Pediatrics

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PEDIATRICS
| r. ä . | t rr sIt i r , | r. !. | ri t 1 m ar , | r. | . 1 i ||i ar1 ,
| r. ä . !att | st r ar 1 | r. | . ä t| r t i 1 t r
| art r | ar ], 1 ar i 1 a1 i , | a 1 ar ar 1 kr i Ia !t I| «a, t 1 i It rs
| ¡a| | t | t r , asst ti aIt t 1 i It r
PRIMARY CARE PEDIATRICS . . . . . . . . . . . . . . . . 3
| t ]a |ar Vi si Is
K a Iri Ii t r
| t |i t
| | i |1 | r }a r¡ | rt tt r Ii t r
| m m a r i taIi t r
| t |a¡t 1 | m m a r i taIi t r
1 I| t r Vatti r t s
| t tt |t j m t r Ia| M i |t sIt r t s
K t rm a| | | ¡si ta| | rt «I|
| ai |a rt It ¡ | ri tt
ä | t rI ä IaIa rt
¡a|| ä IaIa rt
1 | t si I¡
CHILD ABUSE AND NEGLECT . . . . . . . . . . . . . . . .12
DEVELOPMENTAL AND BEHAVIORAL . . . . . . .14
PEDIATRICS
| t tt |t j m t r Ia| | t |a¡
| ar ]a a]t | t |a¡
| rt tasi tt | t tt |t j m t r Ia| | i st r1 t r | | |
| t Ia| k|tt | t | ä ¡r 1 rt m t |kä ar 1
| t Ia| k|tt | t | | IIt tIs |k|
| | rt r i t | t ta rrt r I k| 1 t m i r a| | ai r
| |i m i r aIi t r | i st r1 t rs
| r a rt si s
| r tt j rt si s
GENETICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
kj j rt at| It I| t | ¡sm t rj | i t | | i |1
| t «r ä ¡r 1 rt m t
1 I| t r ¡ri st m i t s
¡a rr t r ä ¡r 1 rt m t
| |i r t It |It r ä ¡r 1 rt m t
| ra]i |t X
M a sta |ar | ¡sIrt j | ¡
| |t II | i j ar 1 | a|aIt
| r | t rr | rrt rs t I M t Ia| t |i sm
VatIt r| ksst ti aIi t r
NEONATOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
| r Iar I M t rIa|i I¡
K t rm a| | a| ¡ aI ¡t rm
| t sIaIi t r a| k]t ar 1 ä i tt
K t t r aIa| | t sa sti IaIi t r
| t a Ii r t K t t r aIa| | art
| t sj i raIt r¡ | i sIrt ss i r I| t K t «| t rr
| t sj i raIt r¡ | i sIrt ss ä ¡r 1 rt m t | | ä
¡rar si t r I ¡at| ¡j r t a t I I| t K t «| t rr ¡ ¡ K
M t tt r i a m ksj i raIi t r ä ¡r 1 rt m t M kä
| r t a m t r i a
| i aj | ra]m aIi t 1 t rr i a
| t rsi sIt r I | a |m t r ar¡ 1 ¡j t rIt r si t r | | 1 K
| rt r t| t j a |m t r ar¡ | ¡sj |asi a | | |
| ¡ar t si s t I I| t K t «| t rr
kj r t a
!aa r 1 i tt
K t trt Ii ti r ] | r It rt tt |i Ii s K | |
ä a 1 1 t r | r Iar I | t aI| ä ¡r 1 rt m t ä | | ä
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts ¡
NEUROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
ä t i ta rt | i st r1 t rs
| t r i ]r | t | ri |t ä t i ta rt s
| |t j j ¡ | a| ¡ 1 ¡j t It r i a
| t rt | ra| | a|s¡
1 ¡1 rt tt j | a|a s
K t a ra| ¡a | t | t It tI
K t a rt ta Iar t t a s ä ¡r 1 rt m t s
GASTROINTESTINAL DISEASE. . . . . . . . . . . 33
Vt m i Ii r ]
Vt m i Ii r ] i r I| t K t «| t rr
Vt m i Ii r ] aIIt r I| t K t «| t rr | t ri t 1
kta It | i arr| t a
| | rt r i t | i arr| t a
| | rt r i t | i arr| t a «i I| t a I | ai |a rt It ¡ | ri tt
| | rt r i t | i arr| t a «i I| | ai |a rt It ¡ | ri tt
kta It k| 1 t m i r a| | ai r
| | rt r i t k| 1 t m i r a| | ai r
| t r sIi j aIi t r
k| 1 t m i r a| M ass
| asIrt i r It sIi r a| 1 t m t rr| a]t
