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