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