INFECTIOUS DISEASES . . . . . . . . . . . . . . . . . 43
| t tt r
ä t j si s i r I| t K t t r aIt
M t r i r ]i Ii s
| t 1 i aIri t | tar I| t m s
1 | V | r It tIi t r
| t ri t r| i Ia|I1 r| i Ia| | t ||a |i Ii s
1 Ii Ii s M t 1 i a
ä Irt j It tt tta| | r It tIi t r s
| t rIa ssi sIw| t t j i r ] | t a ]|
| r It tIi t a s M t r t r a t|t t si s
| ri r ar¡ ¡ratI | r It tIi t r
DERMATOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . 51
| i aj t r | t rm aIi Ii s
ä t | t rr| t i t | t rm aIi Ii s
| ar 1 i 1 a
| ttt m a
| m j t Ii ]t
ä ta| i t s
| r¡I| t m a M a |Ii It rm t
ä It tt r s-!t | r st r ä ¡r 1 rt m t
| t 1 i aIri t | tar I| t m s
CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . 54
1 t arI M a rm a rs
| t r ]t r i Ia| 1 t arI | i st ast
| t r ]t sIi tt 1 t arI | ai |a rt
| r It tIi tt | r 1 t tar1 i Ii s
| ¡sr| ¡I| m i as
| t 1 i aIri ts I M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
PEDIATRICS. . . | 1 K ¡ .
HEMATOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
kj j rt at| It kr t m i a
| | ¡si t |t ]i t kr t m i a
| rt r | t Ii ti t r t¡ kr t m i a
ä i t||t | t || | i st ast
ä j | t rt t¡It si s
| |a tt st -t-| | t sj | aIt | t | ¡1 rt ]t r ast | t Ii ti t r t¡
| |t t 1 i r ] | i st r1 t rs
ONCOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
| t a |t m i a
|¡m j | t m a
| rai r ¡a m t a rs
wi |m ’ s ¡a m t a r K t j | rt | |asIt m a
K t a rt | |asIt m a
RHEUMATOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . . 65
| ta|a aIi t r t I | i m | | ai r
| rt «i r ] | ai r s
!a tt r i |t | | t a m aIt i 1 krI| ri Ii s !| k
1 t r t t| -ä t| t r |t i r | a rj a ra
| a«asa|i | i st ast
ENDOCRINOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . 68
| i a| t It s M t ||i Ia s
1 ¡j t I| ¡rt i 1 i sm
1 ¡j t rI| ¡rt i 1 i sm
K t rm a| ä t ta a| | t tt |t j m t r I
| rt tt ti t a s | a | t rI¡
| t |a¡t 1 | a | t rI¡
GENITOURINARY. . . . . . . . . . . . . . . . . . . . . . . . . . . 71
1 t m aIa ri a
| rt It i r a ri a
1 t m t |¡Ii t | rt m i t ä ¡r 1 rt m t
K t j | ri Ii t ä ¡r 1 rt m t
K t j | rt Ii t ä ¡r 1 rt m t
| ri r ar¡ ¡ratI 1 | sIra tIi t r
Vt si tt a rt It ra| | t I|a t V| |
| t r i Ia| k| r t rm a|i Ii t s
RESPIROLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
| j j t r | t sj i raIt r¡ ¡ratI | i st ast s
ä Iri 1 t r
| rt a j ar 1 | j i ]|t IIi Ii s
| t rt i ]r | t 1 ¡ ksj i raIi t r
| t «t r | t sj i raIt r¡ ¡ratI | i st ast s
w| t t ti r ]
| rt r t| i t |i Ii s
| r t a m t r i a
ksI| m a
| ¡sIi t | i | rt si s
ADOLESCENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
1 t a|I| | ssa t s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 1
K t It s
PRIMARY CARE PEDIATRICS
REGULAR VISITS
J j a rj t st . j rt tt r Ii t r , strt t r i r ], a1 tt tat¡
J a sa a| st| t 1 a |t . r t «| t rr , ¡ «t t | j t sI-1 i st| ar]t , ¡ , I, \,
t, 1, ¡ I, ¡ !, ¡ î, I\ m t r I| s
