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NR 602 Midterm Exam Study Guide

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Topics 26-30: Cryptosporidium, Pyloric stenosis, Intussusception, Celiac Disease, & Juvenile Idiopathic Arthritis
Cryptosporidium 
Cryptosporidium is a parasite.  This is a living organism that live sin, or on, another organism.  It can infect bowels and cause cryptosporidiosis.  This is a form of bowel infection called Gastroenteritis, which leads to diarrhea and vomiting.  
In most healthy people, the infection produces a bout of watery diarrhea and will go away within a week or two.  Immunocompromised patients…This can be a life -threatening disease.
SSX: The first SSx usually appear within the week after infection
Watery diarrhea
Dehydration
Lack of appetite
Weight loss
Stomach cramps
Fever
N/V
Some people infected will have no symptoms.  
Preventing the spread with good hand hygiene, washing fruits and veggies, avoid fecal exposure, avoid contaminated water
Symptoms usually resolve on their own
Pyloric Stenosis
Characterized by hypertrophied pyloric muscle, causing narrowing of the pyloric sphincter.  
Occurs in 3/1000 births
Males >females
Familial
Common in first born Caucasian males
Clinical findings:
Regurgitation and NON projectile vomiting first few weeks of life
PROJECTILE vomiting at 2 to 3 weeks old
Insatiable appetite, with weight loss
Dehydration, constipation
Linked to erythromycin administration n first weeks of life
PE: 
Weight loss
Vomit that can contain blood
A distinct “olive” mass that is often palpated in the epigastrium to the right of the midline
Reverse peristalsis is seen
Diagnostics
US
Upper GI series shows a “string sign”
Management
Surgery (Pyloromyotomy) after correction of fluid balance
Prognosis is excellent
Intussusception
Thought to be the most frequent reason for intestinal obstruction in children
Most commonly occurs in children 5 to 10 months of age
Most common cause of intestinal obstruction in children 3 months to 6 yo
80% occur before age 2
Generally idiopathic in younger infants
Sometimes in older children, underlying medical predisposing factors: polyps, Meckel diverticulum, constipation, lymphomas, lipomas, parasites, rotavirus, adenovirus, and foreign bodies.
Can be a complication of CF.
Clinical Findings
Classic Triad: 1) intermittent colicky abdominal pain, 2) vomiting, 3) Bloody mucous stools
Episodic abd pain with vomiting every 5 to 30 minutes
Screaming and drawing legs up, with periods of calm or lethargy b/w episodes
“currant jelly” stools
Hx of URI common
Lethargy
PE
Child may appear glassy-eyed in b/w episodes
Sausage like mass may be felt in RUQ with emptiness in the RLQ (DANCE SIGN)
Abd is distended and tender
Guaiac + stools
Diagnostics
Abd flat plate can appear normal
Plain x ray may show sparse or no intestinal gas or stool with air fluid levels and distention in small bowel only
ABD US is very accurate in detecting intussusception and is TEST OF CHOICE
SHOWS “TARGET SIGN” and the “PSEUDO KIDNEY” SIGN
Management
Emergency: needs pedi radiologist and pedi surgeon
Rehydration, gastric decompression
Radiologic reduction using air contrast enema under fluoroscopy is the gold standard
Surgery is necessary if perforation, peritonitis
IV antibiotics should be given
Celiac Disease
An immune mediated systemic disorder
Triggered by dietary exposure to wheat gluten and related proteins in barley and rye
Typical presentations occur between 6 months and 2 years old
A complete dietary hx is needed:
Past surgery
Growth failure
Delayed puberty can coexist
Chronic diarrhea with frequent, large, foul-smelling, Pale stools
Excessive gas with gas distention
*Chronic or intermittent diarrhea, persistent or unexplained GI symptoms (N/V), weight loss, fatigue
Impaired growth, FTT, Unexplained iron deficiency anemia, abd distention, bloating, cramping
Tests
Serologic testing (Gluten should be eaten more than one meal every day for 6 weeks prior to testing)…IgA tissue transglutaminase antibody (tTGA) and IgA endomysial antibody (EMA)

If serology testing positive, refer for endoscopy with biopsy for definitive diagnosis

