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