Rapid Paediatrics and Child Health E-Book

Helen A. Brough

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Rapid
• Sprache: Englisch

Seitenzahl: 385

Veröffentlichungsjahr: 2011

Beschreibung

This pocket reference and revision guide is a must for all medical students and junior doctors preparing for major exams in paediatrics and child health or needing a rapid reminder during a clinical attachment. Now thoroughly updated and with the addition of key references, this new edition provides quick access to information on common paediatric problems and disorders, their signs, symptoms, and aetiological agents.

It includes sections on surgical problems, procedures, and general paediatric management such as resuscitation techniques, and features tips on how to take a paediatric history. It presents the contents ordered by system and conditions in alphabetical order, reflects current NICE and paediatric surgery guidelines, and features over 15 new presentations including eczema, food allergies and conduct disorder.

Leseprobe

Contents

Title

Copyright

Preface

List of Abbreviations

ACNE VULGARIS

DEFINITION

AETIOLOGY

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ALLERGIC RHINITIS (AR)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ANAEMIA, APLASTIC

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ANAEMIA, HAEMOLYTIC

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ANAEMIA, IRON DEFICIENCY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ANAEMIA OF PREMATURITY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ANORECTAL MALFORMATIONS (ARM)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

APPENDICITIS, ACUTE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ASTHMA

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATION

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ATOPIC ECZEMA

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ATRIAL &ATRIOVENTRICULAR SEPTAL DEFECTS (ASD &AVSD)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATION

MANAGEMENT

COMPLICATIONS

PROGNOSIS

AUTISTIC SPECTRUM DISORDER

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

COMPLICATIONS

PROGNOSIS

BREATH-HOLDING ATTACKS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

BRONCHIOLITIS, ACUTE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CEREBRAL HAEMORRHAGE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CEREBRAL PALSY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CHRONIC LUNG DISEASE (CLD) OF PREMATURITY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CLEFT LIP (CL) AND PALATE (CLP)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

COARCTATION OF THE AORTA (COA)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

COELIAC DISEASE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CONDUCT DISORDER

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

PROGNOSIS

CONGENITAL ADRENAL HYPERPLASIA

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CONGENITAL HYPOTHYROIDISM

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CONGENITAL INFECTIONS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CONSTIPATION

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

COW’S MILK PROTEIN ALLERGY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY AND INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CROUP (ACUTE LARYNGOTRACHEOBRONCHITIS)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CRYPTORCHIDISM

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

DIFFERENTIAL DIAGNOSIS

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

CYSTIC FIBROSIS (CF)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

INVESTIGATIONS

PATHOPHYSIOLOGY

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DELAYED PUBERTY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DEPRESSION

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DEVELOPMENTAL DYSPLASIA OF THE HI P (DDH)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DIABETES MELLITUS (TYPE 1) (DM)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DOWN SYNDROME (TRISOMY 21 )

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DUCHENNE/BECKER MUSCULAR DYSTROPHY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

ENCEPHALITIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

ASSOCIATIONS/RELATED

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

EPIGLOTTITIS, ACUTE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

EPILEPSY IN CHILDHOOD

DEFINITION

CLASSIFICATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

EXOMPHALOS AND GASTROSCHISIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FAECAL SOILING (ENCOPRESIS)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FAILURE TO THRIVE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FEBRILE SEIZURES

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FOOD ALLERGY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FRACTURES

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FUNCTIONAL ABDOMINAL PAIN (FAP)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

FUNGAL SKIN INFECTIONS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

GASTROENTERITIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

GENETIC SKELETAL DYSPLASIAS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

GLOBAL DEVELOPMENTAL DELAY

DEFINITION

AETIOLOGY

EPIDEMIOLOGY

ASSOCIATIONS/RELATED

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

GLOMERULONEPHRITIS, ACUTE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

GROUP B STREPTOCOCCAL (GBS) INFECTION

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HEAD LICE (PEDICULOSIS)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HEARING IMPAIRMENT

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HEART FAILURE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HERNIA, CONGENITAL DIAPHRAGMATIC (CDH)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HERNIAS, INGUINAL

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HIRSCHSPRUNG DISEASE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HYDROCEPHALUS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HYPERTHYROIDISM

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HYPOGLYCAEMIA IN NEONATES

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HYPOSPADIAS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

HYPOXIC–ISCHAEMIC ENCEPHALOPATHY (HIE )

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

IMPETIGO

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

INADVERTENT POISONING

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

INBORN ERRORS OF AMINO ACID METABOLISM

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

INBORN ERRORS OF CARBOHYDRATE METABOLISM

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

INFLAMMATORY BOWEL DISEASE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

INTRAVENTRICULAR HAEMORRHAGE (IVH)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

INTUSSUSCEPTION

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

JUVENILE IDIOPATHIC ARTHRITIS (JIA)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

KAWASAKI DISEASE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

KLINEFELTER SYNDROME

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LACTOSE INTOLERANCE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LEGG-CALVÉ-PERTHES DISEASE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LEUKAEMIA, ACUTE LYMPHOBLASTIC (ALL)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LEUKAEMIA, ACUTE MYELOID (AML)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LIMPING CHILD

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

Prognosis

LIVER DISEASE, CHRONIC

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LIVER FAILURE, ACUTE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LYMPHOMA, HODGKIN

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

LYMPHOMA, NON-HODGKIN (NHL)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MALROTATION OF THE INTESTINE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MARFAN SYNDROME

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MEASLES, MUMPS, RUBELLA (MMR)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MECKEL’S DIVERTICULUM (MD)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MECONIUM ASPIRATION SYNDROME

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MENINGITIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATION

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MESENTERIC ADENITIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

MYOTONIC DYSTROPHY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

NEAR-DROWNING

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

NECROTISING ENTEROCOLITIS (NEC)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

