Burns' Pediatric Primary Care 7th edition 2020

_________ is one of the most common symptoms in childhood. - answervomiting 3 basic causes of Failure to thrive - answerInadequate caloric intake Inadequate caloric absorption Excessive caloric expenditure A hydrogen breath test can help diagnose: - answerIBS, Intestinal Methanogen overgrowth, rapid small bowel transit time, and possibly esophageal and gastric cancer in early stages. Abdominal Migraine Rome III criteria- all must be present - answerParoxysmal episodes of intense periumbilical pain lasting 1-72 hours Intervening periods of usual health (weeks-months) Pain interfering with normal activities Pain associated with >2 of: nausea, vomiting, anorexia, headache, photophobia, pallor No evidence of inflammatory, anatomic, metabolic, neoplastic process Must be present >2 times in previous 12 months Accompanying symptoms of Cyclic Vomiting Syndrome - answerpallor, listlessness, headache, and photophobia. Amount of stool that is considered diarrhea in children <2yrs - answerstool volume of >10ml/kg in 24 hours Amount of stool that is considered diarrhea in children >2yrs - answer4 or more stools in 24 hours An ------- -------- generally causes causes bilious vomiting. - answerobstructive lesion Ancylostoma duodenale (hook worm) - answeroften asymptomatic, or have stinging/burning sensation in their feet followed by puritis, papulovesicular rash for about 2 weeks, pharyngeal itching, hoarseness, nausea and vomiting, as it migrates through lungs, cough, pneumonitis Treat with Albendazole, pyrantel pamoate, repeat stool check in 2 weeks. Appendicitis Physical Findings (6) - answer1. RLQ involuntary guarding with rebound tenderness 2. +Psoas sign (Iliopsoas Test): pain with right thigh extension 3. +Obturator sign: pain with internal rotation of flexed right thigh 4. Positive Rovsing's sign: RLQ pain when pressure is applied to LLQ 5. Local abdominal tenderness 6. Low grade fever (high fever suggests perforation or another diagnosis) Average age with appendicitis - answer6-10 years, perforation more common in children <5yrs Bloody vomit comes from: - answeractive bleeding in the upper GI tract (gastritis, peptic ulcer disease) Campylobacter jejuni - answerfrom raw and undercooked poultry, unpasteurized milk, contaminated water stool culture for diagnosis treat with rehydration, Azithromycin, Erythromycin, and Metronidazole. Ciprofloxacin is not first line but can be used. Celiac disease - answerimmune-mediated; triggered by exposure to gluten, barley, rye can order serologic testings Childhood functional abdominal pain (FAP) - answerRecurrent abdominal pain with no specific organic etiology, ROME III criteria -once a week for at least 2 months and 25% loss of daily functioning, somatic symptoms Children require relatively ____________dosages of H2RAs than adults. - answerhigher Clinical findings of Celiac disease - answerFTT, iron-deficiency anemia, abdominal distension Clinical findings of CMPI or CMA - answeranaphylaxis, oral swelling, urticaria, rash, angioedema, nasal pruritis, rhinitis, wheezing, nausea/vomiting, diarrhea, bloody stool Clinical findings of malabsorption syndromes - answerchanges in growth parameters skinfold thickness/lean body mass Delayed growth/puberty/tanner staging Clinical signs of dehydration - answerCapillary refill >2 seconds, slow rebound on skin turgor, & tachypnea. Sunken eyes, Dry mucous membranes, presence of tears, decreased UOP. Clostridium difficile - answerSpread from stool in other infected people or from the environment via oral fecal route. During or after several weeks of abx, but can occur without abx history. stool culture for diagnosis Oral metronidazole is drug of choice in children; if refractory, oral vancomycin CMPI and cow's-milk allergy (CMA) - answerhypersensitivity to cow's milk protein - cow's milk allergy is antigen mediated can order skin patch allergy tests, serum IgE may need