Intussusception

A 15-month-old child is seen for cramping, colicky abdominal pain of 12 h duration. He has had two episodes of vomiting and a fever. Physical examination is remarkable for a lethargic child abdomen is tender to palpation. Leukocytosis is present. During examination, the patient passes a bloody stool with mucus. Definition. Intussusception occurs when a portion of the GI tract slips or telescopes into the portion just distal to it. Most intussusceptions are ileocolic. Risk Factors Etiology. The...

Hypothyroidism see Endocrine Chapter Infants Of Diabetic Mothers

You are called to see a 9.5-pound newborn infant who is jittery. Physical exam reveals a large plethoric infant who is tremulous. A murmur is heard. Blood sugar is low. Definition. Infants of diabetic mothers (IDM) are those infants whose mothers have or develop diabetes during their pregnancy. Risk Factors Etiology. Maternal hyperglycemia leads to fetal hyperglycemia, which in turn leads to fetal hyperinsulinemia. Insulin is a growth hormone, which, in combination with the hyperglycemia,...

Asthma

A 6-year-old boy presents to his physician with end-expiratory wheezing scattered throughout the lung fields. He is noted to have nasal flaring, tachypnea, and intercostal retractions. These symptoms are triggered by changes in the weather. He has a family history of asthma and atopic dermatitis. He has never been intubated or admitted to the pediatric ICU. His last hospitalization for asthma was 6 months ago. He takes medication for asthma only when he starts to wheeze. Definition. Asthma is a...

Hemolyticuremic Syndrome Hu5

A 3-year-old child presents to the emergency center with history of bloody diarrhea and decreased urination. The mother states that the child's symptoms began 5 days ago after the family ate at a fast-food restaurant. At that time the patient developed fever, vomiting, abdominal pain, and diarrhea,On physical examination the patient appears ill. He isj)ale and lethargic. Definition. Hemolytic uremic syndrome is a systemic disease that causes acute renal failure in young children, as well as...

Immune Deficiencies

In immunodeficiency, infections are characterized by increased frequency, unusual severity, a prolonged course or persistence of infection, and at times unusual organisms. Some common clinical manifestations that may be seen in immunodeficiency are recurrent sinopulmonary infections, failure to thrive, persistent thrush, diarrhea, and malabsorption. Associated conditions may include skin lesions such as eczema and pyoderma. Patients may have autoimmune disease and hematologic abnormalities such...

Scarlet Fever

A 7-year-old complains of a headache and a sore throat. On physical examination he has a temperature of 103 F, 3+ tonsils with exudate, and a strawberry tongue. In addition he has circumoral pallor, and a sandpaper rash on his face, trunk, and upper extremities. Pastia lines are also noted. Definition. Scarlet fever is caused by a streptococci infection. Risk Factors Etiology. Group A (3-hemolytic streptococci are the agent. It usually is associated with pharyngitis. However, it may follow...

Enuresis

A 7-year-old boy has problems with bedwetting. The mother says that during the day he has no problems but is usually wet 6 of 7 mornings. He does not report dysuria or frequency, and has not had increased thirst. The mother also says that he is a deep sleeper. Definition. Enuresis is the involuntary passage of urine in a child who is reasonably expected to be toilet trained. Day and night bladder control is usually attained by age 5 years. Risk Factors Etiology. Incidence of enuresis declines...

Congenital Adrenal Hyperplasia

A 1-month-old infant is seen with vomiting and severe dehydration. Physical examination reveals ambiguous genitalia laboratory tests show hyponatremia. Definition. CAH results from Cortisol deficiency, which causes increased corticotropin secretion and subsequent hyperplasia. Risk Factors Etiology. CAH is a series of autosomal recessive disorders 21-hydroxylase deficiency is the most common cause of CAH, followed by 1 l 3-hydroxylase deficiency and 3(3-hydroxysteroid dehydrogenase....

Chlamydia

A 16-year-old boy presents to the emergency center with a persistent penile discharge. The patient states that 1 week ago he saw his family physician for this same problem. At that time the physician gave him an IM shot of penicillin. However, the patient states that the discharge did not resolve with the penicillin therapy. He would like a second opinion. Definition. Chlamydia are intracellular obligate parasites with a cell wall, and they are responsible for a variety of diseases in sexually...

An 18monthold has failure to thrive and developmental delay The patient also has a history of recurrent ear infections

The acquired immunodeficiency syndrome (AIDS) has HIV types 1 and 2 as its agent. Infection with HIV-2 is rarely found in children. Risk Factors Etiology. Most HIV-infected children are born in developing countries. The majority of HIV cases are acquired via vertical transmission from mother to child. Cesarean section combined with prenatal, intrapartum, and neonatal zidovudine (ZDV) therapy significantly reduces transmission of HIV. In developing countries breast-feeding is an...

A 12hourold newborn is noted to have bilateral conjunctival injection tearing and some swelling of the left eyelid

Conjunctivitis is an inflammatory response of the conjunctival vessels to a variety of insults. Risk Factors Etiology. Ophthalmia neonatorum is caused by chemicals or infection. Chemical conjunctivitis caused by instillation of silver nitrate is the most common cause of conjunctivi-' ' tis presenting in the first 24 hours of life. Neisseria gonorrhoeae and Chlamydia trachomatis are common infectious causes of neonatal conjunctivitis. Chlamydia is the most common infec- OGJA wf-f ,U...

A mother brings her 5yearold daughter to the physicians office because the child has developed a rash in the

Atopic dermatitis is an inflammatory skin disorder characterized by erythema, edema, pruritus, exudation, crusting, and scaling. Risk Factors Etiology. Patients with atopic dermatitis may have a family history of asthma, hay fever, and atopic dermatitis. Presentation. In infancy the patient may present with an erythematous, pruritic rash with weepy patches on the cheeks, neck, wrist, hands, and extensor aspects of the extremities. Atopic dermatitis in infancy frequently coincides...

A newborn is noted to have white plaques on his buccal mucosa that are difficult to remove

Oral thrush is an infection of the oropharynx caused by Candida albicans. Risk Factors Etiology. Candida infection of the mouth occurs in infants, the immunosup-pressed, patients with poor oral hygiene, and patients taking inhaled steroids. Oral thrush is commonly seen in neonates because of contact with the organism in the birth canal. Presentation. Thrush causes painful inflammation of the tongue, palates, and buccal mucosa. Physical Examination. The lesions of oral thrush look...

Sudden Infant Death Syndrome

A 2-month-old term infant born without any complications via spontaneous vaginal delivery is brought to the emergency center via ambulance with CPR in progress. According to the mother, the patient was in his usual state of good health until 4 am when she found the patient cyanotic and not breathing. The mother states that at midnight the infant was fed 4 ounces of formula without any difficulty. After the feeding, the child was placed to sleep in a crib. At 4 am the mother returned to check on...