NEONATAL JAUNDICE

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

NEPHROTIC SYNDROME

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

NEUROCUTANEOUS SYNDROMES

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

NOCTURNAL ENURESIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

OBESITY IN CHILDREN

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

OESOPHAGEAL ATRESIA AND TRACHEO-OESOPHAGEAL FISTULA

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

OSGOOD-SCHLATTER SYNDROME

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

OTITIS MEDIA, ACUTE AND CHRONIC

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PATENT DUCTUS ARTERIOSUS (PDA)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PERSISTENT PULMONARY HYPERTENSION (PPH)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PHIMOSIS AND FORESKIN DISORDERS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PNEUMONIA

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PNEUMOTHORAX

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOgy

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PRECOCIOUS PUBERTY (COMPLETE)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PRECOCIOUS PUBERTY (PARTIAL)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COM plications

PROGNOSIS

PRIMARY IMMUNE DEFICIENCY

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

PROGNOSIS

PULMONARY VALVE STENOSIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

PYLORIC STENOSIS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COM PLICATIONS

PROGNOSIS

RENAL FAILURE, ACUTE (ARF)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

RENAL FAILURE, CHRONIC (CRF)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

RESPIRATORY DISTRESS SYNDROME (RDS)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

RETINOPATHY OF PREMATURITY (ROP)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGy

iNVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

RHEUMATIC FEVER

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY and EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SAFEGUARDING CHILDREN

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORYAND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SCABIES

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SCHOOL REFUSAL

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SEPTICAEMIA

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SHORT STATURE

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SICKLE CELL ANAEMIA

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SLEEP-RELATED DISORDERS

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SMALL BOWEL ATRESIA

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

STICKY EYE/CONJUNCTIVITIS

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SUDDEN INFANT DEATH SYNDROME (SIDS)

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

SUPRAVENTRICULAR TACHYCARDIA (SVT)

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

TESTICULAR TORSION

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

TETRALOGY OF FALLOT

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

THALASSAEMIA

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COM PLICATIONS

PROGNOSIS

TICS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

TRANSIENT TACHYPNOEA OF THE NEWBORN (TTN)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

TRANSPOSITION OF THE GREAT ARTERIES

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COM PLICATIONS

PROGNOSIS

TURNER SYNDROME

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

UPPER RESP IRATORY TRACT INFECTION (URTI )

DEFINITION

AETIOLOGY

ASSOC IATIONS/RE LATE D

EPIDEMIOLOGY

HISTORY

EXAMInatio N

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

URINARY TRACT ANOMALIES

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

URINARY TRACT INFECTION

DEFINITION

AETIOLOGY

ASSOC IATIONS/RE LATE D

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

VARICELLA (CHICKENPOX)

DEFINATION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

VENOUS ACCESS

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

VENTRICULAR SEPTAL DEFECT (VSD)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

VISUAL IMPAIRMENT

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATION

INVESTIGATIONS

MANAGEMENT

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY

EXAMINATIO N

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

DEFINITION

AETIOLOGY

EPIDEMIOLOGY

HISTORY

EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

VITAMIN D DEFICIENCY

DEFINITION

AETIOLOGY

ASSOC IATIONS/RE LATE D

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

WHOOP ING COUGH (PERTUSSIS)

DEFINITION

AETIOLOGY

ASSOCIATIONS/RELATED

EPIDEMIOLOGY

HISTORY AND EXAMINATION

PATHOPHYSIOLOGY

INVESTIGATIONS

MANAGEMENT

COMPLICATIONS

PROGNOSIS

APPENDIX 1 Taking a History in Paediatrics

WHAT IS THE DIFFERENCE BETWEEN ADULT AND PAEDIATRIC CONSULTATIONS?

IMPORTANT POINTS TO NOTE BEFORE TAKING A HISTORY

PRESENTING COMPLAINT

GENERAL ENQUIRY

SYSTEMS REVIEW IF INDICATED

PAST MEDICAL HISTORY

IMMUNISATIONS

GROWTH AND DEVELOPMENT

DRUG HISTORY

FAMILY HISTORY

EDUCATIONAL/EMOTIONAL HISTORY

SOCIAL HISTORY

APPENDIX 2 Neonatal Resuscitation

APPENDIX 3 Formal Assessment of the Neonate at Birth

APPENDIX 4 Examination of the Newborn

GENERAL

SKIN

HANDS

LIMBS

HEAD

FACE

MOUTH

TONGUE

NOSE

NECK

THORAX

CARDIOVASCULAR

ABDOMEN

GENITALIA

HIPS

FEET

APPENDIX 5 Breastfeeding Versus Bottlefeeding

APPENDIX 6 Infant Feeding

1989 WHO/UNICEF TEN STEPS TO SUCCESSFUL BREASTFEEDING

LAPSE IN BREASTFEEDING

MATERNAL SUPPORT

FORMULAFEEDS

WEANING

APPENDIX 7 Paediatric Resuscitation

APPENDIX 8 Developmental Stages in Children

APPENDIX 9 Immunisation Schedule

APPENDIX 10 Child Health Promotion Programme

APPENDIX 11 Status Epilepticus

THINK OF A CAUSE

MANDATORY INVESTIGATIONS

FURTHER READING

Eula

This edition first published 2010, 2010 by Helen A. rough and Ram Nataraja.

Previous edition: 2004.

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwells publishing program has been merged with Wileys global Scientific, Technical and Medical business to form Wiley-Blackwell.

Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Brough, Helen.

Rapid paediatrics and child health/Helen Brough, Ram Nataraja. – 2nd ed.

p.; cm. – (Rapid series)

Rev. ed. of: Rapid paediatrics and child health/Helen Brough… [et al.]. 2004.

ISBN 978–1-4051-9330-6 (pbk.: alk. paper) 1. Pediatrics-Handbooks, manuals, etc. I. Nataraja,

Ram. II. Title. III. Series: Rapid series.

