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35 Cards in this Set

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What diagnosis should be completed with a vomiting child
CBC with diff
Electrolytes
CRP and ESR
Possible Blood and urine
stool for culture
What DDx would be rule out in a vomiting newborn?
Newborn-congenital obstructive malformation such as atresia or web, meconium ileus, or Hirschsprung disease
What DDx would we rule out in a infant that is vomiting
Infant-overfed, gastroenteritis, UTI, a mild obstructive lesion, pyloric stenosis, malrotation, or volvulus, intussusception, a metabolic disorder, or an inborn error of metabolism, nutrient imbalance, GER or psychosocial disorder.
what is the basic management of vomiting?
Antiemetics-ondansetron (2 mg for children 8 to 15 kg, 4mg for children 15 to 30 kg and 8mg for greater than 30 kg) reduces the vomiting
Rehydrate
Resume maintenance fluid level
Refeeding infants should continue breast
GERD
discription
and the clinical findings
hx
and the PE
This can be shown in infants as infrequent vomiting.

History-birth, medical, and social Hx
Feeding difficulties, Failure to thrive (FTT), Acute life threating events
Sandifer syndrome, Heartburn, 24-hr diet recall

PE-Signs of FTT
Torticollis, Hoarseness, Anemia
Tooth erosion
Rash
Diagnostic studies with gerd
Esophageal PH
Upper GI
Intraluminal esophageal impedance
Radionucleotide
Abdominal US
CBC with diff
UA and urine culture
H-pylori
Management in GERD
Breastfeeding should be continued
If the baby is formula feed then the formula should be switched to a hypoallergic trail for a 1-2 week period.
-smaller more frequent meals
prone position is most beneficial
What is the classification for constipation
Dx
Management:
less than 3 BM a week
DX: XRay
mangement: multidisiplinary
education
Peptic ulcer disease:
Description
sex?
fx?
Functional s/t?
bug?
Description
Duodenal-duodenal mucosa and submucosa
Gastric-mucosal defects
Epidemiology
PUD rate in children under 10 years; common between 12 and 18 years
Male to female ration -2:1 to 3:1
Common in low socioeconomic status; AA & Hispanic
Primary-no underlying cause
Secondary-ulcerogenic events
Stress-related, medication, and critical illness in children
Chronic related to NSAIDS
Cytomegalovirus & H-pylori (10%) in children; colonization suggest 8 to 63%
PUD findings
HX
Asymptomatic or symptoms wax and wane
Pain (onset, duration, severity)
Infants-poor feedings, vomiting
Toddler & preschoolers-poorly localize abdominal pain
School-age children & adolescents-poorly localized epigastric or right lower quadrant pain; may related to food, milk, antacids
Predisposing factors-alcohol, smoking, aspirin, NASIDS, or corticosteroids
PUD
PE and Diagnostics
PE
Ht, wt, HC, BMI, & percentile
Funduscopic
Careful mouth exam
Lungs for wheezing
Rectal exam

