P year‎ > ‎Paediatrics‎ > ‎

12.09.12 Teaching notes

Neonatal jaundice
  • Timescale
    • Abnormal in first 24 hrs
    • Abnormal after 3 weeks
      • But start to worry after 2
  • Causes
    • Biliary atresia
    • HDN
    • Infection
    • Hyperthyroidism
      • Checked at birth
  • Diagnosis
    • Check split bili
      • Biliary atresia => Rise in CONJUGATED bilirubin

Cow's milk allergy
  • Presents around 4-6 weeks
  • Symptoms
    • Rectal bleeding
  • Try switching to Neocate
    • But need to demonstrate return of symptoms on switching back for a diagnosis

Hydrocoele
  • 20-25% at birth
  • Most are non-communicating
  • Most fix slowly after birth
  • Hernia is the only differential
    • Varicocoele => Characteristic "bag of worms"

Abdominal hernias
  • Umbilical (true)
    • Come out at right angles
    • Umbilicus right at the tip
  • Supra-umbilical
    • Just above umbilicus
    • Gives a crescent-shaped skin fold round the umbilicus
  • Epigastric
    • Far above umbilicus
  • Umbilical hernias almost never strangulate
    • Can safely leave for a while

Beckwith–Wiedemann syndrome
  • Overgrowth disorder usually (but not always) present at birth 
  • Characterized by an increased risk of childhood cancer and certain congenital features
  • Five common features:

Inguinal hernia
  • R testis descends later => Hernias more common on R
  • Spot incarceration by red surface
    • Necrosis => Toxin release => Vasodilatation
  • Frequency:
    • 1% for girls
    • 3.5% for boys
  • 50% risk of incarceration @ six months
    • => Always operate
    • Do it FAST if you can't reduce it
  • Kids don't need canal repair or mesh

Pyloric stenosis
  • Features
    • Typically presents at 3-6 weeks
    • Milky projectile vomits after feeding
    • Olive-shaped upper abdominal mass
    • Dry nappies (oliguria)
  • Chemical:
    • Hypochloraemic metabolic alkalosis
      • Loss in vomit
    • Hypokalaemia
      • Kidneys (aldosterone)
    • Dehydration
  • Size cut-off for diagnosis
    • 4 x 16 mm at 6 weeks
  • Typically in first-born male child
    • Combination of genetics + maternal placental factors
  • Treatment leaves the thick muscles in place
    • Just cut (longitudinally) to release presure
    • It will slowly thin over time

Notes
  • Erythromycin can be used to encourage gastric emptying (off-label)
    • ONLY agent indicated in kids
  • If BP falls in a child, PANIC
    • They're really good at compensating
  • There are TWO umbilical arteries
    • Attach to each of the internal iliacs
  • Umbilical vein
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