[DNLM: 1. Pediatrics-Handbooks. WS 39 B875r 2010]

RJ48.R375 2010

618.92–dc22

2009051053

ISBN: 9781405193306

Preface

Rapid Paediatrics and Child Health is part of a series of books for medical students that are designed to facilitate learning about core topics in a structured format. Each page is divided into our own “surgical sieve”: Definition, Aetiology, Associated/Related, Epidemiology, History, Examination, Pathophysiology, Investigations, Management, Complications and Prognosis.

In the second edition we have included over 150 common conditions that cover the major topics in all paediatric medical, surgical and neonatal specialities. All of the topics have been updated with the current paediatric medical and surgical guidelines including NICE. There is also a new section called Further Reading where suggested papers for each chapter are listed in line with evidence based practice. Core knowledge, important investigative techniques and treatment modalities are all included in each chapter. The investigations suggested are for guidance and are not always necessary for a child with the condition.

This book has been designed to be easy to carry around and also to allow rapid access to information whether in the outpatient department, the ward or theatre, so you can consolidate theory with practice.

The authorship team consisting of both a paediatric and a paediatric surgical SpR means that we have brought different experiences in paediatrics to the book to create a truly unique resource. We hope you enjoy reading this book as much as we have enjoyed writing it!

List of Abbreviations

F female M male 1º primary 2º secondary ↑ increase(d) ↓ decrease(d) → to/lead(s) to >  greater than <  less than ~ approximately × times ABC airway, breathing, circulation ABG arterial blood gases ABVD adriamycin, bleomycin, vinblastine, dacarbazine ACTH adrenocorticotrophic hormone AD autosomal dominant ADHD attention deficit hyperactivity disorder AFP alpha-fetoprotein AIDS acquired immunodeficiency syndrome ALL acute lymphoblastic leukaemia ALP alkaline phosphatase ALT alanine aminotransferase ALTE apparent life-threatening event AML acute myeloid leukaemia AN anorexia nervosa AP anteroposterior APTT activated partial thromboplastin time AP50 alternative pathway complement activation assay AR aortic regurgitation AR autosomal recessive ARDS acute respiratory distress syndrome ARIA allergic rhinitis and its impact on asthma ARF acute renal failure AFP alpha-fetoprotein ARM anorectal malformation ASD atrial septal defect ASOT antistreptolysin O titre AST aspartate aminotransferase ATG antithymocyte globulin ATN acute tubular necrosis ATP adenosine triphosphate AUSS abdominal ultrasound AV atrioventricular AVPU alert, verbal response, painful response, unresponsive AVSD atrioventricular septal defect AXR abdominal X-ray BD twice a day BCG bacille Calmette–Guérin BiPAP bilevel positive airways pressure BM blood monitor/monitoring BMD Becker muscular dystrophy BMI Body Mass Index BMJ British Medical Journal BMT bone marrow transplant/transplantation BP blood pressure BPD bronchopulmonary dysplasia bpmbeat per minute BTS British Thoracic Society CAD coronary artery disease cAMP cyclic adenosine monophosphatase CBT cognitive-behavioural therapy CCDC consultant in communicable disease control CD Crohn’s disease CDH congenital diaphragmatic hernia CF cystic fibrosis CFTR cystic fibrosis transmembrane regulator CGD chronic granulomatous disease CGG cytosine-guanine-guanine CHB complete heart block CHD congenital heart disease CHF congestive heart failure CH100 total complement activity assay CLD chronic lung disease CMV cytomegalovirus CNS central nervous system COA coarctation of the aorta CPAP continuous positive airways pressure CPK creatinine phosphokinase CRF chronic renal failure CRHD chronic rheumatic heart disease CRP C-reactive protein CSF cerebrospinal fluid CSOM chronic secretory otitis media CT computed tomography CTG cardiotocography/graph CVID common variable immune deficiency CVP central venous pressure CVS chorionic villous sampling CXR chest x-ray DD differential diagnosis DDH developmental dysplasia of the hip DDT dichlorodiphenyltrichloroethane DEXA dual-energy X-ray absorptiometry DIC disseminated intravascular coagulation/coagulopathy DIP distal intraphalangeal DISIDA di-isopropyl iminodiacetic acid DKA diabetic ketoacidosis DM diabetes mellitus DMD Duchenne muscular dystrophy DMPK dystrophia myotonica protein kinase DMSA dimercaptosuccinic acid DNA deoxyribonucleic acid DNAse deoxyribonuclease DPT diphtheria, pertussis, tetanus DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th edition DTap Diptheria, tetoinus, pertussis DTPA diethylenetriamine penta-acetic acid DVT deep vein thrombosis EAS external anal sphincter EBV Epstein–Barr virus ECG electrocardiogram/graph ECMO extracorporeal membrane oxygenation EEG electroencephalogram EHF extensively hydrolysed formulas ELISA enzyme-linked immunosorbent assay EMG electromyogram/graph ENT ear nose throat EPO erythropoietin ERCP endoscopic retrograde cholangiopancreatography ESR erythrocyte sedimentation rate ET endotracheal FVIII–FXI factor VIII to factor XI FAB French–American–British FAS fetal alcohol syndrome FBC full blood count FEV forced expiratory volume FFP fresh frozen plasma FGFR3 fibroblast growth factor receptor 3 FH father’s height (cm) FMR1 fragile × mental retardation 1 FMRP fragile × mental retardation protein FSH follicle-stimulating hormone G6PD glucose-6-phosphate dehydrogenase GBS group B streptococcus GCS graduated compression stockings/Glasgow Coma Score G-CSF granulocyte colony stimulating factor GFR glomerular filtration rate GH growth hormone GI gastrointestinal GN glomerulonephritis GnRH gonadotrophin-releasing hormone GOR gastro-oesophageal reflux GORD gastro-oesophageal reflux disease GP general practitioner GSD glycogen storage disease G&S Group & Save GTCS generalised tonic-clonic