clinical notes of pediatrics

clinical notes of pediatrics pinned «Causes of chronic diarrhea 🔹infant * post infection secodary lactase deficiency * caws milk / soy protien intilerance *coeliac dis. * cystic fibrosis *AIDS 🔹Childhood * post. Inf. Sec. Lactase def. *IBS. *lactose intlerance *coeliac dis. *IBD»

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Boot shaped 💚 TOF
With picture of pneumonia

what is the abnormality 🤔

TGA ... egg shaped 💚

Bleeding in neonatal period 🎈
🎃 Baby looks well ?
✔ swallowing of maternal blood product .
✔ Vit . K def . ➡️ Hemorrhagic disease of newborn
✔ Bleeding tendency ➡️ thrombocytopnea of inherited coagulopathy
✔ immunthrombocytopnea ➡️ mother has SlE or ITP
......
Looks ill ☹
✔ DIC ➡️ bleeding from any site
✔ Sepsis with multiorgan failure ➡️ with hematological dysfunction
✔ Malena and abdominal distension with red abdomen ➡️ NEC esp in premature infants .

✴ Indication of biopsy in nephrotic syndrome :-
✔ Age less than 1 yr or more than 8 yr
✔ persistanct Hypertension or hematurea ➡️ features against MCNS
✔ positive viral screen
✔ positive FHx of kidney disease
✔ symptoms of systemic disease .

Amount of ascite that can be detected clinically ➡️ more than 150 ml
By US ➡️ 50 ml
By Ct ➡️ 20 ml

❌ Contraindicatiom for phototherapy
✔ direct hyperbilirubinemia
✔ porphyria
✔ Familial non hemolytic anemia
✔ Gilbert syn .
✔ Criglar najar syn .

✴ Diffrentiate between Spleen and kidney :)
✔ splenic notch maybe felt
✔ spleen on percussion ➡️ dullness
Kidney ➡️ resonance
✔ kidney bimanually palpable
✔ enlargment of spleen toward the umblicus While kidney inferiorly
✔ spleen move with respiration

❌ In abdominal examination don't forget to examine
✔ The back for spina bifida
✔ Examine the genitalia for Ambigous genitalia
✔ Femoral LN and vessels
✔ Supraclavicular LN
✔ If less than 2 month examine for congenital Hip dislocation
شلون نفحص ال superficial mass ؟
✴ Cheek should touch the chest
حسب د اعلان ...
يعني نگول للمريض يرفع راسه واذا هو صغير احنه نرفعه

🤔 How to diffrentiate between cyanosis of respiratory and cardiac cause ?
✴ give the patient O2 if there is improvement ➡️ respiratory cause .
If not its cardiac ...

🚫 Approach to Neonatal vomiting
⚛ When you have patient with vomiting you have to be sure if its real vomiting ?
What is the type of this vomiting ?
Does the patient active , alert , or sick and ill ?
Not bile stain ?
Tolerate feeding ?
No hx of constipation ?
No abdominal distension
No blood in vomitus
لذلك ال General look مهم
🚫 If well , active , no abdominal distension , no constipation , no bile or blood in vomitus ➡️ Benign causes
✔ overfeeding لذلك نسألها كم مرة ترضعه
✔ GERD ➡️ usually in late neonatal period and its effortless
✔ Swallowing of maternal blood and secretion ➡️ Gastritis ➡️ Rx ⚛ Gastric wash with Ns ندفع 5 cc ونسحبها لحد ما يصير clear
✔ Food or milk allergy
✔ Hypertrophic pyloric stenosis ( baby earlier is healthy ) .
🚫 If ill patient
⚛ Medical causes ➡️
✔ Infection ➡️ sepsis , meningitis
✔ Raised intracranial pressure
✔ Inborn error of metabolism
⚛ Surgical causes
✔ Esophageal atresia ➡️ large amount of frothy secretion , scaphoid abdomen cuz there is no Air .
If with SOB ➡️ Fistula
✔ Doudenal atresia ➡️ On x ray double bubble sign
..........
🚫 Upper GIT obstruction
✔ earlier vomiting
✔ less abdominal diatension
🚫 Lower Git obstruction
✔ vomiting late
✔ remarkable abdominal distension
✔ multiple air fluid level on X ray

Ix for neonatal convulsion ➡️
✔RBS if Hpoglycemia ➡️ manage it
✔S ca ➡️ If hypoca ... ➡️ Rx حسب ما معروف
وال meningitis
ندزهم CBC
CRP
Lp
ال Rx
نعالج سبب ال convulsion
بالإضافة الى علاج ال convulsion نفسه

Drug of choice in neonate ➡️ luminal ( phenobarbital )
Loading dose ➡️ 20 mg / kg
نگدر نضيف عليها بعد 10 mg / kg لحد ما نوصل لل 40 mg /kg
وراهة ب 12 - 24 ساعة نحول ع ال maintenance
5 mg / kg ÷2
لأن ال diazepam اكو risk of hypotension and apnea

🚫 When we have patient with seizure
Its important to know the cause
✔ hypoglycemia ➡️ send for RBS
✔ hypocalcemia ➡️ send for S.ca
✔ CNS infection ➡️ CBC , CRP , Lp
✔ CNS Hemorrhage
✔ Neonatal encephalopathy ( birth asphyxia ) ➡️ the commnest one
✔ Hyponatremia ( introducing hypotonic fluid to the mother * oxytocin in GW 5% * ➡️ cross placenta ➡️ dilutional hyponatremia .
لذلك مهم نعالج السبب
ونمنع حدوث ال convulsion مرة ثانية
من خلال ال Anticonvulsant

Pneumothorax