Ventriculoperitoneal shunt complications - Revision history

Jonrako at 02:59, 8 August 2021

2021-08-08T02:59:18Z

← Older revision		Revision as of 02:59, 8 August 2021
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	==Evaluation==		==Evaluation==
	[[File:NormalVPshunt.jpg\|thumb\|Slit-like ventricles is to be ~~expected~~ in a functioning shunt]]		[[File:NormalVPshunt.jpg\|thumb\|Slit-like ventricles are expected to be seen on CT in a well-functioning shunt]]
	*CBC, Chem7, coags		*CBC, Chem7, coags
	*Blood cultures		*Blood cultures

Jonrako at 02:57, 8 August 2021

2021-08-08T02:57:16Z

← Older revision		Revision as of 02:57, 8 August 2021
Line 39:		Line 39:

	==Evaluation==		==Evaluation==
	[[File:NormalVPshunt.jpg\|thumb]]		[[File:NormalVPshunt.jpg\|thumb\|Slit-like ventricles is to be expected in a functioning shunt]]
	*CBC, Chem7, coags		*CBC, Chem7, coags
	*Blood cultures		*Blood cultures

Jonrako at 02:16, 8 August 2021

2021-08-08T02:16:03Z

← Older revision		Revision as of 02:16, 8 August 2021
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	==Evaluation==		==Evaluation==
			[[File:NormalVPshunt.jpg\|thumb]]
	*CBC, Chem7, coags		*CBC, Chem7, coags
	*Blood cultures		*Blood cultures

Rossdonaldson1: /* Clinical Features */

2021-03-11T17:29:16Z

Clinical Features

← Older revision		Revision as of 17:29, 11 March 2021
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	==Clinical Features==		==Clinical Features==
	*~~Develop~~ over several days		*Typically develop over several days

	===Adults===		===Adults===
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	*[[nausea and vomiting (peds)\|Vomiting]], irritability, [[bulging fontanelle]]		*[[nausea and vomiting (peds)\|Vomiting]], irritability, [[bulging fontanelle]]
	**Often '''very subtle''': a caregiver-reported change in behavior predicts malfunction		**Often '''very subtle''': a caregiver-reported change in behavior predicts malfunction


	===Physical Exam===		===Physical Exam===

Rossdonaldson1: Rossdonaldson1 moved page Ventriculoperitoneal shunt problems to Ventriculoperitoneal shunt complications

2021-03-11T17:27:01Z

Rossdonaldson1 moved page Ventriculoperitoneal shunt problems to Ventriculoperitoneal shunt complications

← Older revision	Revision as of 17:27, 11 March 2021
(No difference)

ClaireLewis at 23:51, 1 October 2019

2019-10-01T23:51:08Z

← Older revision		Revision as of 23:51, 1 October 2019
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	===Adults===		===Adults===
	*Cephalgia, [[nausea and vomiting]], lethargy, [[ataxia]], [[altered mental status]]		*[[headache\|Cephalgia]], [[nausea and vomiting]], [[lethargy]], [[ataxia]], [[altered mental status]]
	*Paralysis of upward gaze ("sunset eyes"), dilated pupils, [[cranial nerve palsies]]		*Paralysis of upward gaze ("sunset eyes"), dilated pupils, [[cranial nerve palsies]]

	===Infants===		===Infants===
	*Vomiting, irritability, bulging fontanelle		*[[nausea and vomiting (peds)\|Vomiting]], irritability, [[bulging fontanelle]]
	**Often '''very subtle''': a caregiver-reported change in behavior predicts malfunction		**Often '''very subtle''': a caregiver-reported change in behavior predicts malfunction


			===Physical Exam===
			*Neither sensitive nor specific
			*[[AMS\|Decreased level of consciousness]], erythema along shunt tract, [[bulging fontanelle]], [[nausea/vomiting]], irritability should raise suspicion
			*Valve chamber abnormality
			**Gently compress chamber and observe for refill
			**Difficulty compressing chamber indicates distal flow obstruction
			**Slow refill (>3s) indicates proximal obstruction

