Wednesday, February 10, 2010

Hepatitis C

This is a virus that is indistinguishable from the signs and symptoms of Hepatitis A and B. The only way to differentiate this is to obtain a blood work for the hepatitis panel.

Signs and Symptoms:
  • fever
  • malaise
  • anorexia
  • nausea
  • vomiting
  • jaundice
  • hepatitis
  • asymptomatic

They noticed that jaundice secondary to Hepatitis C occurs less than 20% of the time and abnormalities in liver function is less pronounced as compared to Hepatitis B. Persistent infection in children occur 50-60% of the time but most children are asymptomatic. Studies on therapy has been limited and the available mode of treatment is only effective half of the time. With advancing age people who have chronic hepatitis C infection are a a risk of developing chronic hepatitis and possible cirrhosis or hepatocellular carcinoma. Children with chronic infection should be screened periodically.

There is a 5% chance an infant of an infected mother would acquire the infection. The anti-HCV test should not be performed until after 18 months of age because it might result in a false positive because of passive maternal antibody which is present in their bloodstream.

Resource: The Redbook by the American Academy of Pediatrics

Monday, February 1, 2010

What is Intussusception?

This is the most common cause of intestinal obstruction from 3 months of age to 6 years old. This usually involves the lower gastrointestinal tract resulting in a telescoping of the more proximal part into the distal portion of the gut. There is a male to female predominance as 4:1. As a pediatrician this is one of the differential diagnosis we think of once babies are inconsolable .

Signs and Symptoms:
  • sudden onset of severe paroxysmal colicky pain
  • infant looks normal in between episodes
  • this can be accompanied by straining and loud cries
  • if this is not reduced the infant will become progressively weak and lethargic
  • vomiting may occur early in the course
  • blood may start passing within the first 12 hours which is called the currant jelly stool because mucous and blood are intermixed together, but this might not occur in 1-2 days in some cases


The history and physical is usually sufficient to diagnose this entity. Plain abdominal x-ray maybe warranted to show signs of obstruction. Barium enema will show a filling defect resulting from the obstruction.

Differential Diagnosis:

It is particularly difficult to sometimes differentiate this from gastroenteritis. Meckel's diverticulm is usually painless with bloody stools. The bloody stools from Henoch-Schonlein Purpura usually have joint pains.


This is considered an emergency procedure once diagnosis is certain and if there are no signs of shock or dehydration reduction by using an air enema is thetreatment of choice if not exploratory laparotomy with manual reduction by the surgeon is indicated.