Burns' Pediatric Primary Care 7th edition 2023 with complete solution

Epigastric pain can be from issues in which areas/organs: Liver, biliary tree, pancreas, stomach, and duodenum Periumbilical pain can be caused by issues in which areas/organs: distal end of the small intestine, cecum, appendix, and ascending colon Colonic pain is caused by issues in which area Lower abdomin Suprapubic pain is caused by issues in which organs/area? distal intestine, urinary tract, pelvic organs, Common Diagnositc studies for abdominal pain/issues UA & culture, CBC w/diff, CMP,BMP, ESR,CRP, Thyroid Panel Stool= O&P, culture, WBC, pH, reducing substances, fat collection Pregnancy tests, Urine for gonorrhea, chlamydia and Pap smear/Vaginal cultures Common diagnostic studies for GI issues XR, US, CT, MRI, nuclear medicine Specialized tests that can be ordered Duodenal Aspirate, Esophageal pH probe, Capsule endoscopy, breath hydrogen test, and sweat chloride test Indications for Duodenal Aspirate diarrhea from things like giardia, unintentional weight loss, dyspepsia(reflux/GERD), and abdominal pain A hydrogen breath test can help diagnose: IBS, Intestinal Methanogen overgrowth, rapid small bowel transit time, and possibly esophageal and gastric cancer in early stages. Sweat chloride test is used to diagnose: Cystic Fibrosis. This is usually done when a patient is having digestive problems, & FTT along with history of respiratory issues. Most common reasons for the use of Probiotics IBS, Infectious diarrhea, antibiotic associated diarrhea, and colic What is Colic? Crying for no apparent reason that lasts 3 hrs/day and occurs 3 days/wk in otherwise healthy infant 3months Potential causes of vomiting in Newborn or young infants infectious process, congenital GI anomaly, CNS abnormality, or newborn errors of metabolism Potential causes of vomiting in Infants or young children Gastroenteritis, GERD, milk/soy protien allergies, pyloric stenosis or obstructive lesion, inborn errors of metabolism, intussusception, child abuse, &intracranial mass Potential causes of vomiting in older children and adolescents Gastroenteritis, systemic illness, CNS (cyclic vomiting syndrome, abdominal migraine, meningitis, brain tumor), intussusception, rumination, superior mesenteric artery syndrome, pregnancy _________ is one of the most common symptoms in childhood. vomiting Non-bilious vomiting is generally caused by: infection, inflammation, and metabolic, neurologic, or psychological problems. An ------- -------- generally causes causes bilious vomiting. obstructive lesion Bloody vomit comes from: active bleeding in the upper GI tract (gastritis, peptic ulcer disease) Rumination Syndrome a condition in which people repeatedly and unintentionally spit up (regurgitate) undigested or partially digested food from the stomach, rechew it, and then either reswallow it or spit it out. Usually seen in infants under 1 year of age. What is superior mesenteric artery syndrome? a digestive condition that occurs when the duodenum (the first part of the small intestine) is compressed between two arteries (the aorta and the superior mesenteric artery). This compression causes partial or complete blockage of the duodenum. Clinical signs of dehydration Capillary refill 2 seconds, slow rebound on skin turgor, & tachypnea. Sunken eyes, Dry mucous membranes, presence of tears, decreased UOP. Stages of dehydration minimal or none: 3% loss of body weight, assessment wnl Stages of dehydration Mild to Moderate: 3%-9% loss of body weight, fatigued or restless, irritable, thirsty eager to drink, eyes slightly sunken, decreased tears, dry mouth, skin recoil 2sec, prolonged cap refill, cool extremities, decreased UOP Stages of dehydration severe: 9% loss of body weight, lethargic, apathetic, unconscious, unable to drink, tachycardia, bradycardia in most severe cases, weak thready or impalpable pulses, deep breathing, deeply sunken eyes, absent tears, parched mouth, recoil of skin 2 seconds or tenting, prolonged or minimal cap refill, cold, mottled cyanotic extremities, minimal or no UOP. Children require relatively ____________dosages of H2RAs than adults. higher Types of Histamine 2 receptor blockers (H2RAs) Famotidine (pepcid) and Ranitidine (zantac) Famotidine (pepcid) dosage for infants 1-3 months 0.5mg/kg/dose once daily for up to 8 weeks Famotidine (pepcid) dosage for infants 3 months- 1yr 0.5mg/kg/dose every 12h (maximum dose:20mg/dose) Ranitidine (zantac) dosage for infants 1 month children 16yrs 4-8mg/kg/day divided twice daily (max dose:300 mg) Ranitidine (zantac) dosage for children 16yrs 150mg stice daily or 300mg once HS Proton Pump Inhibitors (PPIs) used for peds Lansoprazole (prevacid) Omeprazole (prilosec) Pantoprazole (protonix) Lansoprazole (prevacid) dose for children 1-11 years old 30kg 15mg once daily for up