seizures GU genitourinary GVHD graft versus host disease HA haemophilia A HAV hepatitis A virus Hb haemoglobin HB haemophilia B HBV hepatitis B virus HC haemophilia C HCG human chorionic gonadotrophin HCV hepatitis C virus HDL high-density lipoprotein HFO high-frequency oscillation Hib Haemophilus influenzae b HIDA hepatobiliary iminodiacetic Acid HIE hypoxic–ischaemic encephalopathy His histidine HIV human immunodeficiency virus HLA human lymphocyte antigen HR heart rate HS hereditary spherocytosis HSP Henoch–Schönlein purpura HSV herpes simplex virus HT hypertension HTLV human T-lymphotrophic virus HUS haemolytic uraemic syndrome IAS Internal anal sphincter IBS irritable bowel syndrome ICP intracranial pressure ICS inhaled corticosteroids ICSI intracytoplasmic sperm injection ICU intensive care unit Ig immunoglobulin IGFBP-3 insulin-like growth factor-binding protein 3 IHD ischaemic heart disease INR international normalised ratio IM intramuscular IP intraphalangeal IUGR intrauterine growth restriction/retardation IV intravenous IVH intraventricular haemorrhage IVIg intravenous immunoglobulin IVU intravenous urogram JVP jugular venous pulse LABA long-acting β2-agonist LBW low birthweight LCPD Legg–Calvé–Perthes disease LDH lactate dehydrogenase LFT liver function test LGA large for gestational age LH luteinising hormone LHRH luteinising hormone-releasing hormone LIF left iliac fossa LN lymph node LP lumbar puncture LRTI lower respiratory tract infection LVF left ventricular function LVH left ventricular hypertrophy MAG3 mercaptoacetyltriglycine MALT mucosa-associated lymphoid Tissue MCH mean cell/corpuscular haemoglobin MC&S microscopy culture and sensitivity MCUG micturating cystourethrogram MCV mean cell/corpuscular volume MDD major depressive disorder Men C meningitis C MH mother’s height (cm) MMR measles, mumps, rubella MR mitral regurgitation MRI magnetic resonance imaging MSE mental state examination MSU mid-stream specimen of urine MVP mitral valve prolapse NA noradrenaline NAI non-accidental injury NBM nucleus basalis magnocellularis/nil by mouth NBT nitroblue tetrazolium NEC necrotising enterocolitis NEJM New England Journal of Medicine NF neurofibromatosis NG nasogastric NHL non-Hodgkin lymphoma NICE National Institute for Health and Clinical Excellence NICU neonatal intensive care unit NK natural killer NNU neonatal unit NO nitric oxide NSAID non-steroidal anti-inflammatory drug NSPCC National Society for the Prevention of Cruelty to Children OCA oculocutaneous albinism OCD obsessive–compulsive disorder OCP oral contraceptive pill OGD oesophagogastroduo denoscopy O/N overnight OPV oral polio vaccine ORT oral rehydration therapy OTC over the counter PA pulmonary artery PAS periodic acid–Schiff PCP Pneumocystis carinii pneumonia PCR polymerase chain reaction PDA patent ductus arteriosus PE pulmonary embolism PEN pharmacy equivalent name PET positron emission tomography PICU paediatric intensive care unit PKU phenylketonuria PNH paroxysmal nocturnal haemoglobinuria PO per oral POS polycystic ovary syndrome PPH persistent pulmonary hypertension PPV positive pressure ventilation PROM prolonged rupture of membranes PSC primary sclerosing cholangitis PTH parathyroid hormone PTSD post-traumatic stress disorder PUVA psoralen ultraviolet A QDS four times a day RAH right atrial hypertrophy RBC red blood cell/count RDS respiratory distress syndrome REAL revised European and American lymphoma REM rapid eye movement Rh rhesus rhGH recombinant human growth hormone RIF right iliac fossa RNA ribonucleic acid ROM range of movement ROP retinopathy of prematurity RSV respiratory syncytial virus RTA road traffic accident RUSS Renal ultrasound RVH right ventricular hypertrophy RVT renal vein thrombosis SBP systolic blood pressure SC subcutaneous SCBU special care baby unit SCID severe combined immunodeficiency SCIg sub-cutaneous immunoglobulin SD standard deviation S/E side effects SGA small for gestational age SIADH syndrome of inappropriate antidiuretic hormone SIDS sudden infant death syndrome sIgAD selective IgA deficiency SIRS systemic inflammatory response syndrome SLE systemic lupus erythematosus SMA superior mesenteric artery SOB shortness of breath SPAG small particle aerosol generation SSPE subacute sclerosing panencephalitis SSRI selective serotonin reuptake inhibitor STD sexually transmitted disease SUDEP sudden unexpected death in epileptic patients SUFE slipped upper femoral epiphysis SVC superior vena cava SVT supraventricular tachycardia T3 tri-iodothyronine T4 thyroxine TB tuberculosis TDS three times a day TFT thyroid function test TGA transposition of the great arteries THAM tris(hydroxymethyl)-aminomethane THI transient hypogammaglobulinaemia of infancy TLC total lung capacity TOF tracheo-oesophageal fistula TOP termination of pregnancy TORCH toxoplasma, other (syphilis, HIV), rubella, cytomegalovirus, hepatitis TPN total parenteral nutrition TRH thyrotrophin-releasing hormone TS transient synovitis TS1&2 tuberous sclerosis 1&2 TSH thyroid-stimulating hormone TSI thyroid-stimulating immunoglobulin TSS toxic shock syndrome TTN transient tachypnoea of the newborn TTP thrombotic thrombocytopenic purpura U&E urea and electrolytes UC ulcerative colitis UDPGA uridine diphosphoglucuronic acid UGI upper gastrointestinal UKALL United Kingdom Medical Research Council protocol for childhood ALL URT upper respiratory tract URTI upper respiratory tract infection USS ultrasound scan UTI urinary tract infection UTR untranslated region UV ultraviolet VACTERL vertebral, anal, cardiac, tracheal, (o)esophageal, renal, limb VE varicella embryopathy VF ventricular fibrillator VON varicella of the newborn VSD ventricular septal defect VT ventricular tachycardia VUR vesicoureteric reflux VZV varicella zoster virus WAS Wiskott-Aldrich syndrome WCC white cell count WHO World Health Organization WPW Wolff–Parkinson–White (syndrome) XLA X-linked Bruton’s agammaglobulinaemia