• ¡t ar|¡ a r Ii | a]t t, I| t r t tt r¡ t I| t r ¡t ar
• ¡t ar|¡ aIIt r a]t ¡ ¡
J | i sIt r¡
• j rt ]r ar t¡ ar 1 r t t r aIa| | i sIt r¡
• It t 1 i r ] ar 1 1 i t I st t ¡a| |t ¡
• i m m a r i taIi t r s st t ¡a| |t s I ar 1 1
• 1 t tt |t j m t r Ia| asst ssm t r I st t ¡a| |t \
• ]rt «I| , t r t r]¡, aj j t Ii It , s|t t j ar 1 rt ti t « t I s¡sIt m s
• j asI m t 1 i ta| | i sIt r¡, Iam i |¡ ar 1 st ti a| | i sIt r¡, a||t r]i t s
ar 1 m t 1 i taIi t r s
J j | ¡si ta| t tam
• ]rt «I| . st ri a| | t i ]| I, «t i ]| I, | t a1 ti rta m It rt r tt
• | t a1 ar 1 r t t|. 1 ¡sm t rj | i t It aIa rt s, rt 1 rt I|t t, j a|aIt ,
It r Iar t ||t s ar It ri t r t|t st s | t I«t t r 1-¡ î m t r I| s, j t sIt ri t r
| t I«t t r I-\ m t r I| s , sIra| i sm a s, ti si t r , I¡m j ar i t m t m | rar t s, | t ari r ]
• tar1 i t tasta |ar. aa sta |IaIi t r , j t ri j | t ra| j a |st s i r t|a 1 i r ]
It m t ra|s , | | ¡t ar|¡ aIIt r a]t 1
• t| t sI, a| 1 t m i r a|, | | , s|i r
• M ä | . | i j s | ar|t « ar 1 1 rIt |ar i It sIs , stt |i t si s, |a m | t satra|
sj i r t | ai r¡ j aIt| , j i ]m t r IaIi t r , si r a s IratI
• r t a rt |t ]i t. j ri m i Ii tt rt I|t tt s i r r t «| t rr s ar 1 i r t ar|¡ i r Iar t¡
J tt a r st ||i r ]Iar Ii ti j aIt r¡ ]a i 1 ar tt st t K a Iri Ii t r , | t |i t, ar 1 | | i |1
| r }a r¡ | rt tt r Ii t r ä t tIi t r s
• | t a|I| ¡ i r Iar Is s| t a |1 | t j t si Ii t r t 1 It r s|t t j t r si 1 t t r | at|
1 t trt ast i r ti 1 t r tt t I ä | | ä - st t ä a 1 1 t r | r Iar I | t aI|
ä ¡r 1 rt m t ä t tIi t r s
NUTRITION
Bre as t Fe e ding
J tt |t sIra m ¡ 11 m | It r Ii rsI It « 1 a¡s – t|t ar I|a i 1 «i I| r a Iri t r Is ar 1
i m m a r t |t ]i t j rt It tIi t r It r | a| ¡
J Ia || m i || j rt 1 a tIi t r | ¡ 1-I 1 a¡s m aIa rt m i || | ¡ ¡ !-\! 1 a¡s
J sa j j t rI It r m t I| t rs «| t «ar I It | rt asI It t 1 t .]. | a | t t| t | t a]a t ,
|atIaIi t r tt r sa |Iar I s| t a |1 sIarI «| i |t i r | t sj i Ia|
J asst ssm t r I t I a1 t | a aIt i r Ia|t . «t i ]| I ]ai r , r a m | t r t I «t I 1 i aj t rs,
r a m | t r t I | t «t | m t tt m t r Is, j aa st 1 a ri r ] sa t|i r ], s«a||t «i r ]
J It t 1 i r ] st| t 1 a |t
• j rt m aIa rt i r Iar Is. | I-1 | t a rs
• It rm i r Iar Is. | 1.!-\ | t a rs
J | rt asI-It 1 | a| i t s rt | a i rt sa j j |t m t r IaIi t r «i I|
• ti Iam i r | ]i tt r | M aI | i rI|
• ti Iam i r | ¡ri -Vi -ä t | t r | i -Vi -ä t |
• I|a t ri 1 t aIIt r t m t r I| s i I r t I sa IIi ti t r I i r «aIt r sa j j |¡
• i rt r j rt m aIa rt i r Iar Is . î «t t |s It ¡ sI | i rI| 1 a¡
• i rt r t tt|a si tt |¡ | rt asI-It 1 i r Iar Is . aIIt r t m t r I| s
J tt r Irai r 1 i taIi t r s
• m t I| t r rt tt i ti r ] t| t m t I| t raj ¡ t r ra1 i t atIi tt tt m j t a r 1 s
• m t I| t r «i I| 1 | VIk| | ä , atIi tt a r Irt aIt 1 ¡ | , | t rj t s j ri m ar¡ t r
i r | rt asI rt ]i t r
• m t I| t r a si r ] a|tt | t | ar 1 It r 1 ra ]s aIIt tIs | rt asI m i || i r I «a¡s.