Bone density testing (bone problems may the first symptom of celiac disease)
Juvenile Idiopathic Arthritis (Page 551-554)
Subtypes
Oligoarticular: Characteristics: Four or less joints w/ persistent disease never having more than four-joint involvement and extended disease progressing to more than four joints within the first 6 months
Polyarticular (RF negative): Five or more joints with symmetrical involvement
Polyarticular (RF positive): Symmetric involvement of both small and large joints with erosive joint disease
Systemic: Either polyarticular or oligoarticular disease
Enthesitis-related arthritis: Weight bearing joints involved especially the hip and intertarsal joints and a hx of back pain, which is inflammatory in nature or sacroiliac joint involvement
Psoriatic arthritis: Asymmetric or symmetric small or large joints
Undifferentiated
Diagnosis requires a persistent arthritis for more than 6 weeks in a pediatric pt younger than 16 years old.
Underlying cause unclear
Heterogenous disorder
Likely environmentally induced in genetically predisposed individual
Oligoarticular JIA is the most common subtype
Affects Girls>Boys
Clinical Findings
Pain-generally a mild to moderate aching
Joint stiffness-worse in the morning and after rest; arthralgia may occur during the day
Joint effusion and warmth
Systemic symptoms found more commonly in systemic and polyarticular subtypes: anemia, anorexia, fever, fatigue, lymphadenopathy, salmon-colored rash, weight loss, growth disturbances rheumatoid nodules
PE:
Key Findings: 
Swelling of the joint with effusion or thickening of synovial membrane
Heat over the inflamed joint and tenderness along joint  line
Loss of ROM and function
Uveitis and decreased vision

Diagnostics:
JIA is a diagnosis of exclusion; NO diagnostic lab test for JIA
Useful tests include: CBC, ESR, CRP, Lyme titers, LFTs, ANA
MRI can help in managing joint pathologic conditions
Management
Refer to pediatric rheumatology
Ophthalmology referral if positive ANA
Therapy depends on the severity of the disease

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[Solved] NR 602 Midterm Exam Study Guide

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Topics 26-30: Cryptosporidium, Pyloric stenosis, Intussusception, Celiac Disease, & Juvenile Idiopathic Arthritis Cryptosporidium Cryptosporidium is a parasite. This is a living organism that live sin, or on, another organism. It can infect bowels and cause cryptosporidiosis. This is a form of bowel infection called Gastroenteritis, which leads to diarrhea and vomiting. In most healthy people, the infection produces a bout of watery diarrhea and will go away within a week or two. Immunocompromised patients…This can be a life -threatening disease. SSX: The first SSx usually appear within the week after infection Watery diarrhea Dehydration Lack of appetite Weight loss Stomach cramps Fever N/V Some people infected will have no symptoms. Preventing the spread with good hand hygiene, washing fruits and veggies, avoid fecal exposure, avoid contaminated water Symptoms usually resolve on their own Pyloric Stenosis Characterized by hypertrophied pyloric muscle, causing narrowing of the pyloric sphincter. Occurs in 3/1000 births Males >females Familial Common in first born Caucasian males Clinical findings: Regurgitation and NON projectile vomiting first few weeks of life PROJECTILE vomiting at 2 to 3 weeks old Insatiable appetite, with weight loss Dehydration, constipation Linked to erythromycin administration n first weeks of life PE: Weight loss Vomit that can contain blood A distinct “olive” mass that is often palpated in the epigastrium to the right of the midline Reverse peristalsis is seen Diagnostics US Upper GI series shows a “string sign” Management Surgery (Pyloromyotomy) after correction of fluid balance Prognosis is excellent Intussusception Thought to be the most frequent reason for intestinal obstruction in children Most commonly occurs in children 5 to 10 months of age Most common cause of intestinal obstruction in children 3 months to 6 yo 80% occur before age 2 Generally idiopathic in younger infants Sometimes in older children, underlying medical predisposing factors: polyps, Meckel diverticulum, constipation, lymphomas, lipomas, parasites, rotavirus, adenovirus, and foreign bodies. Can be a complication of CF. Clinical Findings Classic Triad: 1) intermittent colicky abdominal pain, 2) vomiting, 3) Bloody mucous stools Episodic abd pain with vomiting every 5 to 30 minutes Screaming and drawing legs up, with periods of calm or lethargy b/w episodes “currant jelly” stools Hx of URI common Lethargy PE Child may appear glassy-eyed in b/w episodes Sausage like mass may be felt in RUQ with emptiness in the RLQ (DANCE SIGN) Abd is distended and tender Guaiac + stools Diagnostics Abd flat plate can...
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