Pediatric Patho (Part Ii)

Front 1

Congenital Heart Disease
(Risk Factors)

Back 1

- maternal infection in 1st tri (RUBELLA)

- maternal diabetes

- drugs/ETOH

- chromosomal

- family Hx

- nutritional deficiency & hypercalcemia

- maternal age > 40 yrs

Front 2

Congenital Heart Disease
(Acyanotic)

Back 2

Increased pulmonary blood flow

- Atrial Septal Defect (ASD)

- Ventricular Septal Defect (VSD)

- Patent Ductus Arteriosus (PDA)

Obstruction of flow from the ventricles

- Coarctation of the Aorta (COA)

Front 3

Congenital Heart Disease
(Cyanotic)

Back 3

Decreased pulmonary blood flow

- Tetralogy of Fallot (ToF)

Mixed Flow

- Transposition of the Great Arteries (TGA)

Front 4

Congenital Heart Disease
(S/S)

Back 4

-poor feeding & sucking

- low wt, slender of build = Failure to Thrive

- dyspnea, tachypnea, diaphoresis, *retractions, grunting, flaring

- wheezing/coughing

- no exercise restrictions

- skin changes (pallor or mottling)

- hepatomegaly

Front 5

Atrial Septal Defect

(ASD)

Back 5

- abnormal communication btwn atria

- higher pressure of left atrial chamber

---> oxygenated blood shunts from LEFT to RIGHT atria, back into lungs (not body)
- right atrial enlargement

- often asymptomatic

- Dx by heart murmur

Front 6

Ventricular Septal Defect

(VSD)

Back 6

- abnormal communication btwn ventricles

- LEFT to RIGHT shunt (higher pressure in LV)

---> pulmonary overcirculation

- small defects close in 1-2 yrs or else surgery

- VSD may be present with other heart defects

Front 7

Patent Ductus Arteriosus

(PDA)

Back 7

- persisting fetal cardiac structure

- connects AORTA to PULMONARY ARTERY

- mixes v O2 blood going to lungs w/ ^ O2 blood going to the body

- if left patent, Heart Failure may occur

Front 8

Coarctation of the Aorta

(COA)

Back 8

- narrowing of lumen of the aorta, impeding flow

- ^ BP in left vntricle

- newborns present with CHF

- once ductus arteriosus closes, rapid hypotension, acidosis & shock

- older children HTN in UE

- pulse absent or v in LE

- cool, mottled skin & leg cramps w/ exercise

Front 9

Tetralogy of Fallot
(ToF)

Back 9

Four Defects
- Ventricular Septal Defect (VSD)
- Overriding aorta straddles the VSD
- Pulmonary Valve Stenosis (narrowing)
- Right Ventricular Hypertrophy

-the Right Ventricle can severely narrow causing v O2 blood to flow RIGHT to LEFT
- *child may appear cyanotic (blue)

KNEE-CHEST POSITIONING - surgery to correct

Front 10

Transposition of the Great Arteries

(TGA)

Back 10

- Aorta & Pulmonary Artery connect to wrong chambers

- Aorta leaves Right Ventricle taking v O2 blood to the body

- Pulmonary Artery leaves Left Ventricle taking ^ O2 blood to the lungs

- Patent Foramen Ovale & Ductus Arteriosus allow for mixing of ^ & v O2 blood and keep infant alive

Front 11

Hirschsprung Disease

(Aganglionic Megacolon)

Back 11

- mechanical obstruction from inadequate instestinal motility

- absence of ganglion cells in colon

- migration arrested during embryongenisis

- long segment (small intestine) vs short segment (large intestine)

- aganglionic section usually includes rectum & proximal colon

Front 12

Hirschsprung Disease

(S/S)

Back 12

- delayed passage of meconium

- accumulation of stool

- failure of internal anal sphincter to relax

---> chronic *constipation

- n/v/d

- abdominal distention

- enterocolitis may occur (v artery flow = necrosis)