1 t trt ast m i || j rt 1 a tIi t r ar 1 It r 1 i rt tI|¡ It ti t It | a| ¡
• m t I| t r Ia|i r ] tt rIai r m t 1 i taIi t r s m t sI art saIt .
t .]. ar Ii m t Ia| t |i It s, | rt m t tri j Ii r t , t| |t ram j | t r i tt |, | i ]| 1 t st
1 i att j am , t r]t Is, ]t |1 , m t Irt r i 1 att |t , It Irat¡t|i r t
Advantage s of Bre as t Fe e ding
J “ | rt asI is | t sI
J tt m j t si Ii t r t I | rt asIm i ||
• t r t r]¡. I1 |ta|It t.
• tar| t | ¡1 raIt . |atIt st
• j rt It i r . «| t ¡ î1X m t rt t asi |¡ 1 i ]t sIt 1 I| ar tast i r , tast i r
I1X , t sst r Ii a| am i r t ati 1 s |t «t r tt r It r I I| ar tt «’ s m i ||, |t «t r
rt r a| st |a It |t a1 It r 1 t tt |t j i r ] |i 1 r t ¡s
• IaI. t| t |t sIt rt |, Iri ]|¡tt ri 1 t s, t sst r Ii a| Irt t IaII¡ ati 1 s a j It !1X
t r t r]¡ Irt m IaI
• i rt r . | i ]| t r | i t atai |a| i |i I¡ !1X t I i rt r i s a| st r| t 1 ts. ¡ 1X Irt m
tt «s m i || , sa j j |¡ It r Ii rsI t m t r I| s
| t 1 i aIri ts \ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
J i m m a r t |t ]i t
• |t «t r a||t r]t r i ti I¡ I| ar tt «’ s m i || j rt It i r
• | ]k, m atrt j | a]t s, atIi tt |¡m j | t t¡It s, |¡st t¡m t , |atIt It rri r
|atIt It rri r i r | i | i Is E.coli ]rt «I| i r i r It sIi r t
• |t «t r j 1 j rt m t It s ]rt «I| t I |atIt | ati ||a s i r I| t | | IratI
j rt It tIi tt a]ai r sI j aI| t ]t r i t i r It sIi r a| | atIt ri a
J | t r 1 i r ]
J t tt r t m i ta|
J tt r tt r i t r I
Complications of Bre as t Fe e ding
J st rt Itrat|t 1 r i j j |t s. Ir¡ «arm tt m j rt sst s, m assa]t , Irt | a t r I It t 1 s
J | rt asI t r ]t r]t m t r I. tt r Ii r a t | rt asI It t 1 i r ] ar 1 It r j a m j i r ]
J m asIi Ii s a sa a||¡ 1 a t It ä . aureusat| a i rt 1 Irt m | a| ¡ . Irt aI
«i I| tt |1 tt m j rt sst s | t I«t t r It t 1 s, t|t tati ||i r It r m t I| t r,
tt r Ii r a t r a rsi r ] I– i r ti si t r ar 1 1 rai r a]t
J | rt asI m i || }aa r 1 i tt . ¡ X t I r t «| t rr s st t !aa r 1 i tt ä t tIi t r
J j t t r «t i ]| I ]ai r . tt r si 1 t r 1 t | ¡1 raIi t r t r Iai |a rt It I| ri tt
J I| ra s| . t| t t| | a| ¡’ s m t a I| It r «| i It t| t t s¡ m aIt ri a|, Irt aI «i I| ar Ii Ia r ]a|
Alte rnative s to Bre as t Fe e ding
J It rm a |at . ¡ 11-¡ I1 |ta|I|]I1 a¡ = ¡ !1-¡ î1 ttI|]I1 a¡ m i r i m a m
• tt «s | ast 1 It rm a |at , t .]. ä M k, ä i m i |at, | r Ia|at «i I| i rt r
• st ¡a j rt It i r | ast 1 It rm a |at t .]. | st m i |, | rt st | t t «i I| i rt r