ACNE VULGARIS

DEFINITION

Chronic inflammatory dermatosis. Classified as mild, moderate, or severe.

AETIOLOGY

Infantile acne: <3 months of life; transient and usually due to maternal androgens.

Adolescent acne:

1. ↑Sebum production : androgenic stimulation of hyper-responsive pilosebaceous units.

2. Impaired flow of sebum : obstruction of the pilosebaceous duct by hyperkeratosis.

3. Propionobacterium acnes: gram-positive anaerobe is implicated in the inflammation.

Associations/related: Puberty, may ↑ premenstrually, POS, excess cortisol (Cushingsyndrome).

EPIDEMIOLOGY

Developed world: Affects 79–95% of the adolescent population, peaking at 14–18 years; tends to recede by early twenties.

Developing world: Acne incidence is considerably lower; likely combination of environmental and genetic factors.

HISTORY

Usually self-diagnosed, acute onset, greasy skin, may be painful.

EXAMINATION

Open comedones: Whiteheads; flesh-coloured papules.

Closed comedones: Blackheads; black colour is due to oxidation of the melanin pigment.

Other features: Pustules, nodules, cysts, scarring, and seborrhoea.

Distribution: Primarily affects the face, neck, chest and back (where sebaceous glands are most numerous).

PATHOPHYSIOLOGY

Gross distension of the pilosebaceous follicle with neutrophil infiltration. Closed comedones may contain serous fluid. Severe acne can create fistulas between inflamed glands.

INVESTIGATIONS

Not indicated unless other signs of androgen excess; prepubertal body odour, axillary/pubic hair or genital maturation; postpubertal infrequent menses, hirsutism or truncal obesity (suspect POS).

Bloods: Free testosterone, FSH, LH.

Urine: 24-hour urinary cortisol (if Cushing syndrome is suspected).

MANAGEMENT

Indication for treatment is based on classification and degree of psychosocial impact. In severe acne, therapy should be commenced early to prevent scarring. General advice should include use of non-greasy cosmetics, daily face wash. Dietary restriction is not beneficial in the treatment of acne.

Single topical preparations

1. Benzoyl peroxide : keratolytic agent, encourages skin peeling, and bactericidal (S/E: irritation and bleaching of clothes).

2. Vitamin A derivatives : retinoids reduce obstruction within the follicle.

3. Antibiotics : clindamycin or erythromycin is effective but when used as single agents may result in P. acne resistance.

Combination topical preparations

1. Topical retinoids and antibiotics are synergistic.

2. Topical benzoyl peroxide and antibiotics reduce the likelihood of P.acne resistance and are also more effective.

Systemic preparations

1. Antibiotics : tetracyclines (doxycycline, minocycline). S/E: discoloration of teeth. Macrolides (erythromycin or azithromycin) or trimethoprim-sulphamethoxazole (Septrin).

2. Vitamin A derivative : isotretinoin (Roaccutane PO): 4–6-month course only by specialist prescription for severe acne (S/E: potent teratogen, hyperlipidaemia).

3. Hormones : oestrogen-containing OCP, antiandrogens (spironolactone S/E: hyperkalaemia), cyproterone acetate in females only.

Physical treatments: Short-term efficacy from optical treatments such as lasers, light sources and photodynamic therapy.

COMPLICATIONS

Physical: Facial scarring (atrophic/keloid), hyperpigmentation, 2˚ infection and fistulas.

Psychosocial: Lack of self-confidence.

PROGNOSIS

Generally improves spontaneously over months/years. At 25 years, persists in 12% of women and 5% of men.

ALLERGIC RHINITIS (AR)

DEFINITION

Inflammation of the membrane lining the nose. ARIA definition; intermittent (<4 days/week or <4 weeks) versus persistent (>4 days/week and >4 weeks). Impact on quality of life : mild, moderate or severe. ‘Seasonal’ (spring/summer) versus ‘perennial’ definition is also important in the UK.

AETIOLOGY

Parental atopy. AR is more likely to occur in first-born children (hygiene hypothesis).

ASSOCIATIONS/RELATED

Children with AR have an increased risk of developing asthma, sinusitis or otitis media. Allergic conjunctivitis frequently co-exists.

EPIDEMIOLOGY

Seasonal AR is found in 10% and perennial AR in 10–20% of the population. Prevalence is increasing.

HISTORY

Itchy nose, rhinorrhoea, sneezing, persistent nose blowing, congested nose, snoring, throat clearing, morning halitosis (post-nasal drip), chronic cough.

EXAMINATION

Allergic nasal crease, allergic ’salute’, allergic ’shiners’ (dark circles under eyes), Dennie-Morgan (infra-orbital skin) folds, mouth breathing. On nasal inspection, pale hypertrophied inferior nasal turbinates. If polyps are seen, think of cystic fibrosis or aspirin-sensitive asthma in the older child.

PATHOPHYSIOLOGY

Allergen on the nasal mucosa/eyes binds to IgE on mast cells and leads to release of inflammatory mediators (histamine/leukotriene). Mucosal cellular infiltration leads to the late phase response and chronic exposure leads to hypertrophy of the nasal turbinates and increased mucous production.

