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.jpeg "The acute abdomen.") |
| The acute abdomen. |
Abdominal pain is one of the most common reasons children visit clinics and emergency departments. While most cases are mild, some may indicate serious conditions like appendicitis, bowel obstruction, or peritonitis that require urgent treatment.
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What is Diabetic Ketoacidosis (DKA)?
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| Insulin action. |
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes caused by insulin deficiency, leading to:
· Hyperglycemia
· Dehydration
· Ketone
production
· Metabolic
acidosis
DKA is most common in children with type 1 diabetes mellitus (T1DM) and may be the first sign of the disease.
What is Respiratory Distress?
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Physical examination findings in respiratory distress.
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_Page_052.jpg "Newborn Baby Care Guide: Normal Signs, Apgar Score, Resuscitation & IUGR Explained")
The normal newborn
The vast majority of babies are born in good condition at full term and do not require any medical involvement. Most babies in the UK are born in hospital, where a paediatrician is usually available to attend ‘high-risk’ deliveries, where it is anticipated that resuscitation will be required. A healthy newborn infant should cry soon after birth, have pink mucous membranes, good muscle tone, a normal heart rate and regular respiration. They can be dried and placed on the mother’s chest. The cord is clamped after a minute or two. Skin-to-skin care helps establish breastfeeding. Newborn babies, especially premature babies, are covered in a waxy material called vernix. Post-term infants may have very dry, cracked skin. Babies pass a green – black stool called meconium that changes to a normal yellow – brown seedy stool after a few days. It is recommended that infants be given vitamin K at birth to prevent potentially catastrophic bleeding. Newborn infants are routinely examined within the first few days to exclude congenital abnormalities (see Chapter 10) and have blood taken from a heel prick around day 5 to screen for hypothyroidism and metabolic disorders (see Chapter 7).
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Genetics And Inherited Disorders
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Unusual patterns of inheritance
Imprinting: Certain genetic disorders show a phenomenon called imprinting—where the expression of the allele depends on which parent it is inherited from. For example, in Angelman’s syndrome, the abnormal deleted genes are on the maternally derived chromosome 15, but the normal paternal copy is imprinted (silenced) and so the child develops features of the disease including neurodegenerative disease, seizures, hand-flapping and an unusually happy demeanour. The same genetic material, if deleted from the paternal chromosome 15, with the maternal genes imprinted, leads to Prader– Willi syndrome, with neonatal hypotonia and feeding difficulties, developmental delay and later onset obesity and delayed sexual development.
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Screening
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Screening atms to identify unrecognized disease in apparently well people. The cost must be considered and balanced against that of treatment if the problem presents later. Conditions suitable for screening should:
CARBOHYDRATE MALABSORPTION,
INCLUDING LACTOSE
MALABSORPTION
Carbohydrate malabsorption is a frequent clinical condition caused by fermentation of unabsorbed carbohydrates by colonic flora and giving rise to symptoms. Although lactose is the most commonly malabsorbed sugar, other carbohydrates, including oligosaccharides, disaccharides, and monosaccharides such as fructose, can cause symptoms related to malabsorption.
LYMPHANGIECTASIA AND ABETALIPOPROTEIN
DEFICIENCY
Intestinal lymphangiectasia is an unusual disorder characterized by dilated lymphatic channels in the mucosa, submucosa, or subserosa of the small intestine, leading to protein-losing enteropathy. Waldman originally described an idiopathic form, primary intestinal lymphangiectasia; however, obstruction to the flow of lymph in certain cardiac diseases or hematologic malignant diseases and retroperitoneal lymph node enlargement due to chemotherapeutic, infectious, or toxic agents can secondarily lead to lymphangiectasias that present in the same manner as primary intestinal lymphangiectasia.
CRONKHITE-CANADA SYNDROME
AND OTHER RARE DIARRHEAL
DISORDERS
 |
Cronkhite-Canada syndrome is a rare, nonfamilial gastrointestinal polyposis syndrome that commonly presents with diarrhea. It is characterized by hyperpig-mentation, hair loss, and dystrophic changes in the fingernails. Individuals of European and Asian descent are most frequently affected, but the syndrome has been reported in all ethnic groups. The cause is not known, but the frequent association with hypothyroidism, systemic lupus erythematosus, rheumatoid arthritis, and scleroderma suggests an autoimmune origin. The syndrome is characterized by development of innumerable polyps throughout the gastrointestinal tract except in the esophagus. The polyps are hamartomas; there is an increased risk of colorectal cancer (25%), however. Patients commonly present with diarrhea and weight loss accompanied by typical dermatologic manifestations that include hyperpigmentation and onychodystrophy. Management is largely supportive, with nutritional support, accompanied by antisecretory and antiinflammatory treatment. Immunosuppressive therapy with glucocorticosteroids and azathioprine has also been reported to ameliorate symptoms, but the duration of treatment is not known.