• i rt r It rIi Ii t 1 It rm a |a rt tt m m t r 1 t 1
• a st t r t It rm a |a tt r si sIt r I|¡
J sj t ti a| It rm a |at . It r j rt It i r | ¡j t rst r si Ii ti I¡, |atIt st i r It |t rar tt ,
]a|atIt st m i a, | | | , t I| t r m a|a| st rj Ii t r s¡r 1 rt m t s a|| rart
J tt «s m i ||
• s| t a |1 r t I | t a st 1 a r 1 t r 1 m t r I| s t I a]t | t taa st t I | i ]| rt r a|
st |a It |t a1 , j t t r i rt r a| st rj Ii t r ar 1 i r aj j rt j ri aIt t r t r]¡ 1 i sIri | a Ii t r
• | t m t m i || sIarIi r ] 1-¡ I m t r I| s a r Ii | I\ m t r I| s, I| t r IX t r s|i m m i ||
J tt ]ar 1 i t I i s r t I rt tt m m t r 1 t 1 i r Ii rsI I ¡t ars
Table 1. Die tary Sche dule
Age Food Comme nts
1 It \ m t r I| s | rt asI m i ||, It rm a |a tar | t a st 1 t tt|a si tt |¡ a r Ii | t m t r I| s t I a]t
\ It t m t r I| s i rt r t r ri t| t 1 tt rt a|s ri tt tt rt a|s Ii rsI | t taa st |t ss a||t r]t r i t
\ It I m t r I| s j a rt t 1 tt ]t Ia| |t s ¡t ||t «It rar ]t tt ]t Ia| |t s Ii rsI ar 1 ]rt t r |asI m t rt | a ||
att i 1 tt ]t Ia| |t s «i I| | i ]| r i Iri It tt r It r I | t t Is, sj i r at| , Ia rr i j s
i r Irt 1 a tt tt ]t Ia| |t s | t It rt Ira i I
t It 1 m t r I| s j a rt t 1 Ira i Is ar 1 }a i tt s att i 1 1 t sst rIs
j a rt t 1 m t aIs, Ii s| , j t a |I¡, r t t ]] «| i It a r Ii | ¡ I m t r I| s ri s| t I a||t r]¡
t ]] ¡t ||
1 It ¡ I m t r I| s Ii r ]t r It t 1 s, j t t |t 1 Ira i I, t| t t st K 1 j t ar a Is t r ra«, | ar1 tt ]t Ia| |t s Ii || a]t 1 It \ ¡t ars
ar 1 tt t |t 1 tt ]t Ia| |t s r t a1 1 t 1 sa ]ar, sa|I, IaI t r st ast r i r ]s
COLIC
J ra |t t I 1’ s. a r t tj |ai r t 1 j art t¡sm s t I i rri Ia| i |i I¡ ar 1 tr¡i r ] It r
- 1 | t a rsI1 a¡ ar 1 - 1 1 a¡sI«t t | It r - 1 «t t |s i r ar t I| t r«i st | t a|I| ¡,
«t ||-It 1 | a| ¡
J t tta rs i r ¡ .! | a| i t s
J t Ii t |t ]¡. ]t r t ra||¡ rt ]ar1 t 1 as a |a] i r I| t 1 t tt |t j m t r I t I r t rm a|
j t ri sIa|Ii t m t tt m t r I i r | | IratI
J t I| t r rt ast r s «| ¡ | a| i t s tr¡. | a r ]t r t r ]as j ai r s, It t | t I t r tt |1 ,
t tt rsIi m a |aIt 1 , r t t 1 It sa t| t r | t | t |1
J Ii m i r ]. t r st I ¡ 1 1 a¡s It 1 m t r I| s t I a]t , j t a| t-î «t t |s
J att ra]t \1-¡ I1 m i r a It sI1 a¡ It r Ii rsI 1 m t r I| s
J t| i |1 tri t s, j a ||s a j |t ]s ar 1 j asst s ]as st t r aIIt r It t 1 i r ]
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts !
