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12.10.04 Final bits

Skin conditions - Distribution
  • Eczema
    • Inside of the arms and the back of the knees (flexor surfaces)
    • Chronic eczema is found on the ankles more often than psoriasis
  • Psoriasis
    • Back of the elbows and front of the knees (extensor surfaces)
  • Similarities:
    • Both tend to affect the hands, feet, and nape of the neck
    • Both rashes appear frequently on the scalp

UTI Cutoffs
  • Single organism cultured
  • > 40 WBC
  • +ve nitrities
  • CFU cutoff
    • 1E4 - 1E6?
    • Depends on degree of suspicion, gender, etc
  • Thickened urothelium on USS


Kidney scans

  • DMSA
    • Static scan
    • Good for showing "missing" bits of kidney e.g. from scarring
  • MAG3
    • Shows renal elimination (dynamic)
    • Good for monitoring reflux
      • NB Reflux grades I - IV


Constipation
  • You should NEVER have poo in your rectum
    • Shows loss of recto-colic reflex
    • Takes months to return
  • Fix with movicol/dulcolax
    • For months/years


Failure to thrive

  • Endogenous
    • Inborn error of metabolism
    • GI problems (e.g. gas and acid reflux) causing pain
    • Absorption problems (Cystic fibrosis, diarrhoea, liver disease, celiac disease)
    • Problems getting food in (e.g. cleft palate, tongue tie)
    • Allergies (e.g. milk)
    • Raised metabolism (e.g. parasites, asthma, urinary tract infections, fever-inducing infections, heart disease)
  • Exogenous
    • Physical inability to produce enough breastmilk
    • Insufficient numbers of feeds (sleepy baby syndrome)
    • Inability to procure formula when needed
    • Purposely limiting total caloric intake
    • Not offering sufficient age-appropriate solid foods for babies and toddlers over the age of six months
  • Mixed
    • e.g. A child who is not getting sufficient nutrition may act content so that caregivers do not offer feedings of sufficient frequency or volume
    • e.g. A child with severe acid reflux who appears to be in pain while eating may make a caregiver hesitant to offer sufficient feedings


Fluid balance

  • Dehydration
    • 5% mild
    • 10% moderate
    • 15% severe
  • Calculate needs based on surface area:
    • Neonate 10%
    • 3 years 30%
    • 5 years 50%
    • 12 years 75%
  • Replacement
    • Calculate maintenance fluids based on % of adult needs
    • Add the additional deficit over 48 hours
      • 2/3 in the first day
      • 1/3 in the second day
    • Check the sodium and switch to hypotonic fluid if necessary


Osmolar gap

  • Twice the sodium and potassium, plus urea
  • Gap is GLUCOSE and ALCOHOL


Notes
  • Kidney malformation
    • Duplex normally fine
    • Horseshoe => Obstruction
  • Cloaca develops into urogenital system and rectum
    • Some animals retain just a single opening
  • Hypospadias = Birth defect of the urethra in the male that involves an abnormally placed urinary meatus
  • Take bloods from external jugular, if you're brave!
  • Buy the Oxford handbook of clinical specialties


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