How Good is Cholecystectomy For Biliary Dyskinesia in Pediatric Patients?
Discussion Biliary disease includes gallstones, cholecystitis (inflammation of the gallbladder), cholangiopathy and cholangitis (pathology of the bile ducts), biliary dyskinesia, gangrene, and cancer. Some are often overlapping as gallstones often contributing to cholecystitis and cholangitis. Biliary dyskinesia (BD) is well-recognized in adults. Adult criteria include: “abdominal pain located in the epigastrium and/or right upper quadrant along with; buildup of pain to a steady level and lasting 30 minutes or longer, pain occurring at different intervals and not daily, severe enough to interrupt activities or lead t...
Source: PediatricEducation.org - January 30, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Potential Treatments for Hyperacusis?
Discussion Hearing is functional in human fetuses at approximately 25-27 weeks gestation.. The aural anatomical structures are developed by ~32 weeks gestation. Hyperacusis does not have a specific definition but in general is an increased sensitivity to sounds (either intensity or loudness). Some authors describe it as “…decreased sound tolerance where there is a negative reaction to the physical characteristics of the sound,” and other authors use “…increased sensitivity to sound in levels that would not trouble a normal individual.” Phonophobia is a true fear of sounds with anticipati...
Source: PediatricEducation.org - January 23, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Common Dietary Fermentable Carbohydrates?
Discussion Parents may often come to the pediatrician for concerns about crying and colic, increased belching, abdominal distention, increased flatulence, abdominal pain or stool changes. They complain of increased “gassiness,” which could mean any or a combination of these problems, or something different that they believe is referred to the abdomen. In newborns parents’ intolerance for crying and normal changes in the abdomen (e.g. appearing larger or smaller) may have them complain of “gassiness” but they do not mean actual belching or flatulence. In older children, parents may state that t...
Source: PediatricEducation.org - January 16, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is An Emotional Support Animal?
Discussion Humans have had animals in their lives for millennia. Domesticated animals have been used for work, food, protection, and companionship among other activities. Dogs are a common species that are trained for a myriad of tasks including providing therapeutic benefits to persons with permanent or temporary disabilities including persons with psychiatric problems. The utilization of animals in medical/psychiatric therapeutic treatment programs is known as animal assisted activities (AAA) and animal assisted therapy (AAT). These programs have at least a 225-year history of being used. AAA tend to focus on recreation ...
Source: PediatricEducation.org - January 9, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Happy Holidays
PediatricEducation.org is taking a year end break and will return on January 9, 2023. We wish everyone a happy and safe holiday season and all the best in the New Year. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - December 26, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Do Epsom Salts Help?
Discussion Epsom salt is magnesium sulfate. It is named Epsom from the town in England, close to London where it was supposedly discovered. Magnesium is an important trace element. It is a co-factor for ATP metabolism, DNA and RNA synthesis and regulation, and multiple other enzymatic reactions. Hypermagnesemia is quite uncommon and usually would occur because of renal insufficiency or being iatrogenically produced. Hypomagnesemia is a serum concentration of < 0.75 mmol/L. Symptoms are often non-specific such as lethargy, anxiety, headache, decreased appetite, nausea and sleeping problems. Muscle spasms and muscle assoc...
Source: PediatricEducation.org - December 19, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is Diastasis Recti Abdominis?
Discussion Ventral wall hernias are common. They can be congenital or acquired and it is estimated that approximately 25% of people will have one at some point in their life. True hernias have a fascial defect and therefore contents can protrude through and potentially become incarcerated and/or strangulated. Common ones include: Epigastric occurs between the sternum and umbilicus. It can appear midline or slightly off-center. In children they can spontaneously resole. Umbilical occurs around the umbilical structures. These again often spontaneously resolve. Spigelian occurs in anterior abdominal wall adjacent to the semi...
Source: PediatricEducation.org - December 12, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is the Current Classification for Ehlers-Danlos Syndrome?
Discussion As with any potential problem there is a often a range from normal to abnormal and this is true for joint hypermobility. Generalized joint hypermobility is hypermobility in multiple joints with few or no other symptoms. Generalized hypermobility spectrum disorder (also known as joint hypermobility syndrome) has hypermobility along with other symptoms such as pain, reduced muscle strength, and decreased proprioception and balance. Other clinical entities with hypermobility include Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta. In the office, a 5-point questionnaire with 2 or more “yes...
