1 / 33

Morning Report

Morning Report. March 22, 2011. Septic Arthritis. Most common organism? Staph Aureus Presentation? Acute Monoarthritis Erythema Warmth Swelling Intense pain on movement Fever – 70%. Septic Arthritis. Definitive Diagnostic Test? Joint fluid analysis and culture

osric
Download Presentation

Morning Report

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Morning Report March 22, 2011

  2. Septic Arthritis • Most common organism? • Staph Aureus • Presentation? • Acute • Monoarthritis • Erythema • Warmth • Swelling • Intense pain on movement • Fever – 70%

  3. Septic Arthritis • Definitive Diagnostic Test? • Joint fluid analysis and culture • Other labs or studies? • CBC • ESR/CRP • US • CT/MRI

  4. Septic Arthritis • Emergency? • Outcome depends of timing of diagnosis, initiation of antibiotics, adequacy of drainage, virulence and host factors

  5. Osteomyelitis • Presentation • Fever • Localized pain • Erythema • Swelling • Pinpoint tenderness • Decreased ROM

  6. Osteomyelitis • Diagnosis? • Bone scan • MRI • Bone Culture • Other labs? • WBC • ESR/CRP • Blood culture – 60% • Bone culture – 80% • Plain films

  7. Transient or Toxic Synovitis • Emergency? • Benign, self-limited • Causes? • Acute or post infection • Trauma • 30% of all nontraumatic limps

  8. Transient Synovitis • Presentation? • Limp • Painful hip • Afebrile or low-grade • Otherwise appears well • Mild restriction of ROM

  9. Transient Synovitis • Diagnosis? • Exclude septic arthritis and osteo • Four predictors associated with septic arthritis • History of fever • Inability to bear weight • ESR >40 • WBC >12

  10. Transient Synovitis • Treatment? • Rest • Anti-inflammatory • Most children do very well

  11. JIA • Definition of arthritis • Joint effusion + 2 of the following • Stress pain • Limited ROM • Increased warmth • JIA • One joint for at least 6 weeks • Cause • Host • Enviromental

  12. JIA • Oligo • Most common • Girls 1-3y • Large joints • Knee, ankle, wrist elbow • Morning stiffness • ANA + • Anterior uveitis

  13. JIA • Poly • Symmetric involvement • Small and large joints • Most RF – • RF+ are typically adolescent females and behave like adult RA • Systemic • Fevers • Evanescent rash • Salmon pink macules • Other • HSM, pericarditis, serositis, LAD

  14. JIA • Psoriatic • Knees and small joints of hands and feet • Look for the rash • Other • Nail changes or dactylitis • Enthesitis • More common in boys • Asymmetric lower limbs • Tendons of heel, plantar fascia or patella • May develop ankylosingspondylitis or other HLA-B27 diseases

  15. JIA • Diagnosis? • History and exam • Testing? • CBC • ESR/CRP • ANA • RF • Radiographs

  16. JIA • Treatment • Anti-inflammatories • Rheumatologist • Intra-articular corticosteroids • Disease modifying agents • MTX • Sulfasalazine • Biologics • PT

  17. Lyme Disease • Name of infective agent • Borreliaburgdorferi • Transmission • Ticks • Presentation • Erythemamigrans • Arthritis • May occur months to years after infection • Other • Meningitis, cranial nerve palsies, carditis, ocular involvement

  18. Lyme Disease • Diagnosis • History and PE • Lab testing • Culture • Stain • PCR • Blood, synovial fluid or synovial tissue • Serologic testing • IgG may remain positive for years

  19. Lyme Disease • Treatment • Antibiotics • Ceftriaxone or • Amoxicillin or • Doxycycline • Anti-inflammatories • Prognosis for children • Good

  20. Growing Pains • Definition • Intermittent • Nonarticular • Diagnosis • History and normal PE • Benign • Age range • 3-10y

  21. Growing Pains • Pain • At night • Limited to calf, thigh or shin • Short-lived • Alleviated by • Heat • Massage • Mild analgesics

  22. SCFE • Definition • Femoral head is displaced from the femoral neck • Typical patient • Overweight • Boy • 10-14y

  23. SCFE • History and PE • Trauma • Acute • Pain • Inability to walk • Subacute or Chronic • Pain • Limb held flexed and externally rotated • Passive internal rotation is painful

  24. SCFE • Diagnosis • Radiographs • Bilateral 30% • Treatment • Referral to ortho for repair • No weight bearing • Close follow up

  25. Legg-Calve-Perthes • Definition • Avascular necrosis of the capital femoral epiphysis • Typical patient • Boy • 4-10y

  26. Legg-Calve-Perthes • Presentation • Limp • Pain • Reduced hip ROM • Diagnosis • Radiographs • MRI • Early disease • Treatment • Refer to ortho • Splints • Casts • surgery

More Related