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Peds

Unit 5

QuestionAnswer
cleft pallete in plate & lip both; comes from failure of maxillary & medial nasal processes to fuse; when they dont close together and lip close; can be bilateral or unilateral; kids tend to have dental anomalies - missing/deformed teeth on side of cleft
complete cleft involves bone and soft tissue
partial cleft bones arent fused but tissue is ok
reasons for cleft pallete closure appears by wk 10 of gestation; genetic hx; linked with folic acid, environmental, maternal alcohol and smoking
cleft pallete s/sx not be able to make seal around nipple or suction of milk - leaks - complete cleft risk for choking
cleft pallete tx surgery - sometimes before leaving hospital - stages of surgery depending on degree - post op - goal is to prevent trauma, infection of suture line - no spoon or straws
esophageal atresia absense of normal body opening or abnormal closure of a body passage - esophagus ends in blind pouch; maybe fistula connecting trachea and esophagus
esophageal atresia s/sx copious amts of thin mucous right after mouth, cyanotic, respir distress, choking/gasping, if fistula - air goes into belly - distended, risk for aspiration/pneumonia, put ng tube and wont pass - NPO
esophageal atresia tx/ni preventing respiratory complications, IV fluids, suctioning and NPO, surgery with in 1st few days, if pt not able to have surgery - gastrostomy, surgery done in stages - fistula as getting older esophageal dilation done, put in ICU
pytoric stenosis (narrowing) obstruction of pyloric canal d/t thickening of pyloric & narrowing of passage between stomach and duodenum, pylorus also elongates, can cause total obstruction and dilation of stomach, wont present initially - over time develop sx
pytoric stenosis s/sx seen between wk 2-4, start to vomit after every feed and progress to projectile vomiting, irritable, miserable, dehydration, palpate round mass RUQ, parastalic waves in belly
pytoric stenosis tx surgery, pyloromyotomy - aka FREDET - RAMSTEDT procedure, circular muscle fibers of pylorous cut to widen canal, 4-6hrs of clear liquids,
Gastroesophageal reflux relaxation of cardiac sphincter allows gastric contents into esophagus, more common in premies or child with neurological impairment but can affect full term as well
GERD s/sx spitting up lg amts, NOT projectile - but pneumonia and aspiration possible, irritable, getting older - chest hurts, abdominal pain, if severe enough - FTT - not gaining wt/growing, most of the time resolves by 18months
GERD tx change formulas (soy milks), thicken (add rice), positioning after feeding - keep upright, can put on belly, if sx severe enough - meds/surgery to create valve reflux, older - watch what you eat, no spicy foods and sit upright
hirschprung disease AKA? also termed congenital aganglionic mega colon
hirschprung disease def autonomic parasympathetic ganglia in muscular wall of intestine are absent; leads to persistent constipation/obstruction; usually shows early in life but may not appear until teens
hirschprung disease s/sx newborn - failure to pass meconium, refusing to suck, abdominal distention, bile-stained of meconium emesis; older child - hx of abdominal distention , chronic constipation w/passage of ribbonlike, foul smelling stools
hirschprung disease dx/tx barium studies, rectal biopsy which confirms absense of nerve cells; surgery to remove aganglionic portion of bowel to relieve obstruction maybe done in stages, TPN, enema
intussusception proximal segment of bowel telescopes into more distal segment, most common site - ileocecal valve ileum slips into cecum pulling mesentary w/it; walls of intestine rub causing itis & obstruction leading to ischemia, necrosis, perforation & hemorrhage
intussusception s/sx/tx sudden severe abdominal pain, vomiting, palpable mass in abdomen, currant jelly stools - blood and mucous - classic sx; can be life threatening; barium enema may reduce telescoping d/t pressure it puts on bowel; may require surgery to reduce telescoping
lead poisoning (plumbism) toxic levels of lead in blood; lead-based primary source; airborne exposure problem; children absorb & retain more lead in proportion to body wt-