Source: PediatricEducation.org - December 5, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How is Endometriosis Diagnosed?
Discussion Endometriosis is classically defined as endometrial tissue occurring outside the uterine lining. It is a common cause of chronic pelvic pain and dysmenorrhea in adolescents. It can present differently in adolescents than adult women and usually can appear like many other common problems such as chronic constipation or gastrointestinal dysmotility. It is estimated that ~25-38% of adolescents with chronic pelvic pain have endometriosis. Use of clinical criteria versus laparoscopic documentation of disease makes the epidemiology of this problem more challenging. The cause is not wholly agreed upon but many believe ...
Source: PediatricEducation.org - November 28, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Is This Primary Exertional Headache?
Discussion Commonly occurring primary headaches include tension, cluster and migraine headaches. “Other primary headaches” are often situational. Patients can have more than 1 type of these “other” headaches along with more common headaches. Other primary headaches as a group tend to be self-limited with long remission periods. Some other primary headaches include: Thunderclap headache Explosive sudden onset with maximum intensity in less 1 minute and resolution within 5 minutes usually 43/100,000 persons in adults Primary or secondary Secondary causes include intracranial hemorrhage, stroke, thro...
Source: PediatricEducation.org - November 21, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Potential Benefits and Risks of Premasticated Foods?
Discussion Premastication is the prechewing of foods or medicines by another person before feeding to an infant. It is also used to pretaste or temperature test foods. It was a common practice for millennia, especially before modern food technology, as a way to transition an infant from a solely liquid based diet to a mixed diet mainly of solid food. Rates of premastication vary, with less developed countries having an increased incidence/prevalence (up to 50%) but it is not uncommon in developed countries (in the US 14% is reported). Saliva is also used to clean other people, treat cuts/itches or insect bites as well. Pla...
Source: PediatricEducation.org - November 14, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is a Dilated Pore of Winer?
Discussion Dilated pore of Winer (DPW) was first described by Louis H. Winer in 1954 in his article entitled “The Dilated Pore, A Trichepithelioma.” It is a benign follicular tumor with particular histopathological characteristics. Its’ differential diagnosis includes: Comedomal acne Pilar sheath acanthoma – seen as a solitary papule with keratin plug on the central area of face Nevus comedomes – multiple dark comedomes with central dilated dark openings Epidermal inclusion cysts – more nodular with or without keratin plug where the keratin material has a foul odor Tricofolliculoma Basa...
Source: PediatricEducation.org - November 7, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Anal Itching?
Discussion Pinworms are caused by the parasite Enterobius vermicularis. Humans are the only known reservoir and are infected by fecal-oral transmission of eggs or indirectly such as through contaminated clothing or bedding. It is commonly seen in children and can easily pass to family members, plus people can become easily reinfected. The incubation period is usually 1-2 months and eggs can survive outside humans for 2-3 weeks. Adult worms migrate at night from the anus to the perianal skin and vulvar areas causing anal or vulvar itching. The itching can cause sleep problems and scratching can cause secondary bacterial inf...
Source: PediatricEducation.org - October 31, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Can a Consultation Be Made Better?
Discussion Most physicians go into medicine because they like people and want to help them and their families. Clinical patient care can also be fun, interesting, intellectually challenging and provide a creative outlet. All physicians will never know everything and need help with patient care problems that arise. That is when a patient should be referred for a consultation. Effective consultations have several important components which can be overlooked. When clear questions with background information are asked and the consultant provides specific clear recommendations answering the question but also planning for contin...
Source: PediatricEducation.org - October 24, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Which Side Are the Organs On?
Discussion Although externally vertebrates present with bilateral symmetry, this is not necessarily true internally for humans. Humans have a normal left-right asymmetry of their internal organs. For example, the right lung has 3 lobes and is slightly larger than the left lung with 2 lobes. The normal asymmetry is called situs solitus (SS). Complete reversal of the normal abdominal and thoracic organ positions is called situs inversus totalis (SIT). Variations on the laterality between situs solitus and SIT has been referred to by different names including situs ambiguous or heterotaxy. For this case, the term situs ambigu...
Source: PediatricEducation.org - October 17, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news