E

Eczema (Atopic Dermatitis)

• Definition: Chronic inflammatory skin disorder characterized by pruritus, xerosis, and eczematous lesions.

• Epidemiology: Most common in infants and children; often associated with atopy (asthma, allergic rhinitis).

• Clinical Features:

  • Infants: Face, scalp, extensor surfaces.

  • Older children: Flexural surfaces (antecubital fossa, popliteal fossa).

  • Lichenification, excoriations, and oozing in chronic cases.

• Investigations: Primarily clinical; allergy testing may be indicated.

• Management:

  • Emollients, topical corticosteroids, topical calcineurin inhibitors (tacrolimus).

  • Avoid triggers (soaps, irritants, allergens).

  • Severe cases: Systemic immunomodulators (methotrexate, cyclosporine).

• Complications: Secondary bacterial infection (S. aureus), sleep disturbance, psychological impact.

Electrolyte Imbalance

• Definition: Abnormal serum levels of sodium, potassium, calcium, magnesium, or phosphate affecting homeostasis.

• Common Pediatric Causes:

  • Sodium: Diarrhea, vomiting, renal disease.

  • Potassium: DKA, renal tubular disorders, medication effects.

  • Calcium: Hypoparathyroidism, vitamin D deficiency.

• Clinical Features: Lethargy, seizures, arrhythmias, muscle weakness, tetany.

• Investigations: Serum electrolytes, ABG, renal function tests.

• Management: Treat underlying cause; carefully correct imbalances IV or orally.

Emesis (Vomiting in Children)

• Definition: Forceful expulsion of gastric contents through the mouth.

• Etiologies:

  • Gastrointestinal: Gastroenteritis, obstruction (pyloric stenosis, malrotation).

  • Metabolic: Uremia, diabetic ketoacidosis.

  • Neurologic: Raised ICP, infections.

  • Infectious: Meningitis, sepsis.

• Clinical Assessment: Frequency, bilious/non-bilious, presence of blood or coffee-ground material.

• Complications: Dehydration, electrolyte disturbances, malnutrition.

• Management: Supportive hydration, antiemetics (ondansetron), treat underlying cause.

Encopresis

• Definition: Repeated voluntary or involuntary passage of feces in inappropriate places in children >4 years.

• Etiology: Functional constipation, psychological stress, neurologic disorders.

• Clinical Features: Fecal soiling, abdominal pain, hard stools.

• Investigations: Mainly clinical; abdominal X-ray if impacted stool suspected.

• Management:

  • Behavioral therapy, scheduled toileting.

  • Laxatives for stool softening (polyethylene glycol, lactulose).

  • Parental education and support.

Enuresis

• Definition: Recurrent involuntary urination at night (nocturnal) or daytime in children >5 years.

• Types:

  • Primary: Never achieved continence.

  • Secondary: Occurs after a period of dryness.

• Etiology: Genetic, bladder dysfunction, sleep arousal issues, urinary tract infection, psychological factors.

• Investigations: Urinalysis, renal ultrasound, bladder diary.

• Management:

  • Behavioral: Fluid restriction at night, enuresis alarms.

  • Pharmacologic: Desmopressin, anticholinergics if overactive bladder.

Epiglottitis

• Definition: Acute inflammation of the epiglottis causing upper airway obstruction.

• Etiology: Historically Haemophilus influenzae type b; now rare due to Hib vaccination.

• Clinical Features: Sudden onset fever, sore throat, drooling, tripod posture, muffled voice, inspiratory stridor.

• Investigations: Lateral neck X-ray (“thumb sign”), rapid airway assessment.

• Management:

  • Emergency airway stabilization (do not attempt throat exam before airway secured).

  • IV antibiotics (ceftriaxone).

  • ICU monitoring.

• Complications: Respiratory failure, sepsis, death if untreated.

Epilepsy

• Definition: Chronic neurological disorder characterized by recurrent unprovoked seizures.

