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Common Paediatric Presentations Medical and Surgical Presentations Contents 01 02 Respiratory Diarrhoea and Vomiting 03 04 05 Abdominal Pain Fever Rashes RED FLAG/IMPORTANT SYMPTOMS highlighted in redRespiratory • Viral URTI • Coryzal, cough, sore throat etc. • Bronchiolitis • Almost all in <1 years • Mostly due to RSV • Coryzal, increased WOB, poor feeding, wheeze + crackles • Worse on day 3/4, resolve in one week • Croup • 6 months - 2 years • Parainfluenza, RSV • Barking cough, increased WOB • Oral dexamethasoneRespiratory • Foreign Bodies • Especiallyacute onset breathlessness, unsupervised child • Viral-induced wheeze • Typically < 3 years • Often during viral infections • SOB, increased WOB, wheeze • Asthma • Dry cough, worse at night, atopy • Triggers: viruses, exercise, cold weather etc. • Pneumonia Diarrhoea and Vomiting • Gastroenteritis • Mostly viral (rotavirus/norovirus) • Main concern- dehydration/hypoglycaemia à ‘5 in 5’ method • May lead to lactose intolerance • BEWARE E.coli gastroenteritis- causes bloody diarrhoea and can cause HUS. • UTI • Especially in babies • Pyloric Stenosis • Projectile vomiting, first few weeks of life • Tx: Laparoscopic pyloromyotomy • DKA (vomiting) • IBD/Coeliac- diarrhoea (sometimes bloody), weight loss, mouth ulcers • Cows Milk Protein Allergy • Bloating, D+V, urticaria after feeds (generally present <1 year old) • Tx: diary free diets for breastfeeding mothers,hydrolysedformulas Vomiting bile?- Malrotation leading to volvulus until proven otherwise In vomitingadolescents- Consider alcohol/drugs, or pregnancy. Abdominal Pain • Appendicitis (mostly between 10-19 years) • Intussusception • Severe colicky pain • Pale, lethargic, redcurrant jelly stool (late sign) • Can be associated with viral infections • Tx: Enema (water, air, contrast) • Obstruction- intussusception, volvulus, hernia, malrotation etc. • Testicular Torsion • DKA • Pneumonia • IBD • HSP Female adolescents with abdominal pain?- consider ectopic pregnancy BOYS- ALWAYS CHECK THE TESTESFever • Infections- pneumonia, UTI, septic arthritis etc. • Sepsis • Prolonged CRT, irritable, floppy, mottling etc. • Non-blanching rash- Meningococcal sepsis causing DIC • Bacterial Meningitis • Most commonly Neisseria meningitidis (meningococcus) or Strep. Pneumoniae (pneumococcus) • All babies up 3 months with fever get lumbar puncture, blood cultures etc. • Kawasaki Disease • Systemic, medium sized vessel vasculitis (i.e. not infectious) • Persistent fever over 5 days, widespread rash, strawberry tongue, bilateral conjunctivitis, cervical lymphadenopathy, peeling skin on palms/soles. • Tx: aspirin, IV immunoglobulins • Key complication: coronary artery aneurysm (follow-up ECHOs) Febrile Convulsions (6m-5y) • 1/3 will have further convulsion in future illness (not during current illness). • Very slight increased risk of developing epilepsy.Kawasaki Disease (SO SO MANY!) Rashes Impetigo Urticaria • Staph aureus • Tx: anti-histamines • Stay off nursery/school until scabs crusted over • Tx: top. Hydrogen peroxide orfusidic acid Chickenpox Hand, foot and mouth • Varicella virus • Coxsackie virus • Tx: supportive, IVaciclovir in immunocompromised • Often other viral symptoms- but no school exclusion • Stay off nursery/school until scabs form ‘Viral Exanthemas’ Rashes Measles • Macular rash starts on face Scarlet fever Rubella Slapped Cheek/Erythema • Fever, coryzal, conjunctivitis • Group A strep • Rash starts on face • Koplik spots in mouth • ‘Sandpaper’ rash, • Mild fever, joint pain, Infectiosum strawberry tongue, sore lymphadenopathy • Parvovirus B19 • Notifiable disease throat, fever • Tx: supportive • Coryzal, rash on face, then • School exclusion for 5 days • Tx: penicillin V • School exclusion for 6 trunk and limbs from rash onset • Tx: supportive • Can return to school 24hrs days from rash onset • No school exclusion after antibiotics Rashes Eczema Herpeticum Pityriasis Rosea • HSV • Unknown cause- ?herpes Roseola • Blistering, sometimes appear • Often older children • AKA “viral rash” bloody • Characteristic ‘herald patch’, • High grade fever + coryzal for • Tx: Oralaciclovir usually on torso then 3-5 days then subsides spreads • Rash then appears- pale pink, • Rash faint red or blanching, non-itchy NB: Eczema may also become infected locally with e.g. staph or pink, slightly scaly, oval strep. • Can take 3 months to resolve Other non-blanching rashes: Rashes • ITP (Idiopathic thrombocytopenic purpura) • Acute leukaemias • Haemolytic Uraemic Syndrome (HUS) • Mechanical (e.g. forceful coughing, vomiting) Meningococcal septicaemia Henoch–Schönlein Purpura (HSP) • Non-blanching • Small vessel vasculitis • Purpura + petichae • Immediate IV antibiotics • Non-blanching purpura + petichae • Joint pain + abdominal pain • Tx: supportive • ALWAYS do urinalysis- kidney involvement in up to 50% Bruising/petichae + Fever + Pale?- Think leukaemiaThanks! Any questions? ocallatt@dundee.ac.uk https://www.facebook.com/dundeeunipaedssociety