- poor feeding = FTT

Front 13

Meckel Diverticulum

(Rule of 2's)

Back 13

- 2% of population affected

- 2x more common in males

- 2 y/o when symptoms present

- 2 " in length (diverticula)

- 2' from ileocecal valve

- 2 types of abnormal tissue (pancreas & stomach)

Front 14

Meckel Diverticulum

(Etiology)

Back 14

- congenital sac found in lower ileum

- produces acid (intestinal lining sensitive)

- ulcers ---> perforation ---> peritonitis (RUQ pain)

- can become a fistula opening at umbilicus

- may cause intestinal obstruction (strangulation)

Front 15

Hypertrophic Pyloric Stenosis (HPS)

(Risk Factors)

Back 15

- male (4:1) 3wks - 3mos

- ^ gastrin secretion by mom in 3rd tri

- ^ gastrin in baby may be mom's stress

- exogenous prostaglandin E

- trisomy 21

- Transforming Growth Factor alpha (TGFa)

Front 16

Hypertrophic Pyloric Stenosis

(Etiology)

Back 16

- TGFa causes hypertrophy in smooth muscle of pylorus

- gastric outlet obstructed (olive shaped RUQ)

- projectile, non-bile stained vomit

- emesis ^

- DEHYDRATION

Front 17

Intussusception

(Etiology)

Back 17

- telescoping (invagination) of one portion of intestine into another

- hypertrophied Peyer's patches 2ndary to viral infection

- can be intestinal lesions

- often unknown

Front 18

Intussusception

(S/S)

Back 18

- "currant-jelly stools"

- venous congestion

- blood cells in lumen

- sausage shaped mass in abdomen

- legs drawn up, collicky

Front 19

Celiac Disease

(Gluten Induced Enteropathy)

Back 19

- autoimmune disease exacerbated by glutens

- wheat, barley, rye

- causing intestinal inflammation

---> damage to villi ---> malabsorption
---> malnutrition

Four Characteristics

- steatorrhea

- general malnutrition

- abdominal distention

- 2ndary vit deficiencies

Front 20

Esophageal Atresia

&

Transesophageal Fistula

Back 20

Atresia

- esophagus ends in a blind pouch

Fistula

- esophagus joins with trachea through a fistula
Both

- polyhydramnios is a risk factor

- embryonic failure in 4th & 5th week

- surgical emegencies

- aspiration, pneumonia & resp distress

Front 21

Esophageal Atresia

&

Transesophageal Fistula
(Other Anomalies)

Back 21

- EA & TEF can also indicate other midline deficits

Vertebral

Anal

Cardiovascular

Tracheal

Esophageal

Renal

Limb deformities

Front 22

Nephrotic Syndrome

Back 22

- 2-6 y/o

- kidney disorder (glomerulus dysfunction)

- ^ renal permeability to protein

- hyperproteinuria (~2g albumin lost)

---> hypoalbuminemia ---> ^ hepatic lipid synth

---> hyperlipidemia (^ cholest & triglyc)

- edema from v renal blood flow & ^ ADH

- v IgG ---> ^ infection

- hypercoag ---> thrombosis

Front 23

Glomerulonephritis

Back 23

- school age children

- inflammation of capillaries in the glomerulus

- followed by bacterial or viral infection (strep)

- self-limiting immunologic response

- inflammation damages capillary walls, vessels become smaller, glomerular filtration rate decreases (oliguria) RENAL INSUFFICIENCY

Front 24

Fluid Calculations

Back 24

Output

0.5 - 2.0 mL/kg/hr

IV Maintenance:

Daily

< 10 kg - 100 mL/kg = 1000 mL/day

10 - 20 kg - 50 mL/kg = 500 mL/day

> 20 kg - 25 mL/kg = 25x mL/day

Hourly

< 10 kg - 4 mL/hr = 40 mL/hr

10 - 20 kg - 2 mL/hr = 20 mL/hr

> 20 kg - 1 mL/hr = 1x mL/hr