P year‎ > ‎Paediatrics‎ > ‎

12.08.30 Day 3 lecture notes

Growth curves
  • ICP Model: There are 3 overlapping growth phases:
    • Conception to infancy, driven by nutrients
      • GH not necessary at all => Don't pick up GH deficiency until 4 years
    • Childhood, driven by GH
    • Puberty, driven by androgens
  • SGA
    • Birth weight less than 9th centile for gestational age
  • If head circumference is climbing the centiles, think about raised ICP
  • Initial loss of birth weight
    • Due to loss of ECV
    • 6% decrease is normal
    • But beware hypernatraemic dehydration if too much more
  • Fontanelles close:
    • Anterior: 18 months
    • Posterior: 9 months
  • Dates:
    • Normal term is 40 weeks
    • Term is 37-42 weeks
  • Plotting
    • If term (37-42 weeks), plot on normal chart using actual age
    • If <37 weeks
      • Use preterm charts on the left until postmentrual age is 42 weeks
      • After that, plot actual age on the normal chart, but with an arrow left to the corrected age
        • Corrected age = postmenstrual age - 40


Paediatric oncology

  • Commonest tumours
    • Leukaemia
    • Brain tumours
    • Lymphomas
  • Solid extra-cranial tumours are relatively uncommon
    • Neuroblastomas 8-10%
    • Nephroblastomas (Wilms' tumour) 7-8%
      • Excellent prognosis, even if lung mets
  • Neuroblastomas
    • Often present non-specifically
    • 60% are abdominal
      • Often adrenal => e.g. hypertension
      • Check urinary catecholamines
    • 14% pelvic
    • 2% neck
      • Horner's syndrome
  • Tumours NOT to biopsy
    • Optic glioma
    • Intracranial secreting giant cell tumour
    • Pontine glioma


Coeliac disease

  • 1% of Caucasians
  • HLA DQ2, DQ8
    • If both => 60% risk
  • Associated with Dermatitis herpetiformis
  • Anti-tTG typically used
    • But anti-EMA is also fine these days
    • Make sure you check total IgA too, to exclude IgA deficiency
  • Association with Downs' syndrome
  • Can present with almost anything
    • Neurological disturbance
    • Malignancy
    • Reduced fertility
    • Thyroid dysfunction
    • Poor dentition
    • Stroke
      • As a result of anaemia, which is pro-thrombotic


IBD

  • Gold standard for diagnosis is MRI
  • Abdo ultrasound is an evolving modality
    • Very useful for kids
  • Barium follow-through is dangerous because of radiation
  • Capsule endoscopy is great but MAKE SURE there are no strictures!
  • Faecal calprotectin
    • Released by neutrophils
    • Marker of active gut inflammation
  • Exclusive enteral nutrition
    • Either polymeric or elemental
    • Pure (hydrolysed) protein + carbs
    • Works really well but tastes like arse


Other notes

  • Raised ICP in children
    • Atypical signs
    • Fontanelles can absorb a lot of the pressure
  • IBD-U
    • Mixed-picture IBD
    • 80% resolve into Crohns, 20% to UC
  • Transient lactose intolerance following gastroenteritis
    • Lactase is in brush borders and is washed out
  • Bacterial vs Viral gastroenteritis is indicated by blood in stool
  • Sandifer's syndrome
    • Arching of the neck or back due to discomfort from GORD
  • Odynophagia = Pain from swallowing
  • Omeprazole takes 2-6 weeks to reach full effect!
    • Can cover with ranitidine for that time
  • Constipation takes ages to fix
    • Use shitloads of Movicol for several days to get everything out
    • Then use maintenance Movicol for several months to allow colon to return to normal size
Comments