to 12 weeks Lansoprazole (prevacid) dose for children 1-11 years old 30kg 30mg once daily for up to 12 weeks Omeprazole (prilosec) dose for children 1 year old 5-10kg 5mg once daily for up to 12 weeks Omeprazole (prilosec) dose for children 1 year old 10-20kg 10 mg once daily for up to 12 weeks Omeprazole (prilosec) dose for children 1 year old 30kg 20mg once daily for up to 12 weeks Pantoprazole (protonix) dosage for infants and children 5years old 1.2mg/kg/day once daily for 4 weeks Pantoprazole (protonix) dosage for children 5-11 years old 40kg 20mg once daily for up to 8 weeks Pantoprazole (protonix) dosage for children 5-11 years old 40kg 40mg once daily for up to 8 weeks Pantoprazole (protonix) dosage for children and adolescents 12-16 years old 20 or 40 mg once daily for up to 8 weeks Sucralfate (carafate) dose child 40-80mg/kg/day divided q6 on empty stomach before meal and at bedtime Sucralfate (carafate) dose adult 250 mg/day divided q6 take on empty stomach before meal and at bedtime Disorders requiring alteration in diet as adjunct therapy constipation, celiac disease, FTT, IBS, GER, IBD, eosoniphilic esophagitis, pancreatitis, liver disease Dysphagia structural causes Esophageal narrowing Extrinsic obstruction Dysphagia non-structural causes Motility disorders of oropharynx/esophagus Prematurity/neurologic impairment from CP or other disorders Mucosal injury - GERD, eosinophilic esophagitis Symptom history with dysphagia progressive dysfunction, persistent drooling/cough, discomfort, picky eating/food refusal, heartburn, halitosis, chest pain Cyclic vomiting syndrome (CVS) idiopathic disorder that has recurrent, sudden onset attacks of repeated retching and vomiting that are separated by symptom free intervals of weeks to months. Family history of migraine headaches. Accompanying symptoms of Cyclic Vomiting Syndrome pallor, listlessness, headache, and photophobia. Abdominal Migraine Rome III criteria- all must be present Paroxysmal episodes of intense periumbilical pain lasting 1-72 hours Intervening periods of usual health (weeks-months) Pain interfering with normal activities Pain associated with 2 of: nausea, vomiting, anorexia, headache, photophobia, pallor No evidence of inflammatory, anatomic, metabolic, neoplastic process Must be present 2 times in previous 12 months Eosinophilic Esophagitis Isolated inflammation of esophagus by eosinophil related to food ingestion Symptoms of Peptic Ulcer Disease Vague, dull abdominal pain most common Symptoms may wax and wane Pain with eating; can awaken from sleep GI tract bleeding Poor feeding, GI bleeding, slow growth in infants Poorly localized pain in older children Iron deficiency anemia Family history of PUD Predisposing factors H.pylori A bacterial infection transmitted via vomit, saliva, feces, contaminated water Causes chronic inflammation in antrum and stomach body. The cause of most ulcers Average age with appendicitis 6-10 years, perforation more common in children 5yrs Appendicitis Physical Findings (6) 1. RLQ involuntary guarding with rebound tenderness 2. +Psoas sign (Iliopsoas Test): pain with right thigh extension 3. +Obturator sign: pain with internal rotation of flexed right thigh 4. Positive Rovsing's sign: RLQ pain when pressure is applied to LLQ 5. Local abdominal tenderness 6. Low grade fever (high fever suggests perforation or another diagnosis) Intussusception Triad Colicky Abdominal pain Vomiting Currant jelly (bloody mucous) stool Intussusception clinical findings sausage like mass in RUQ distension, tenderness of abdomen history of recent URI common grossly bloody or guaiac + stools Childhood functional abdominal pain (FAP) Recurrent abdominal pain with no specific organic etiology, ROME III criteria -once a week for at least 2 months and 25% loss of daily functioning, somatic symptoms IBS (irritable bowel syndrome) A chronic condition in which the bowels are sensitive to certain foods and stress causeing discomfort, improved with defecation. is a FAP Celiac disease immune-mediated; triggered by exposure to gluten, barley, rye can order serologic testings Lactose intolerance abdominal pain, diarrhea, nausea, flatulence, bloating after ingestion of lactose-containing foods can order lactose hydrogen breath test CMPI and cow's-milk allergy (CMA) hypersensitivity to cow's milk protein - cow's milk allergy is antigen mediated can order skin patch allergy tests, serum IgE may need epi pen Clinical findings of Celiac disease FTT, iron-deficiency anemia, abdominal distension Clinical findings of CMPI or CMA anaphylaxis, oral swelling, urticaria, rash, angioedema, nasal pruritis, rhinitis, wheezing, nausea/vomiting, diarrhea, bloody stool Clinical findings of malabsorption syndromes changes in growth parameters skinfold thickness/lean body mass Delayed growth/puberty/tanner staging