What does lead interfere with in the bodily system? lead interferes w normal cell fx, particularly nervous system - impacts brain, affects blood cells, kidneys & vitamin D & calcium metabolism, once in body deposited in bones & teeth then slowly released by bones
lead poisoning s/sx early - irritabily, hyperactivity, poor concentration, aggression, impulsiveness, may also develop learning disabilities, hearing impairment & growth delays; can lead to encephalopathy can occur or degenerative disease of brain
blood levels of lead if >10mcg/dl - follow up; >44mcg/dl - trmt - chelation therapy and follow up
lead poisoning tx chelation therapy - admin of chemical that binds to lead and increase rate of excretion , find source of lead, not instint fx, catch early as possible b/c brain damage
gastroenteritis def and tx diarrhea and vomiting - viral or bacterial cause; can lead to dehydration; tx to stop diarrhea including antibiotics, if bacterial cause, if in health care facility - contact isolation
phenylketouria (PKU) disorder affecting body's ability to use protein; child lacks live enzyme - phenylanine hydroxylase needed to convert phenylanine into tryosine; can lead to mental retardation; 48-72hrs of milkthen test b/c not present at birth
what diet does PKU require? no meat, dairy, nuts, chicken, can have fruits and veggies, special formula
malabsorption syndrome celiac disease; hild unable to digest gluten which is found in wheat, barley, rye and oats
celiac disease 6-8m or 1yr +; doesnt appear until solid foods ingested; gluten free diet required; cant absorb nutrients - immune system attacks vili; abdominal distention, chronic diarrhea & FTT; life-long; puts at risk for growth retardation and GI cancers as adults
what are gluten restrictions? what can they have? can have rice and corn; gluten included in mayo and canned soups
hypospadius uretheral opening along ventral surface of penile shaft - commonly seen w/CHORDEE - ventral curature of penis - downward - thick bond that pulls downward - picked up at birth
hypospadius tx/ni surgery; extend urethra to penis & make opening where it should be; done in stages; 16-18months; if parents wants circumcision, wait until surgery - place stint b/c inflammation
epispadias urethra opens on dorsal or upper surface of penis - often seen w/exstrophy of bladder' tx - surgery
cryptorchiolism def and dx undescended testicle(s), can result in sterility; present at birht - CT or US to confirm
cryptorchiolism tx/ni hormone therapy - HCG may help descent - usually by age 1; if HCG doesnt work orchiopexy by 2 yrs of age - can increase risk of testicular cancer
Wilms tumor (nephroblastoma) highly metastatic cancerous tumor in kidney tumor; dx - 2-5yrs; genetix link; tumor comes from embryonic tissue left from birth and begins to grow rapidly in area of kidney
Wilms tumor s/sx externally none - go for checkup and find a mass on abdomine - may have hematuria, hypertension - MUST NOT BE PALPATED once mass discovered; u/s, ct, MRI, will eval for metastasis to liver, lungs, bones
Wilms tumor tx/ni surgery followed by chem, removal of kidney & tissue, radiation if lg tumor or extensive metastasis
nephrotic syndrome characterized by edema, proteinuria, hypoalbuminemia, hyperlipidemia, altered immunity
primary nephrotic syndrome MCNS or minimal change nephrotic syndrome - only affects kidneys
secondary nephrotic syndrome systemic - such as diabetes, sickle cells, etc
nephrotic syndrome s/sx, dx edema, hypertension, irritability, possible respiratory distress, anorexia, increased susceptibility to infection; dx - y/a, renal biopsy
nephrotic syndrome tx chronic disorder - remission that lasts 12-18 months; corticosteroids to reduce edema, oychophosamide, diuretics, urine testing, diet changes, good skin care
acute glomerulonephritis inflammation of glomeruli and nephrons of kidney, follow group A beta strep - blocks glomeruli which allows RBC & protein to escape into urine
acute glomerulonephritis s/sx tea-colored urine, oliguria, proteinuria, comes on 1-3 weeks after strep infection, periorbital edema, anorexia & malaise, headache, fever, irritability
acute glomerulonephritis dx u/a, blood & protein test, hx of strep
acute glomerulonephritis tx bedrest, antibiotics, diuretics, I&O, wts, urine testing, diet changes - low salt diet - resolves completely usually but can go on for more than a year and turn into chronic glomerulonephritis - unusual
Created by: breinard