties
- infant botulism
- hypothyroidism
- celiac dz
- DM
- CF
- cows milk intolerance