Rectal and Intestinal Polyps findings asymptomatic or painless, bright red rectal bleeding, complaints of diarrhea, constipation, changes in bowel habits. pallor/edema from anemia/hypoproteinemia ophalmologic changes, dental anomalies,osteomas of skull, jaw, extremities multiple lipomas Treatment for anal fissure Diet modification, Sitz bath, hydrocortisone cream, lubricant Symptoms seen in Crohn Disease Fever, weight loss, delayed growth velocity, short stature, delayed bone age, arthralgia/arthritis in large joints, pain in umbilical region and RLQ, anorexia, malabsorption/lactose intolerance, diarrhea, pain with stooling, jaundice, oral aphthous ulcers. Erythema nodosum painful nodules on anterior shins due to subcutaneous inflammation, seen in Crohn disease Diagnostic studies for Crohns Disease inflammatory markers Nutritional labs CBC, liver enzymes Stool O&P, culture, fecal alpha 1-antitrypsin, fecal calprotectin assay Bone age,abdominal films,Ileocolonoscopy, esophagoscopy ulcerative colitis (UC) a chronic inflammatory bowel disease (IBD) primarily located in the colon and rectum symptoms of ulcerative colitis Abdominal pain/cramping (LLQ) Anorexia Weight loss Fever Diarrhea Abdominal distention Abdominal tenderness & firmness High pitched bowel sounds Rectal bleeding Ulcerative colitis diagnostic studies CBC, iron-binding capacity, total protein, albumin, ESR, CRP Stool for WBC, blood, culture Bone age Colonoscopy Perinuclear neutrophil cytoplasmic antigen Fecal calprotectin assay FTT Onset between 2-4 months usually congenital disorders FTT Onset between 4-8 months associated with feeding problems 3 basic causes of Failure to thrive Inadequate caloric intake Inadequate caloric absorption Excessive caloric expenditure Encopresis as repetitive, voluntary or involuntary passage of stool in the underwear or inappropriate places after an age when the child should be able to control bowel movements with or without constipation Hirschsprung's disease (congenital megacolon) absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis Symptoms of Hirschsprung's Disease constipation, delayed meconium, bilious vomiting, diarrhea, FTT, explosive bowel movements, diarrhea seen with downs syndrome Toilet refusal syndrome is present when a child demonstrates a patter of successfully using the toilet to urinate but refuses to use the toilet for bowel movements. Amount of stool that is considered diarrhea in children 2yrs stool volume of 10ml/kg in 24 hours Amount of stool that is considered diarrhea in children 2yrs 4 or more stools in 24 hours Campylobacter jejuni from raw and undercooked poultry, unpasteurized milk, contaminated water stool culture for diagnosis treat with rehydration, Azithromycin, Erythromycin, and Metronidazole. Ciprofloxacin is not first line but can be used. Clostridium difficile Spread from stool in other infected people or from the environment via oral fecal route. During or after several weeks of abx, but can occur without abx history. stool culture for diagnosis Oral metronidazole is drug of choice in children; if refractory, oral vancomycin E.coli 0157:H7 undercooked beef, especially hamburger, unpasteurized milk and juice, raw fruits, vegetables, petting zoos, contaminated water. severe diarrhea that is often bloody, abd pain and vomiting stool culture, must be reported if positive supportive care Associated with HUS** E.Coli Frequent cause of travelers diarrhea, water or food contamination with human feces. stool culture treatment with supportive care and in severe cases, Bactrim, azithromycin, ciprofloxacin, and metronidazole. Listeria monocytogenes thrives in salty and acidic conditions such as fresh soft cheeses, ready to eat deli meat, hot dogs, unpasteurized milk, multiplies at low temperatures diagnosed with blood or CSF cultures, stool cultures IV ampicillin and an aminoglycoside usually gentamicin in severe cases Giardia treatment with tinidazole, metronidazole, nitazoxanide water diarrhea, abdominal pain, bloody diarrhea, must be treated Ancylostoma duodenale (hook worm) often asymptomatic, or have stinging/burning sensation in their feet followed by puritis, papulovesicular rash for about 2 weeks, pharyngeal itching, hoarseness, nausea and vomiting, as it migrates through lungs, cough, pneumonitis Treat with Albendazole, pyrantel pamoate, repeat stool check in 2 weeks. Enterobius vermicularis (pinworm) Transmission via food contaminated w/ eggs; intestinal infection; causes anal pruritis (the Scotch tape test) Tx: Mebendazole/pyrantel pamoate treat family members, re-check in 2 weeks. Pyloric Stenosis in Newborn Projectile vomiting usually starting at 2-3 weeks. Insatiable appetite with weight loss and dehydration Association with erythromycin in infancy Non bilious vomit, may have blood **"Olive" shaped mass from reverse peristalsis