INVESTIGATIONS

Skin prick tests/specific IgE for seasonal (grass/tree pollen and moulds) and perennial (house dust mite, animal dander) inhalant allergens.

MANAGEMENT

Assess severity and impact on quality of life/sleep. Check compliance with medication and method of delivering intranasal steroids. Ask about asthma symptoms; treating AR will improve asthma control. Avoid irritants (e.g. cigarette smoke).

Allergen avoidance:Pollen: wear glasses during and shower after being outside, close windows (especially early morning and evening), don’t dry clothes outside, fit pollen filter in car. House dust mite prevention strategies: ventilate room, bedding barrier covers, remove soft furnishings/cuddly toys, HEPA filter vacuums, acaricidal sprays.

Non-sedating antihistamines: Relieves itch, sneeze and rhinorrhoea but less effective for nasal congestion. Recommended for mild intermittent AR as a single therapy.

Decongestants: Modifies nasal obstruction. Recommended for short-term use only due to risk of rhinitis medicamentosa (rebound congestion).

Topical nasal steroids: Most effective single therapy. Relieves and prevents itch, sneeze, rhinorrhoea and congestion. Best when used regularly. S/E nasal bleed mainly if administered incorrectly. Newer formulations have minimal (<0.5%) systemic steroid absorption.

Leukotriene receptor antagonists: Second-line treatment. Synergistic effect when combined with non-sedating antihistamines but not as effective as combining antihistamines and nasal steroids.

Immunotherapy: Available in sublingual and subcutaneous preparation. Treatment shows sustained reduction in symptoms and medication scores, prevents new sensitisation to inhalant allergens and decreases the risk of developing asthma.

COMPLICATIONS

Decreased quality of life : poor sleep, impairment of daily activities, problems at school (particularly during exam term).

PROGNOSIS

Seasonal allergic rhinitis tends to diminish with age. If symptoms start in early childhood, the likelihood of improvement is greater than if the onset is in adulthood.

ANAEMIA, APLASTIC

DEFINITION

Pancytopaenia (deficiency of all blood cell elements) associated with bone marrow hypoplasia.

AETIOLOGY

Idiopathic (>40%): Possibly 2º to immunological suppression of multipotent myeloid stem cells by cytotoxic T cells. Phenotypically normal but often have genetic markers of congenital marrow failure syndromes.

Acquired:

1. Viral infection (parvovirus, CMV, HIV, hepatitis, measles).

2. Drugs (chloramphenicol, alkylating agents, methotrexate).

3. Chemicals (DDT, benzene).

4. Radiation.

Inherited:

1. Fanconi anaemia, FA (autosomal recessive, error of DNA repair).

2. Dyskeratosis congenital (rare sex-linked disorder with skin and nail atrophy).

3. Shwachmann syndrome (pancytopaenia in 25%).

ASSOCIATIONS/RELATED

FA: Growth retardation, forearm bones abnormalities, heart and renal tract defects (horseshoe or pelvic kidney) and skin pigmentation.

EPIDEMIOLOGY

2–5/1,000,000/yr. Any age. M > F.

HISTORY

May present with either slow (months) orrapid (days) onset:

1. ↓ RBC: Tiredness, lethargy and dyspnoea

2. ↓ Platelets: Easy bruising, bleeding gums, epistaxis

3. ↓ WCC: Increased frequency and severity of infections (immunodeficiency).

EXAMINATION

Signs of anaemia (pallor), petechiae, bruises, bacterial or fungal infections. No hepatomegaly, splenomegaly or lymphadenopathy.

PATHOPHYSIOLOGY

Macro: Pale or white bone marrow.

Micro: Hypocellular bone marrow composed of empty marrow spaces, fatcells, fibrousstroma and isolated foci of lymphocytes and plasma cells. Classic ‘chicken wire’ appearance.

INVESTIGATIONS

Blood: ↓Hb, ↓platelets, ↓neutrophils, normal MCV, low or absent reticulocytes.

Blood film: Leukaemia exclusion.

Bone marrow trephine biopsy: For diagnosis and exclusion of other causes (bone marrow infiltration : lymphoma, leukaemia, malignancies).

Chromosomal abnormalities: ↑ Random breaks in peripheral lymphocytes in Fanconi anaemia. Also prognostic guide; certain mutations associated with earlier onset of leukaemia/haematological abnormalities.

Ham test: For paroxysmal nocturnal haemoglobinuria : measures sensitivity of affected red blood cells to lysis by complement following activation in acidified serum.

MANAGEMENT

Treat the underlying cause: Medication review and underlying infection treatment.

Supportive: Blood and platelet transfusions, antibiotics (therapeutic/prophylactic).

Medical: Immunosuppression; corticosteroids, cyclosporin A, antithymocyte globulin (ATG), androgen (oxymetholone for FA), and antilymphocyte globulin (ALG). Pts who relapse or are unresponsive to an immunosuppressive regimen may benefit from a repeat or alternative course.

Surgical: CVC/Portacath placement for repeated phlebotomy/transfusions. Splenectomy with heavily transfused and allosensitised pts refractory to medical therapies and with no HSCT donor.

Haematopoietic stem cell transplantation (HSCT): Definitive treatment in severe aplastic anaemia; from an HLA-identical family member. Cure rate approaching 90%.

COMPLICATIONS

Complication of disease process: Bleeding, infections (bacterial and fungal), sepsis and ↑d risk of developing myelodysplastic syndromes or leukaemia if the duration of illness is prolonged.

Complication of HSCT: Graft rejection, graft versus host disease, infection (new or reactivated).

PROGNOSIS

Poor prognostic features include : platelets <10×109/l, neutrophils <0.5×109/l, reticulocytes 10×109/l. >50% of patients with all these features lasting more than 3 weeks will die.

