Paeds Attachment Week 3

1) 17d/o female baby came in on week 1 of my attachment, complaint of persistent vomiting for past 1 week after feeding. the vomitus was non bilious, mainly milk and water. one of the consultant witnessed her projectile vomiting was she vomited onto the pants of the consultant. her blood was alkolotic as a result of the vomiting the other consultant did a test feed(ie palpation after feeding) to look for pyloric stenosis, but no mass was palpated. a palpable pylorus on the right to the umbilicus would indicate a positive test feed. normally, pyloric stenosis is more common in baby boy of 6months with family history. this baby girl wasnt fit with any of the risks. she was then sent to do ultrasound scanning after that but it was negative. a second opinion was taken from another radiologist, a second ultrasound was done to pick up any chances of pyloric stenosis. however, the second scan was again negative. the consultant was trying to work out the cause of her vomiting. they changed the type of milk to feed her and the vomiting seem to be settle down a little bit and the baby was starting to gain her weight. she was sent home at the end of week2 but re-admitted on week3 with the same complaint. her mum was very worried and once again a third ultrasound scan was done. and... finally this time, the radiologist picked up a thicken pylorus of a diameter of 11.7mm and, mucsle thickness of 4.3mm. this girl was then send to the other hopsital for pyloromyotomy.
2) 5y/o young boy, came in over the weekend, with the complaint on 1 day diarrhoea and 4times vomit and 3days of abdominal pain. on examination of the abdomen, there was no guarding, soft & non tender. blood test showed a high CRP of 209 & raised white cell count. this boy was given a conservative management to maintain his fluid balance for the next day. however, there was still persisting suprapubic pain and with a spike of temperature on the second day of admission. the surgeons came in to review him but they thought it was just an acute gastroenteritis as his brother was having diarrhoea and vomiting as well. however, the paeds consultant was not convinced to let him home as his CRP was still 109 with persisting pain when he passed urine. he ordered an abdominal ultrasound scan after seeing him on monday ward round. the ultrasound scan showed a mass close to the bladder in the pelvic area, the radiologist proposed a CT scan for him. and the CT showed an appendicular mass, suspected as an appendicular abscess. the paeds consultant was relieved as they could pick it up although the surgical team had missed it. this boy was then sent to the theatre immediately to drain his abscess and he'd a wash to clean his abdominal cavity to prevent further infection.
3) 8w/o baby girl came in because of neonatal abstinence syndrome as her mum was taking methadone(one type of opiod) during pregnancy. she has been in the hospital since birth but i only seen her the first time in my 3rd week of attachment. to prevent her from having withdrawal syndrome, she was taking regular oromorph(one type of morphine) with reducing dosage over period of time. her mum was found to be HCV positive (i suspect that she got it thru sharing needle) and this baby would have to do a HCV PCR test 3-6months later after the window period. she just had her first immunisation yesterday, it was delayed because of her neonatal abstinence syndrome. on top of that, she has congenital umbilical hernia but it wasnt a problem to her at the moment. the baby has very serious social problems and the parents did not come and visit her throughout her admission. her only guardian was her grandma but her grandma did not visit her very often. her main carers at this moment were the nurses in the ward. the social nurses were trying to get hold of the family members as she has no other reasons to stay in the ward once she is out from her oromorph. the plan now is to make her guardian to come in on friday to look after her 24hr til saturday. and discuss with the nurses on any problems handling this baby on sunday. and the baby can be discharged next mon.