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*Physical Exam
	**Neither Sn nor Sp
	**Decreased level of consciousness, erythema along shunt tract, buldging fontanel, nausea/vomiting, irritability should raise suspicion
	*Valve chamber abnormality
	**Gently compress chamber and observe for refill
	**Difficulty compressing chamber indicates distal flow obstruction
	**Slow refill (>3s) indicates proximal obstruction
	~~===Work Up===~~
	*CBC, Chem7, coags		*CBC, Chem7, coags
	*Blood cultures		*Blood cultures
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	***AP and lateral skull, AP chest and abdomen		***AP and lateral skull, AP chest and abdomen
	***Identifies kinking, migration, or disconnection		***Identifies kinking, migration, or disconnection
	**CT		**[[head CT\|CT]]
	***Needed to evaluate ventricular size (if larger, concerning for elevated ICP)		***Needed to evaluate ventricular size (if larger, concerning for elevated ICP)
	***Very helpful to compare to previous study (many patients with shunts have abnormal baseline)		***Very helpful to compare to previous study (many patients with shunts have abnormal baseline)
	***One-third of patients with shunt malfunction will have normal head CT{{Citation needed\|reason=Reliable source needed\|date=March 2016}}		***One-third of patients with shunt malfunction will have normal head CT{{Citation needed\|reason=Reliable source needed\|date=March 2016}}
	**US		**[[Ultrasound]]
	***If the baby has an open fontanelle, you may use US		***If the baby has an open fontanelle, you may use US
	***Some literature for [[ultrasound]] of optic nerve diameter (if normal (3.3cm), lower chance of elevated ICP){{Citation needed\|reason=Reliable source needed\|date=March 2016}}		***Some literature for [[ultrasound]] of optic nerve diameter (if normal (3.3cm), lower chance of elevated ICP){{Citation needed\|reason=Reliable source needed\|date=March 2016}}

Rossdonaldson1: Text replacement - " US " to " ultrasound "

2016-11-13T20:47:24Z

Text replacement - " US " to " ultrasound "

← Older revision		Revision as of 20:47, 13 November 2016
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	**US		**US
	***If the baby has an open fontanelle, you may use US		***If the baby has an open fontanelle, you may use US
	***Some literature for US of optic nerve diameter (if normal (3.3cm), lower chance of elevated ICP){{Citation needed\|reason=Reliable source needed\|date=March 2016}}		***Some literature for [[ultrasound]] of optic nerve diameter (if normal (3.3cm), lower chance of elevated ICP){{Citation needed\|reason=Reliable source needed\|date=March 2016}}

	==Management==		==Management==

Rossdonaldson1: /* Management */

2016-08-29T01:17:53Z

Management

← Older revision		Revision as of 01:17, 29 August 2016
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	*Revisions are extremely common, low threshold to contact Neurosurgery		*Revisions are extremely common, low threshold to contact Neurosurgery
	*[[Ventriculoperitoneal shunt drainage]]		*[[Ventriculoperitoneal shunt drainage]]

			==Disposition==

	==See Also==		==See Also==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T19:42:30Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 19:42, 26 July 2016
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	**Can lead to occlusion and/or abdominal pain (depending on size)		**Can lead to occlusion and/or abdominal pain (depending on size)

	==~~Diagnosis~~==		==Evaluation==
	*Physical Exam		*Physical Exam
	**Neither Sn nor Sp		**Neither Sn nor Sp

ClaireLewis: /* Diagnosis */

2016-07-14T22:35:38Z

Diagnosis

← Older revision		Revision as of 22:35, 14 July 2016
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	*Physical Exam		*Physical Exam
	**Neither Sn nor Sp		**Neither Sn nor Sp
	**Decreased level of consciousness, erythema along shunt tract, buldging fontanel, n/v, irritability should raise suspicion		**Decreased level of consciousness, erythema along shunt tract, buldging fontanel, nausea/vomiting, irritability should raise suspicion
	*Valve chamber abnormality		*Valve chamber abnormality
	**Gently compress chamber and observe for refill		**Gently compress chamber and observe for refill