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
J sa ]]t sIi t r s It r m ar a]t m t r I
• j art r Ia| rt |i t I, rt sI ar 1 rt assa rar tt i I i s r t I I| t i r Iaa |I|
• | t |1 | a| ¡, st t I| t r, tar ri 1 t , m a si t, tata a m , t| t t| 1 i aj t r
• 1 ra ]s t tt | 1 rt j s, ar taIrt j i r t art t I |i II|t | t r t Ii I
• t |i m i r aIi t r t I tt « m i || j rt It i r Irt m m t I| t rs 1 i t I t IIt tIi tt i r
sm a|| j t rtt r Ia]t t I tast s
CHILD INJURY PREVENTION
Injurie s
J r t I atti 1 t r Is - j rt 1 i tIa| |t ar 1 j rt tt r Ia| |t
J |t a1 i r ] taa st t I 1 t aI| Irt m ¡ -\\ ¡t ars t I a]t
J |t a1 i r ] taa st t I j t It r Ii a| ¡t ars t I |i It |t sI
J m ai r taa st s t I i r }a r¡. m t It r tt | i t|t , | a rr s, 1 rt «r i r ], sa i ti 1 t , Ia||s
Ne wborn to 6 Months
J Ia||s. 1 t r t I |t att i r Iar I a|t r t t r a | t 1 , t| ar ]t Ia| |t , i r a | aI| , j |att
i r tri | t r j |a¡j t r | t It rt ar s«t ri r ] j | t r t t r 1 t t r, |t t j tri | rai |s a j
J | a rr s. t| t t| «aIt r It m j t raIa rt | t It rt | aI| i r ], t| t t| m i || It m j t raIa rt
| t It rt It t 1 i r ], 1 t r t I | t |1 ta j t I | t I |i | a i 1 ar 1 i r Iar I aI sam t Ii m t
J sa r t tj t sa rt
J tar st aIs, sm t |t ar 1 tar| t r m t r t ti 1 t 1 t It tIt rs
J | t i st r | t r Irt | | t r Irt r a m | t r r t tI It It |t j | t r t
6 to 12 Months
J sIai r | arri t rs, 1 i stt a ra]t «a||t rs
J j |asIi t tt tt rs It r t |t tIri ta| t a I|t Is, aj j |i ar tt s a r j |a ]]t 1 «| t r r t I i r a st
J |t t j sm a|| t | }t tIs, j |asIi t | a]s, ar 1 m t 1 i taIi t r s t a I t I rt at|
J att i 1 j |a¡ art as «i I| s| arj -t 1 ]t 1 Ia| |t s ar 1 tt rr t rs
J r t tt r |t att a r sa j t rti st 1 i r Ia |
1 to 2 Ye ars
J | a rr s. Ia rr j t I | ar 1 |t s It | at| t I sIt tt
J j t i st r i r ]. |t t j 1 ra ]s ar 1 t|t ar i r ] j rt 1 a tIs t a I t I rt at| , | t i st r
| t r Irt | | t r Irt r a m | t r r t tI It It |t j | t r t , i j t tat s¡ra j i r | t a st
J t| t |i r ]. r t r a Is, ra« tarrt Is, t rar ]t st ]m t r Is, | t I 1 t ]s, ra r r i r ] «| i |t t aIi r ]
J It 1 1 |t r st aI aI I1 || s, It r tt art a r 1 s«i m m i r ] j t t |
J «aIt| It r a r saIt It ¡s, | a||t t r s ar 1 j |asIi t | a]s
2 to 5 Ye ars
J sIrt t I saIt I¡, | i t¡t|t | t |m t I, st aI | t |I ar 1 | t t sIt r st aI aI \1 || s
J sIrar ]t r saIt I¡
J s«i m m i r ] |t sst r s
J r t tt r |t att t| i |1 a r sa j t rti st 1 aI | t m t , t r 1 ri tt «a¡, i r j t t |
| t 1 i aIri ts t M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
IMMUNIZATION
Table 2. Immunization Sche dule
Age Vaccination Route Type Contraindications
I m t r I| s | ¡a| | | V1 i | | M 1 i j I| t ri a - It tt i 1 j rt ti t a s ar aj | ¡|ati s It tatti r t ,
j t rIa ssi s - |i ||t 1 | atIt ri a 1 t It r i I j rt ]rt ssi tt , t tt |ti r ],
It Iar a s - It tt i 1 a r sIa| |t r t a rt |t ]i t 1 i st ast
j t |i t - i r atIi taIt 1 ti ra s
1 i | - tt r }a ]aIt 1 It 1 i j | I| t ri a rt |aIi tt tt r Irai r 1 i taIi t r i I