ANAEMIA, HAEMOLYTIC

DEFINITION

Premature erythrocyte breakdown (haemolysis) causing ↓d erythrocyte lifespan (<120 days) and anaemia (2º to bone marrow activity unable to compensate).

AETIOLOGY

Intravascular or extravascular (reticuloendothelial system; by splenic macrophages). 2º to either hereditary or acquired factors.

Hereditary:

Membrane defects: Spherocytosis (abnormal spectrin : structural membrane protein which alters deformability of RBCs), elliptocytosis (elliptical RBCs), hereditary pyropoikilocytosis.

Metabolic defects: G6PD deficiency, pyruvate kinase deficiencies.

Haemoglobinopathies: Sickle cell disease, thalassaemia.

Acquired (immune):

Autoimmune: Warm or cold antibodies attach to RBCs → activation of complement → intravascular haemolysis and extravascular haemolysis in hypersplenism. Warm antibodies: Idiopathic or associated with SLE, lymphomas or methyldopa. Cold antibodies: Idiopathic/associated with infections (Mycoplasma, EBV) or lymphoma.

Isoimmune: Transfusion reaction, haemolytic disease of the newborn.

Acquired (non-immune):

Trauma: RBC fragmentation in abnormal microcirculation; thrombotic thrombocytopaenia purpura, haemolytic uraemic syndrome, disseminated intravascular coagulopathy, malignant hypertension, pre-eclampsia, artificial heart valves.

Paroxysmal nocturnal haemoglobinuria (PNH): Acute-onset haemoglobinuria; idiopathic or 2º to cold due to complement-mediated lysis.

Infection: Malaria.

ASSOCIATIONS/RELATED

Parvovirus B19.

EPIDEMIOLOGY

Hereditary causes: Prevalent in African, Mediterranean and Middle Eastern populations.

Hereditary spherocytosis (HS): Most common inherited haemolytic anaemia in northern Europe.

HISTORY AND EXAMINATION

Depends on age: Jaundice and anaemia most common symptoms. Neonatal jaundice may require exchange transfusion. Older children may present with chronic anaemia. Hepatosplenomegaly and specific signs of underlying pathogenesis may also be present.

PATHOPHYSIOLOGY

Blood film(haemolytic anaemia): Leucoerythroblastic picture, microspherocytosis, macrocytosis, nucleated RBCs/reticulocytes, polychromasia.

Blood film (underlying cause): Spherocytes, elliptocytes, sickle cells, fragmented RBCs (DIC), malarial parasites, RBC Heinz bodies (G6PD deficiency).

INVESTIGATIONS

Bloods: ↓Hb, ↑MCV due to reticulocytes, ↑unconjugated bilirubin, ↑LDH, ↓haptoglobin, ↓red cell G6PD and pyruvate kinase assays, Hb electrophoresis (identifies variants).

Urine: ↑Urobilirubinogen 2˚ to excess unconjugated bilirubin, haemoglobinuria.

Direct Coombs’ test: Identifies RBCs coated with antibodies using antihuman globulin. Warm antibodies: IgG, agglutinate RBC sat 37º C. Coldantibodies: IgM, agglutinate RBCs at room temperature.

Osmotic fragility test: Detects membrane abnormalities (spherocytosis).

Ham’s test: PNH.

Bone marrow biopsy (rarely required): Erythroid hyperplasia; may be hypoplastic in PNH.

MANAGEMENT

Contributing factor avoidance: Cold exposure (cold antibodies, PNH), drugs (G6PD deficiency), transfusions, folate deficiency (HS), splenectomy (postpone until after childhood).

Autoimmune (warm): Prednisolone, splenectomy, azathioprine/cyclophosphamide.

PNH: Blood transfusions (leucocyte-depleted), anticoagulants for thrombotic episodes, bone marrow transplantation is successful in a small number of patients.

COMPLICATIONS

Renal failure may develop in all cases due to accumulation of RBC breakdown products in the renal tubules. PNH: Can transform into aplastic anaemia or leukaemia. HS: Gallstones, aplastic anaemia in parvovirus infection, megaloblastic and haemolytic crises (↓folate due to hyperactive bone marrow), leg ulcers and corneal opacities.

PROGNOSIS

Depends on the cause.

ANAEMIA, IRON DEFICIENCY

DEFINITION

↓Hb with low mean cell volume (MCV <80 fl) and depleted iron stores.

AETIOLOGY

WHO definition: Hb <11 g/dl (110 g/l) aged 1–2 years and <11.2 g/dl (112 g/l) aged 3–5 years.

General: Three stages in the pathogenesis: Fe2+ depletion → Fe2+-deficient erythropoiesis → Fe2+ deficiency anaemia.

↓dFe2+stores at birth: Prematurity, multiple pregnancy, perinatal bleeding, early umbilical cord clamping, and maternal Fe2+ deficiency.

Nutritional (inadequateFe2+supply): Exclusive breastfeeding >6/12 (insufficient Fe2+ in breast milk); early cow’s milk introduction (↓bioavailability of iron than breast milk and formula milk is fortified with 6 mg iron/l); excessive reliance on milk in the second year of life; ↑d infant fruit juice intake; strict vegetarian diet; behavioral (food refusal, grazing, dieting, eating disorders); Crohn’s disease, coeliac disease (↓d absorption).

↑dFe2+loss: Acute haemorrhage (Meckel’s diverticulum, intestinal duplication cyst, peptic ulcer); chronic haemorrhage (cow’s milk protein intolerance, intestinal duplication, IBD, telangiectasia, intestinal polyp); parasites (hookworm–Ancylostoma duodenale in developing countries); menstruation.

↑dFe2+demand: Growth; prematurity; IUGR; post malnutrition.

ASSOCIATIONS/RELATED

Inner city centres (UK) and Asian communities.

