Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
15 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What is the management of Gastro-oesphageal reflux disease (GORD)
|
General advice:
- Nurse upright wherever possible (for 20min after a feed) - Raise cot to a 30o tilt (put books under legs on one end, never under matress due to increase risk of cot death) - Encourage papoose slings - Small frequent feeds - Add gaviscon to feeds |
GORDS
G - Gaviscon (antacid) O - Omeprazole (proton pump inhibitor) R - Ranitidine (H2 blocker) D - Domperidone (increases gastric emptying) S - Surgery: fundoplication (only really in floopy children CP) |
|
|
In severe gasteroenteritis, where the child is significantly dehydrated & has not passed urine for several hours what is the most concerning complication? How is it diagnoised? How is it managed?
|
a) Haemolytic uraemic syndrome
b) FBC & blood film c) Dialysis |
|
|
|
What is the common presentation of a child with pyloric stenosis?
|
- Progressive projectile vomiting (secondary to gastric outflow obstruction)
- Presents 3-12 weeks of age - >1st born males - Failure to thrive, hungry, scaphoid abdomen, olive shape mass in right upper quadrant |
|
|
|
What investigation should be preformed to confirm the diagnosis of pyloric stenosis?
|
Test feed:
- Observe a feed - Watch for hyperperistalsis - Palpate pyloric mass - Witness a projectile vomit |
Further investigation
- Capillary blood gas: metabolic acidosis - Ultrasound: thickened & lengthened pyloric muscle - U&Es may show raised Na, urea, creatinine & low K & Cl |
|
|
What is the differential diagnois is pyloric stenosis?
|
GORD
|
|
|
|
What typical abnormalities are seen in a blood gas analysis of a child with pyloric stenosis?
|
- Metabolic alkalosis (non-bilious vomiting, acid only)
- Hypokalaemia (dehydration activates renin-angiotensin-aldosterone system = renal Na retension with K loss in urine) - Hypochloraemia (loss of Cl- with H+ in gastric secretions) |
|
|
|
How do you manage a child with pyloric stenosis?
|
- Nil by mouth
- IV access for fluid & electrolyte resuscitation & maintenance - Surgery - Ramstedt's pyloromyotomy |
|
|
|
What is intussusception?
|
- Telescoping of one part of the bowel into the other
- Temporary bowel obstruction with ischemia - hence the severe pain - Peadiatric surgical emergancy |
|
|
|
What are the charateristic features of intussusception?
|
- Age 6 months - 2 years
- Episodic pain with screaming, drawing up legs and pallor - Preceding viral illness - lymph node - 'Redcurrant jelly stool' (late sign) |
|
|
|
What is the management of intussusception?
|
A
B C - IV access, Fluid resuscitation Diagnosis - Ultrasound (donut shaped mass) Treatment - Air enema reduction or surgery |
|
|
|
What is coeliac disease?
|
-Autoimmune disease triggered by gluten in cerals
- Progressive flattening of the small bowel mucosa resulting in malabsorption with steatorrhea - Undiagnosed can result in failure to thrive, iron deficiency anaemia, osteopaenia |
|
|
|
What are the clinical features of coeliac disease?
|
- Distened abdomen
- Thin skin with loss of subcutaneous fat - Wasted buttocks with reduced muscle bulk - Pallor (due to anaemia) - Short stature - Steatorrhea |
|
|
|
How is coeliac's disease diagnosed?
|
- Jejunal biopsy while on a normal diet containing gluten)
|
- Anti-tissue transglutaminase antibodies (TTG) (also, anti-gliaden, anti-endomysial antibodies & total IgA) |
|
|
What conditions are associated with coeliac disease?
|
Anything linked with HLA B8
- Dermatitis herpetiformis - Vitiligo - Pernicious anaemia - Hashimoto's disease - Type 1 diabetes (annual blood test for coeliac antibodies) - Late development of small bowel lymphoma |
|
|
|
What is the treatment of coeliac disease?
|
- Lifelong gluten free diet
- Involve the paediatric dieticians - Gluten rechallenge if diagnosis b4 2yrs or diagnostic uncertainty as cow's milk intolerance can occasionally cause sub-total villus atrophy |
|