t| i |1 | t tt m t s | ¡j t It r i t t r
| ¡j t rt sj t r si tt aIIt r tatti r t
\ m t r I| s | ¡a| | | V1 i | | M
t m t r I| s | ¡a| | | V1 i | | M
¡ I m t r I| s M M | ä | |i tt aIIt r a aIt 1 ti ra st s i m m a r t tt m j rt m i st | a I | t a|I| ¡
1 | V j t si Ii tt t| i |1 rt r s| t a |1
rt tt i tt M M | tatti r t ,
«i I| i r 1 m t r I| s t I
i m m a r t sa j j rt ssi tt I| t raj ¡,
j rt ]r ar t¡
¡ î m t r I| s | ¡a| | | V1 i | | M
\-t ¡t ars M M | ä |
| ¡a| | | V | M r t 1 i | aIIt r a]t I
]ra1 t I 1 t j aIi Ii s | M j a ri Ii t 1 1 | sk]
i r 1 r Iari t | tatti r t
i r 1 1 t st s
¡ \-¡ t ¡t ars ¡ 1 | | M i m m a r t 1 t Ii ti t r t¡, j rt ]r ar t¡
ar 1 | ¡ 1 ¡t ars
I| t rt aIIt r
Adminis tration of Vaccine s
J i r }t tIi t r si It
• i r Iar Is - ¡ I m t r I| s t |1 . ar It rt |aIt ra| I| i ]|
• t| i |1 rt r . 1 t |It i 1
J | ¡a| | | V1 i | . I| t st Ii tt tatti r t s art ]i tt r as t r t | M i r }t tIi t r | t r Iatt |
J t ra| j t |i t tatti r t i s atai |a| |t ar 1 a st 1 i r st m t j rt ti r tt s, | a I r t I i r 1 r Iari t
Contraindications to Any Vaccine
J m t 1 t raIt It st tt rt i ||r t ss I– It tt r
J a||t r]¡ It tatti r t tt m j t r t r I t .]. t ]]
Pos s ible Adve rs e Re actions to Any Vaccine
J |t ta|. i r 1 a raIi t r t r It r 1 t rr t ss
J s¡sIt m i t. It tt r, ras|
J a||t r]i t. a rIi tari a, r| i r i Ii s, ar aj | ¡|ati s
Pos s ible Adve rs e Re actions to Re gular Vaccine s
J | ¡a| | | V
• m i r t r. It tt r, |t ta| rt 1 r t ss, s«t ||i r ], i rri Ia| i |i I¡
• m a}t r. j rt |t r ]t 1 tr¡i r ] ¡ X , | ¡j t It r i t a r rt sj t r si tt sIaIt
¡ .¡ I!1 , st i ta rt ¡ .¡ 1!1
• j rt j | ¡|ati s. att Iam i r t j | t r ¡ 1-¡ ! m ]I|] \ | t a rs j ri t r It
i r }t tIi t r ar 1 | \| aIIt r«ar1 s
J 1 i |
• saIt , a|m t sI r t rt atIi t r
J M M |
• It tt r, m t as|t -|i |t ras| i r I-¡ \ 1 a¡s, |¡m j | a1 t r t j aI| ¡,
arI| ra|]i a, arI| ri Ii s, j art Ii Ii s
J ¡ 1 |
• ar aj | ¡|ati s
TB Skin Te s t (Mantoux)
J strt t r | i ]| ri s| j t j a |aIi t r s t r |¡ 1 | V, Irt m It rt i ]r tt a r Ir¡ «i I|
i r trt ast 1 i r ti 1 t r tt , sa | sIar tt a| a st i r Iam i |¡, | t m t |t ss, a| t ri ]i r a|
J t ti 1 t r tt a]ai r sI strt t r i r ] | t a|I| ¡ j t j a |aIi t r s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
J i r Ira1 t rm a| i r }t tIi t r 1 t r t I a1 m i r i sIt r «i I| M M | tatti r t
J j t si Ii tt rt sa |I ¡ | -j t si Ii tt
• - ¡ ! m m . t| i |1 rt r - \ ¡t ars «i I| r t ri s| IatIt rs
• - ¡ 1 m m . t| i |1 rt r - \ ¡t ars, t r ti rt r m t r Ia| t tj t sa rt
• - ! m m . t| i |1 rt r «i I| t|t st ¡ | tt r IatI, i m m a r t sa j j rt sst 1
J | | | | i sIt r¡ i rrt |t tar I - 1 t t s r t I a sa a||¡ ]i tt j t si Ii tt rt sj t r st
J j t si Ii tt rt atIi t r m t ar s atIi tt 1 i st ast t r j rt ti t a s tt r IatI
DELAYED IMMUNIZATION
Table 3. De laye d Immunization Sche dule
Unimmunize d Childre n Age d 1-6 Ye ars
Vis it Vaccine Note s
i r i Ii a| ti si I | ¡a| 1 i | , M M | r t j t rIa ssi s aIIt r a]t I
