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35 Cards in this Set
- Front
- Back
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What diagnosis should be completed with a vomiting child
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CBC with diff
Electrolytes CRP and ESR Possible Blood and urine stool for culture |
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What DDx would be rule out in a vomiting newborn?
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Newborn-congenital obstructive malformation such as atresia or web, meconium ileus, or Hirschsprung disease
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What DDx would we rule out in a infant that is vomiting
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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.
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what is the basic management of vomiting?
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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 |
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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 |
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Diagnostic studies with gerd
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Esophageal PH
Upper GI Intraluminal esophageal impedance Radionucleotide Abdominal US CBC with diff UA and urine culture H-pylori |
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Management in GERD
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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 |
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What is the classification for constipation
Dx Management: |
less than 3 BM a week
DX: XRay mangement: multidisiplinary education |
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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% |
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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 |
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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 |
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PUD management? Complications?
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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 |
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H.pylori treatment
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Amoxicillin plus Clarithromycin and omeprazole
or Clarithromycin, metronidzole and omeprazole |
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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) |
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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 |
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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) |
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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 |
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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
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Management for acute abd pain
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Management
Consultation & refer No sedatives IV for hydration Treat the cause |
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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. |
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Clinical Findings for IBS
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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 |
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Management of IBS
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Management
Confirm and explain diagnosis Goal is to modify severity Antidepressants serotoninergic agents have not been use in children Treatment: antispasmodics Dietary |
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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 |
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Clinical findings with IBD
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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 |
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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 |
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Management IBD or Crohn Disease
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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 |
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Ulcerative colitis-
Description. cause? expression? |
Descriptive
Reoccurring bloody diarrhea Acute and chronic inflammation limited to the colon Epidemiology Unknown Probably genetic |
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UC Clinical Findings?
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Fever, wt loss (avg 4 kg)
Delay growth Arthritis Anorexia Diarrhea Lower abdominal cramping Oral ulcers Pain increase with stooling Skin lesions |
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UC Diagnostics?
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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 |
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UC Management?
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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 |
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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 |
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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 |
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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 |
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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 |
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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:
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Is able to communicate needs and follow directions
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