EPIDEMIOLOGY

Most common nutritional deficiency disorder worldwide. Incidence: 5–40% depending on community. Peak ages: 6 months to 3 years and adolescent girls. Uncommon in non-premature infants <6/12 (fetally acquired iron reserves).

HISTORY

General: Gradual onset; failure to thrive, poor exercise tolerance, global developmental delay, headaches, and irritability.

Behavioural: Anorexia, pica (ingestion of odd materials with ↑d Fe2+), irritability, impaired concentration, impaired progress at school.

EXAMINATION

General: Signs of anaemia (pallor of skin and mucous membranes, tachycardia) and systolic flow murmurs.

Rarely: Brittle nails and hair (↓epithelial cell iron), spoon-shaped nails (koilonychia), glossitis (atrophy of tongue papillae), angular stomatitis, mild hepatosplenomegaly and lymphadenopathy.

PATHOPHYSIOLOGY

Blood film: Microcytic, hypochromic (central pallor), anisocytosis (variable sizes), poikilocytosis (variable shapes).

INVESTIGATIONS

Bloods: ↓Hb, ↓serum ferritin, ↓serum Fe2+, ↑TIBC, ↓haematocrit, ↓MCV.

Hb electrophoresis: Exclude β-thalassaemia trait or Sickle cell disease.

Bone marrow (only in complicated cases): Erythroid hyperplasia and ↓ bone marrow Fe2+ or total absence of iron.

MANAGEMENT

Preterm: Fortify breast milk with Fe2+. Use Fe2+-fortified milk formula.

Infants: ↑ Highly absorbable haem iron sources (meat, fish) and sources of non-haem iron (such as grains) in vegetarian families. Enhance non-haem iron absorption by eating vitamin C-rich foods at the same meal.

Oral FeSO4: Maximum rise of Hb 0.25–0.4 g/dl/day.

Blood transfusion: Indicated with severe anaemia leading to CHF and cardiovascular compromise. Packed RBCs should be given slowly or partial exchange transfusion.

COMPLICATIONS

Possible impaired mental and psychomotor development. High output cardiac failure in severe cases.

PROGNOSIS

Good outcome if cause is nutritional or due to ↑d demand and promptaction is taken. If underlying GI cause, outcome dependent on underlying cause.

ANAEMIA OF PREMATURITY

DEFINITION

Normocytic, normochromic, hyporegenerative anaemiaina preterm infant associated with a low serum erythropoietin (EPO) level.

AETIOLOGY

Inadequate RBC production 2º to low EPO: EPO initially produced by the fetal liver then the kidneys nearer to term. Liver EPO production stimulated with ↑d degree of anaemia and hypoxia than for the fetal kidney. With the premature neonate RBC production ↓d as liver still 1º source of EPO production.

Shortened fetal RBC lifespan: Fetal RBCs have 50–66% of the lifespan of an adult RBC. 2 º to ↓d intracellular ATP, carnitine and enzyme activity combined with ↑d susceptibility to lipid peroxidation and fragmentation. At birth fetal haemoglobin represents 60–90% of haemoglobin. Adult levels of <5% by 3–6/12.

Blood loss: Intrapartum and aggravated by repeated blood sampling. A blood sampling can account for 10–15% of the total circulating volume.

Low iron stores: Combined with nutritional deficiencies of iron, vitamin E, vitamin B12 and folate may exaggerate the degree of anaemia.

Rarer pathological causes of anaemia in preterm infants

1. Haemolysis: 2º to ABO/Rh blood group incompatibility or haemoglobinopathies.

2. Bone marrow suppression: 2º to infection or renal failure.

3. Bone marrow failure : aplastic anaemia or malignancy.

ASSOCIATIONS/RELATED

Low birthweight, FHx. No association with sex/race.

EPIDEMIOLOGY

Frequency of anaemia of prematurity is inversely related to the gestational age and/or birthweight of the population. 50% of infants <32 weeks will develop symptoms secondary to this condition. Up to 80% of low-birthweight (<2.5 kg) infants require transfusions and 95% of extremely low birthweight (<1.25 kg).

HISTORY AND EXAMINATION

Symptoms and signs of anaemia in a preterm infant:

1. ↓d activity which is improved by transfusion.

2. Poor weight gain despite adequate calorie intake.

3. Tachypnoea, tachycardia, pallor and flow murmurs.

4. If severe, will result in respiratory depression; episodes of apnoea.

PATHOPHYSIOLOGY

See Aetiology.

INVESTIGATIONS

Bloods: Hb <10g/dl, normochromic, normocytic; normalplatelet countandwhite cell count.

Blood film: ↓Reticulocyte count (2˚ ↓ EPO), abnormal RBC forms (sickle cells, target cells in thalassaemia), red cell fragmentation (haemolysis).

Blood typing: ABO/Rh blood group incompatibility of neonate and mother.

MANAGEMENT

Indications for packed RBC transfusion:

1. Hb <8 g/dl.

2. Failure to thrive.

3. Cardiovascular/respiratory compromise.

4. Co-existing pathologies that may be exacerbated by anaemia.

Iron supplementation: May ↓ need for transfusion.

Recombinant EPO: Not advised (Cochrane review).

COMPLICATIONS

Transfusion-acquired infection, transfusion-associated fluid overload, electrolyte imbalances or haemolysis.

PROGNOSIS

Preterm infants are usually started on iron therapy for 2–3/12. Anaemia usually resolves spontaneously by 3–6/12, as adult haemoglobin is produced and intrinsic RBC/EPO production ↑s.

APPENDICITIS, ACUTE

DEFINITION

Acute inflammation of the vermiform appendix.

AETIOLOGY

Obstruction of the appendiceal lumen, causing a cycle of progressive inflammation and bacterial overgrowth.

ASSOCIATIONS/RELATED