• Classification:

  • Focal (partial) vs generalized seizures.

  • Syndromes: Childhood absence epilepsy, Lennox-Gastaut, West syndrome.

• Clinical Features: Vary by seizure type (staring spells, convulsions, myoclonic jerks).

• Investigations: EEG, MRI brain, metabolic/genetic testing in syndromic cases.

• Management:

  • First-line: Antiepileptic drugs (valproate, carbamazepine, levetiracetam).

  • Refractory: Ketogenic diet, epilepsy surgery.

• Special Considerations: Monitor growth, cognitive development, psychosocial impact.

Exanthematous Fever (Viral Rash)

• Definition: Fever associated with characteristic skin rashes caused by viral infections.

• Common Pediatric Causes:

  • Measles (Rubeola) – Koplik spots, cephalocaudal spread.

  • Rubella – mild fever, postauricular lymphadenopathy, fine rash.

  • Roseola (HHV-6) – high fever followed by sudden rash.

  • Varicella – vesicular lesions in crops.

• Management: Supportive, vaccination prevents severe disease.

Exostoses

• Definition: Benign bony growths on the surface of bones, often found in children and adolescents.

• Etiology: Usually hereditary (multiple hereditary exostoses) or sporadic.

• Clinical Features: Painless bony prominences, possible nerve or tendon impingement.

• Investigations: X-ray, sometimes MRI if symptomatic.

• Management: Observation if asymptomatic; surgical excision if painful or limiting function.

Extrahepatic Biliary Atresia

• Definition: Congenital obliteration or discontinuity of extrahepatic biliary system.

• Clinical Features: Persistent neonatal jaundice, acholic stools, dark urine, hepatomegaly.

• Investigations:

  • Ultrasound (absent or small gallbladder).

  • HIDA scan (no biliary excretion).

  • Liver biopsy (bile duct proliferation, fibrosis).

• Management:

  • Kasai portoenterostomy (surgical intervention before 60 days).

  • Liver transplant in progressive liver failure.

Erythema Multiforme

• Definition: Acute, immune-mediated skin condition with target lesions.

• Etiology: Often triggered by infections (HSV), drugs, or idiopathic.

• Clinical Features: Symmetric, round, red lesions with central clearing; may involve mucous membranes.

• Investigations: Clinical diagnosis; biopsy rarely needed.

• Management:

  • Mild: Symptomatic treatment (antihistamines, topical steroids).

  • Severe (Stevens-Johnson syndrome): Hospitalization, supportive care.

Erythroblastosis Fetalis

• Definition: Hemolytic disease of the newborn caused by maternal-fetal blood group incompatibility (usually Rh or ABO).

• Clinical Features: Jaundice, anemia, hepatosplenomegaly, hydrops fetalis.

• Investigations: Direct Coombs test, bilirubin levels, hemoglobin, reticulocyte count.

• Management:

  • Intrauterine transfusions if severe.

  • Phototherapy for hyperbilirubinemia.

  • Exchange transfusions in critical cases.

• Prevention: Anti-D immunoglobulin prophylaxis in Rh-negative mothers.

Esophageal Atresia

• Definition: Congenital discontinuity of the esophagus with or without tracheoesophageal fistula (TEF).

• Clinical Features: Excessive salivation, choking, cyanosis during feeds, inability to pass nasogastric tube.

• Investigations: Chest and abdominal X-ray with NG tube in situ.

• Management: Surgical repair after stabilization; preoperative prevention of aspiration.

• Complications: Anastomotic leak, stricture, gastroesophageal reflux.

Exotropia (Strabismus)

• Definition: Outward deviation of one or both eyes.

• Etiology: Congenital, accommodative, cranial nerve palsy.

• Clinical Features: Misalignment, diplopia, amblyopia risk if untreated.

• Investigations: Cover-uncover test, Hirschberg test, ophthalmology referral.

• Management: Glasses, patch therapy, surgery if persistent.