Pediatrics 6th stage
Session notes د.أوسin rota virus vomiting is before the diarrheoa but not always
small intestine : low amount stoolin colitis high amount stool
one features of malaborption is large bowel diarrhea
shiglla , sallmonilla , E.coli , campylobacter , pesdomembranous colitis , associated listeria
clostiridium toxin for rapid assessment , skip AB
antibiotics cause ( watery diarrhea ) eg: ampicillin
how can you differentiat bloody diarrhea
in chronicityshort-lived is bacterial
long lived parasitic
cow's milk allergy
cause colitis and bloody diarrheoadiarrheoa is two type :
1.non-infectious
2.infectious ( viral , bacterial , parasitic , non-viral )
Bed dysentery ( bacterial )
Walking dysentery ( E.histolytica ) , IBD
Cow's milks allergy findings :
Cough , skin rash , GIT , problem , wheezes ( bloody diarrhea )
Caused by ( bovine , protein ( casein )
Can be replaced by :
Hydrolyzed formula ( utra magen )
Side effect of this formula is Not sweet taste
If not benefit give amino acid
Formula ( elemental formula )
Coat formula
From the mother transmitted by the breast when she ingested the cow's milk then to the baby by breast feeding
Soy formula ( isomil )
Should not give it below 6 monthes , because it contain estrogen
We can administer hypo-allergic diet
Lactose intolerance
occur secondary following acute gastro-enteritis and there no recovery for diarrheoa with excoriated skin of peri-anal region and gases , distended abdomen
This occurred due to mucosal damage of GIT by disturbance in lactase enzyme function
Investigation :
1.culture for bacteria
2.ELISA for viral mainly rota virus
3.microscopic for parasitic showing trophozoite
4.clostridia difficile
Investigation for Lactose
1.ph stool : acidic
2.reducing substance in stool : positive in stool
In urine >>> -ve main galactosemia
Convulsion associated with diarrheoa
( UTI , meningitis , Febrile convlusion , parental diarrhia )
Electrolyte disturbance ( hyponatremia )
Hypoglyemia
Shigllosis ( convulsion + bloody diarrheoa )
How to prove ?
-culture
-CSF
-Serum electrolyte
General exam
First of all ask about permissionTry not to disturb the child
a.general appearance ( look )
1.general health ( looks comfortable , ill , distress , dyspneaic
Irritable , semiconcious , drowsy , unconcious ,
2.dysmorphism ( looks normal , dysmorphic ,
3.nutritional state ( looks thin , emaciated , having good body built , thriven , I have to put him on growth chart )
4.neurodevelopmental : abnormal posture , not moving limb ,
No special posture
Hand :
Looks for clubbing but at least 6 months , peripheral cyanosis
Nail ( kolionychea ( iron deficiency anemia , paronychia ( hypoproteninemia , splinter hemorrhage , capillary refill ( 2 sec ) , pale or not
Face :
Eye : looks for conjuctiva , sclera for jauidice
Mouth : ( yugeine color of tongue , dental caries in heart disease ( source of IE ) , ulceration aphtous , pigmentation ( addison disease ) talk about striking abnormalities ,
Legs :
If any scar , looks for color , edema
General examination is introduction for every systemic exam
Edema due to repiratory porbolem caused by right sided heart failure ( cor pulmonale )
GIT exam :
General exam
Hand looks for clubbing
Causes of clubbing :
in liver cirrohosis , cyanotic heart disease , lung ( bronchiactasis , cystic fibrosis , empyema , pulmonary fibrosis ( fibrosing alveolitis ) , familial , herditary
Abdominal exam :
Looks for angle of nail bed , shamroth test ,
Abdominal :
Any pain
Start from right iliac fossa
Superficial palpation for tenderness and rigidity
Deep : for any mass , deep palapation
Organ paipation :
Liver measure the span if enlarged do abdominal percussion
There is two measures below the costal margin and out the costl margin in palpable liver
Looks for :
Tenderness
Consistency : Soft or hard
Surface : smooth or nodular ( liver cirrohosis )
Edge : rounded
Move with respiration
Spleen
Start from right iliac fossa support with hand on the costal margin , if palaple do percussion
Move with respiration , prescence of spelnic notch , cant get above it , dull in percussion
Kidney is tympanic in palpation
Auscultation
Hernial orfice
Ask for genitalial exam
Leg
Pedal edema
If there is ascites exam for shifting dullness if there is organomegally , if not
exam first with transmitted thrill then shifting dullness
Case Finding of cerebral palsy :
Head ( microcephalic )CP posture Spastic ( crossing for legs )
General exam
General health patient looks well
Nutrition thin
Dysmorphic face
Neurodevelpoment : abnormal posture
In CNS exam
Cranial nerves examination
Upper and lower :
Inpection : abnormal posture, joint swelling , deformity ,
Palpatoin : tone of each limb , reflex , power and sensation
Hyper-reflexia due to upper motor neuron lesion
Power is 5
Tone : hypertonia
Babniski sign : +ve
If Diplegic lower more than upper MNL
If difficult to eat mean psedobulbar palsy CN 10 . 11
Usually Quadriplegic
In cerebellar exam asking for
Finger nose test , ataxic gait , heel – shin test , hypotonia
Causes
Prenatal : cerebral malformation , infection
Natal : birth asphyxia
Post – natal : neontal jaundice , non specific , head trauma
MRI best test for CP showing macrogyria