epi pen Colonic pain is caused by issues in which area - answerLower abdomin Common Diagnositc studies for abdominal pain/issues - answerUA & culture, CBC w/diff, CMP,BMP, ESR,CRP, Thyroid Panel Stool= O&P, culture, WBC, pH, reducing substances, fat collection Pregnancy tests, Urine for gonorrhea, chlamydia and Pap smear/Vaginal cultures Common diagnostic studies for GI issues - answerXR, US, CT, MRI, nuclear medicine Cyclic vomiting syndrome (CVS) - answeridiopathic disorder that has recurrent, sudden onset attacks of repeated retching and vomiting that are separated by symptom free intervals of weeks to months. Family history of migraine headaches. Diagnostic studies for Crohns Disease - answerinflammatory markers Nutritional labs CBC, liver enzymes Stool O&P, culture, fecal alpha 1-antitrypsin, fecal calprotectin assay Bone age,abdominal films,Ileocolonoscopy, esophagoscopy Disorders requiring alteration in diet as adjunct therapy - answerconstipation, celiac disease, FTT, IBS, GER, IBD, eosoniphilic esophagitis, pancreatitis, liver disease Dysphagia non-structural causes - answerMotility disorders of oropharynx/esophagus Prematurity/neurologic impairment from CP or other disorders Mucosal injury - GERD, eosinophilic esophagitis Dysphagia structural causes - answerEsophageal narrowing Extrinsic obstruction E.Coli - answerFrequent cause of travelers diarrhea, water or food contamination with human feces. stool culture treatment with supportive care and in severe cases, Bactrim, azithromycin, ciprofloxacin, and metronidazole. E.coli 0157:H7 - answerundercooked beef, especially hamburger, unpasteurized milk and juice, raw fruits, vegetables, petting zoos, contaminated water. severe diarrhea that is often bloody, abd pain and vomiting stool culture, must be reported if positive supportive care Associated with HUS** Encopresis - answeras repetitive, voluntary or involuntary passage of stool in the underwear or inappropriate places after an age when the child should be able to control bowel movements with or without constipation Enterobius vermicularis (pinworm) - answerTransmission via food contaminated w/ eggs; intestinal infection; causes anal pruritis (the Scotch tape test) Tx: Mebendazole/pyrantel pamoate treat family members, re-check in 2 weeks. Eosinophilic Esophagitis - answerIsolated inflammation of esophagus by eosinophil related to food ingestion Epigastric pain can be from issues in which areas/organs: - answerLiver, biliary tree, pancreas, stomach, and duodenum Erythema nodosum - answerpainful nodules on anterior shins due to subcutaneous inflammation, seen in Crohn disease Famotidine (pepcid) dosage for infants >3 months- 1yr - answer0.5mg/kg/dose every 12h (maximum dose:20mg/dose) Famotidine (pepcid) dosage for infants 1-3 months - answer0.5mg/kg/dose once daily for up to 8 weeks FTT Onset between 2-4 months - answerusually congenital disorders FTT Onset between 4-8 months - answerassociated with feeding problems Giardia - answertreatment with tinidazole, metronidazole, nitazoxanide water diarrhea, abdominal pain, bloody diarrhea, must be treated H.pylori - answerA bacterial infection transmitted via vomit, saliva, feces, contaminated water Causes chronic inflammation in antrum and stomach body. The cause of most ulcers Hirschsprung's disease (congenital megacolon) - answerabsence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis IBS (irritable bowel syndrome) - answerA chronic condition in which the bowels are sensitive to certain foods and stress causeing discomfort, improved with defecation. is a FAP Indications for Duodenal Aspirate - answerdiarrhea from things like giardia, unintentional weight loss, dyspepsia(reflux/GERD), and abdominal pain Intussusception clinical findings - answersausage like mass in RUQ distension, tenderness of abdomen history of recent URI common grossly bloody or guaiac + stools Intussusception Triad - answerColicky Abdominal pain V