How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why? Pediatric patients who present with swelling of the hands and feet must initially be assessed for any musculoskeletal or rheumatologic diseases (Kimura & Southwood, 2018). The differential for childhood joint pain and swelling is very large and includes benign and serious conditions (Kimura & Southwood, 2018). The possible differentials range from avascular necrosis, reactive and postinfectious arthritis, trauma, hematologic, Rickets, metabolic and endocrine disorders, infection, tumors, and systemic rheumatologic diseases such as Kawasaki and lupus (Kimura & Southwood, 2018). Important elements of the pediatric history for swollen hands and feet are presence of fever; pain characterization, including the site, number of joints involved, severity, frequency, duration and pattern of pain; the characterization of the swelling as well as the presence of warmth and discoloration; presence of precipitating factors, such as trauma history; review of systems focusing on history of rash, weight loss, abdominal pain, and ocular abnormalities; other medical conditions such as inflammatory bowel disease, chronic lung or cardiac disease with hypoxia, uveitis, psoriasis, and cystic fibrosis; and any family history for conditions such as autoimmune disorders or inflammatory disorders (Kimura & Southwood, 2018). Evaluation of the pediatric patient with joint swelling and fever would surely narrow down the diagnosis to possible septic arthritis, noninfectious diseases including juvenile idiopathic arthritis, or Kawasaki disease (Kimura & Southwood, 2018). The location of the swelling could also help narrow the diagnosis down. Single joint involvement can indicate bacterial infections or significant trauma and multiple joint involvement can indicate not only bacterial infection, but connective tissue disorders such as SLE, JIA and inflammatory bowel diseases-associated arthritis (Kimura & Southwood, 2018). The pattern of pain such as migratory pain or specific time of day can indicate rheumatic fever or specific types of arthritis (Kimura & Southwood, 2018). Timing of pain can also help such as rapid onset indicating urgent issues such as septic arthritis, osteomyelitis, and vasculitis (Kimura & Southwood, 2018). Questions regarding recent infections can give information that could lead
to the diagnosis of Rheumatic fever or Kawasaki diseases as well as reactive arthritis (Kimura & Southwood, 2018). Next would be a full review of systems and physical examination paying close attention to past medical history, birth history, family history, warmth of joints, color of joints, blood flow to joints via pulse assessment and capillary refill, muscle strength, ability to bear weight, pitting edema, third spacing, or skin breakdown (Kimura & Southwood, 2018).
- Summer '17
- Sickle-cell disease, MIAH, NSG6435 Week 5 Discussion