سشنات د.ندى

Pediatricc 6th stage

Session notes د.ندى العلي
Edema :
It is edema or not ?
It may be due to steroid , allergy , underlying causes
Is this edema localized or generalized
If generalized the most common cause is nephrotic
Then protein osin enteropathy , cardic and liver
Pathophysiology :
Increased hydrostatic pressure
Acute nephritic syndrome
Congestive cardiac failure
Decreased plasma oncotic pressure
Protein calorie malnutrition, Nephrotic syndrome; protein loosing enteropathy
Increased capillary leakage
Allergy, sepsis, angiooedema.
Impaired venous flow
Vanacaval obstruction, hepatic vein obstruction
Impaired lymphatic flow
Congenital lymphedema, Wuchereria bancrofti infection


Clinical approach in renal :
Periorbital edema , history of collagen vascular disesase ( SLE , RA
Rash , joint pain frothy urine protein urea
Cardiac :
Palptation ask about it if > 3 years
Ask about faintaing , bluish episode TOF , Protein energy malnutrition chronic illness persistent diarrhea ,
Hepatic :
Jaundice , umbliical pain neonatal sepsis

Acute diarrheoa :

Acute < 14 days
Chronic > 14 days
< 60 of body weight marsmus without edema
> 60 protracted or persistent diarrheoa with no edema

Important question to ask in acute diarrheoa

1.fever

2. Blood in stool shiga , campylobacter , E.ameoba histolytica in shigillosis is ( acute , fever , bloody) diarrheoa

Acute not bloody diarrheoa , watery

Most common cause Rotal v. 60 % Rarely cause
bloody diarrhea


4-6 month at least breast milk

Sign of breast milk adequcey

a well-hydrated infant voids six to eight times a day. Each voiding should soak, not merely moisten, a diaper, and urine should be colorless.
Stool : By 5 to 7 days, loose yellow stools should be passed at least four times a day.
Growth: Rate of weight gain provides the most objective indicator of adequate milk intake.

Sign of mothers :

Led down reflex and engorgement of breast

The way of sterilization

First wash bottle with cold water + detergent (to remove protein - albumin)
Brush it
Wash it by hot water (to remove lipids - carbohydrate)
Take off the tit and put the bottle in already boiling water for 10-15min
Put the tit for 3-5 min in the boiling water
Then put the bottle in the refrigerator till you will use it
Types of sterilization: o Boiling o Steam Sterilizer o Using chemicals (that are for sterilizing baby feeding equipment)
Number of bottles = number of feeds + 1


Pacifier is route for infection

In Skin turgor take good punch

Ask about Urine output , thirsty
Fluid in take

Degree of dehydration :

( 3-6 % ) of body weight mild
( 6-10 %) moderate
( > 10 % )severe
>14 % ) incompatible with life )

Indication for hospital admission :

1.Moderate – severe

2.Persistent vomiting
3.Social background
4.Diagnose in doubt ( menigitis , parentaral diarrheoa
5.Food poisoning


Treatment

ORS

Oral rehydration should be given to infants and children slowly, especially if they have emesis. It can be given initially by a dropper, teaspoon, or syringe, beginning with as little as 5 mL at a time .The volume is increased as tolerated.

Vomiting best anti-emetics is IV fluid

Avoid metclopromide ( plasil because it causes occulogyric crises )

Assess for Developmental age
If there is discripancy can be due to :

1.UMNL

2.Cerebral palsy
3.degenrative brain disoder

Anti motility drugs avoided due to respiratoy center suppression below 1 year absloyely contraindicated
More than 1 year relatively
If needed give Adsorbent of water Pectin , cauoin

When you give antibiotics

1.less than 3 month
2.marsmus to avoid septecemia
3. malnutrition
4.food poisoning

Normal increment in weight below 3 months 600-900 g or

20-30 g daily

Developental delay causes other than degenrative brain disorder

Kernicterus
CP

IN ASD finding :

1.murmur with spliting
Shunt with failure of weight gaining this indication of heart failure
Not respond to medical mean no weight gaining and recurrent chest infection
When see one anomaly look for others associated anomalies

One of the causes of FTT is chronic organ fialure

Respiratory sounds ( continous is ronchi , intermittent is crepitation )


Vancomycin is given in pnemonia in staph aureus
CXR showing abcess , pnematocele