Diagnostic Studies
CBC
Endoscopy
H-pylori
PUD management? Complications?
Management
2 to 4 wks trail-Antacids (liquid) 0.5mg/kg given between 1 and 3 hrs after eating and before bed
H2 antagonist (pp.808)
Referral to gastroenterologist
Eradication therapy for H pylori per guidelines
Complication
Hemorrhage, perforation, gastric obstruction
H.pylori treatment
Amoxicillin plus Clarithromycin and omeprazole
or
Clarithromycin, metronidzole and omeprazole
Colic definition?
Cause
Diet cause may be?
Persistent infant crying younger 3 months (avg infant cry 2 to 3 hrs)
Epidemiology
No specific cause
Both physical and psychosocial factors
Organic < 5% in infants
Physical factors such as diet (e.g. cow milk)
Clinical findings for colic?
Hx:
What are the red flags?
PE?
HX: demands frequent feedings/fussy with feedings; excessive gas; inconsolable; tense and tight; RED FLAGS-Apneic, cyanosis, struggle to breath; excessive spitting or vomiting
PE: Body temperature; growth parameters; full body exam; abdominal exam for masses, tenderness and bowel sounds; stool for blood and mucus
Colic
Diagnostics?
DDx?
Management?
Diagnostic studies
If child gain weight and examination is normal, no laboratory test
Differential Diagnosis
Abdominal (all causes)
UTI and other infections
Management
Explore the diet e.g. milk, peanuts etc.
Alternate the infant diet
Burn’s suggestive other alternate strategies (pp. 809)
Acute abs pain
Epi
Primary with ?
Withought GI cause?
Refer with
Location
Characteristic
Visceral pain –dull & diffuse
Epidemiology
Primary with GI causes-appendicitis; viral and bacterial enteritis; inflammatory bowel disease; PUD; intussusception; pancreatitis
Without GI causes-ovarian cyst; salpingitis; sexually transmitted diseases; OM; pneumonia; pharyngitis; UTI and others
Refer with pain in the shoulder
Pain that includes referred pain to the shoulder is significant for?
To the back is significant for?
Pain that includes the shoulder may be pneumonia, pleurisy; pancreatitis and the spleen, gallbladder, and liver. Testicular pain occurs with kidney disease and appenditis. Back pain can also accompany retroperitoneal hematoma
Management for acute abd pain
Management
Consultation & refer
No sedatives
IV for hydration
Treat the cause
IBS what is the criteria?
mean age?
Criteria must include:
Abdominal discomfort
Improved with defecation
Onset associated with change in frequency of stool
Change in appearance
mean age of diagnosis in primary care is 52 months.
Clinical Findings for IBS
Clinical findings
HX: Rome criteria; abnormal stool frequency; abnormal stool passage; passage of mucus; bloating or feeling of abdominal distention; psychosocial
PE: Normal PE; normal growth curve and BMI; absence of alarm signals
Diagnostic studies
No lab test
Management of IBS
Management
Confirm and explain diagnosis
Goal is to modify severity
Antidepressants serotoninergic agents have not been use in children
Treatment: antispasmodics
Dietary
Crohn Disease: What is it
sex?
race?
fx?
Crohn disease-inflammatory disease with exacerbations and remissions
Epidemiology
Unknown
Affect 400 of every 100,000 individuals
Males and females equally
More common in white
25% to 40% of cases diagnosis in childhood and adolescence
Siblings are more likely to get Crohn
Clinical findings with IBD
Clinical findings
Low grade fever unknown etiology
Wt loss
Delay growth
Arthralgias and/or arthritis
Obstructive symptoms associate with meals
Pain in the umbilical region and RLQ
Malabsorption
Diarrhea
Jaundice
Mouth sores
Positive family history
Crohn Disease
PE & Diagnostics
PE:CPE; growth parameter; ht and wt with BMI; abdominal exam; perianal tags; clubbing; erythema nodosum
Diagnostic studies
ESR
CRP
Albumin, total protein, folate, vitamin B12
Zinc
Other blood test such as CBC with diff & liver functioning test
Stool test
X-rays; upper GI
Management IBD or Crohn Disease
Refer for endoscopy, definitive diagnosis, consultation, and follow-up care
Medication; antibiotics; adjunctive therapy; with severe disease-hospitalization
Monitor growth
Refer for nutrition therapy
Refer for psychotherapy
Ulcerative colitis-
Description.
cause?
expression?
Descriptive
Reoccurring bloody diarrhea
Acute and chronic inflammation limited to the colon
Epidemiology
Unknown
Probably genetic
UC Clinical Findings?
Fever, wt loss (avg 4 kg)
Delay growth
Arthritis
Anorexia
Diarrhea
Lower abdominal cramping
Oral ulcers
Pain increase with stooling
Skin lesions
UC Diagnostics?
Diagnostic studies
CBC with diff
Stool for WBC, blood, culture
ESR, CRP
Bone age
Colonscopy
Positive perinuclear neutrophil cytoplasmic antigen in 60% to 70%
High fecal calprotectin in active disease
UC Management?
Management
Refer for endoscopy
Medications
Aminosalicylates
Parenteral or oral steroids
Hydrocortisone
Antispasmodics
Iron supplement
Nutrition
Monitor growth
Refer to surgery as indicated
Refer for psychotherapy
Failure to thrive?
Organic vs nonorganic
Poor transition?
Inadequate wt gain
Organic or nonorganic
Epidemiology
Difficulties with formula or breastfeeding
Poor transition in 6 to 12 month-old
8 to 10% children in Primary care show symptoms
Clinical Findings with FTT
History and Physical Examination
HX:
three day diet history
Prenatal factors
Perinatal factors
Collection and interpretation of growth data
General parental concerns (pp.831-832)
PE: wt, ht, BMI, VSS, Skinfold measurements, CPE
FTT
Diagnostic studies and Management
Diagnostic studies
Review newborn metabolic panel
UA and culture
CBC
Serum electrolye
Lead
Differential diagnosis
Management
Nutritional support
Refer as indicated
Manage the causes
Acute diarrhea
Clinical Findings
Management?
Clinical findings
Patterns of diarrhea
Fever; signs and symptoms, number of wet diaper
Dietary recall
Diagnostic studies
Bacterial infection
Management
Restore and maintain hydration
The mother of a 2-year-old child requests information regarding toilet training readiness. The NP tells the mother that the most important factor in determining readiness to toilet train is that the child:
Is able to communicate needs and follow directions