I m t r I| s aIIt r Ii rsI ti si I | ¡a|
I m t r I| s aIIt r st tt r 1 ti si I | ¡a|
¡ I m t r I| s aIIt r I| i r1 ti si I | ¡a|
\-t ¡t ars t |1 | ¡a|, M M |
]ra1 t I 1 t j aIi Ii s | 1,¡ ,t m t r I| s i r 1 r Iari t
¡ \-¡ t ¡t ars t |1 ¡ 1 |
Unimmunize d Childre n Age d 7 ye ars and Ove r
Vis it Vaccine Note s
i r i Ii a| ti si I ¡ 1 |, M M |
I m t r I| s aIIt r Ii rsI ti si I ¡ 1 |
t-¡ I m t r I| s aIIt r st tt r 1 ti si I ¡ 1 |
| ¡ 1 ¡t ars I| t rt aIIt r ¡ 1 r t j t |i t
OTHER VACCINES
BCG vaccine
J i r Iar Is t I j art r Is «i I| i r It tIi t a s ¡ | aI Ii m t t I 1 t |i tt r¡
J ]rt a j sItt m m a r i Ii t s «i I| | i ]| raIt s t I 1 i st ast Ii r It tIi t r
J t IIt rt 1 It a| t ri ]i r a| t| i |1 rt r t r rt st rtt s
Pne umovax
J j rt It tIs a]ai r sI I1 st rt I¡j t s t I ä . pneumoniae
J It r t| i |1 rt r «i I| 1 | V t r sj |t r t tIt m i tt 1 t| i |1 rt r , t .]. si t||t tt ||
1 i st ast , sj |t r i t 1 ¡sIa r tIi t r , I| a|asst m i a
J It r I| t st | i ]| ri s| ]rt a j s, ]i tt tatti r t aI I ¡t ars t I a]t , I| t r
rt tatti r aIt 1-! ¡t ars aIIt r i r i Ii a| 1 t st
Influe nza A
J ]i tt r ar r a a||¡ i r I| t Ia|| si r tt sIrai r s tar¡ Irt m ¡t ar It ¡t ar
J It r t| i |1 rt r «i I| st tt rt t r t| rt r i t 1 i st ast , t .]. tar1 i at, j a |m t r ar¡, t r
rt r a| 1 i st ast s, si t||t tt || 1 i st ast , 1 i a| t It s, t r 1 t tri r t 1 i st r1 t rs, 1 | V,
i m m a r t sa j j rt sst 1 , |t r ]-It rm asj i ri r I| t raj ¡, rt si 1 t r Is t I t| rt r i t
tart Iati |i Ii t s
J tt r Irai r 1 i taIt 1 i I a||t r]i t It t ]]s t r - t m t r I| s t I a]t
He patitis B
J r t « rt tt m m t r 1 t 1 rt a Ii r t |¡ i r | ar a1 a
J st I t I 1 tatti r aIi t r s ]i tt r i r m i 1 -t| i |1 | t t 1 It t ar|¡ It t r s 1, ¡ , t m t r I| s
J ]i tt r i r | ra1 t I i r 1 r Iari t st| t t |s ]i tt r aI 1 i IIt rt r I ]ra1 t s i r t I| t r j rt ti r tt s
J i I m t I| t r i s 1 | sk] tt , I| t r ]i tt 1 | | | tatti r t aI | i rI| , ar 1 tatti r t
aI ¡ ar 1 t m t r I| s
Varivax
J |i tt aIIt r a aIt 1 tari tt ||a ti ra s tatti r t j rt It tIs a]ai r sI t| i t|t r j t t
J m a sI | t sIt rt 1 aI -¡ !¸|
J tar | t ]i tt r aIIt r a]t ¡ I m t r I| s ¡ 1 t st = 1.! m | sa | ta Iar t t a s i r }t tIi t r
J aIIt r a]t ¡ 1, ]i tt I«t 1 t st s \-î «t t |s aj arI
J st rt tt r tt rsi t r raIt s t I - 1!X I1-11X ¡t ar|¡ |t ss t I ar Ii | t 1 ¡ t tt r t ¡t ars ,
|i |t |¡ |i It |t r ] i m m a r i I¡, | a I |t r ]t r sIa 1 i t s art as ¡t I a r atai |a| |t
| t 1 i aIri ts î M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
J m i |1 |t ta| rt atIi t r s i r !-¡ 1X | i ]| t r i r i m m a r t tt m j rt m i st 1
J t IIi tat¡. j rt It tIi t r raIt i s - 11X
J | t r t Ii Is
• att i 1 t| i t|t r j t t !-I 1 a¡s t I It tt r, i It| ¡ ras| , m a|ai st ,
j t ssi | |t | atIt ri a| sa j t ri r It tIi t r , t r tt j | a|i Ii s t r j r t a m t r i a
(s e e Colour Atlas J1)
• m i |1 t r i ||r t ss i I t| i t|t r j t t 1 t t s 1 t tt |t j
• att i 1 j art r Ia| tt sI t I | t i r ] t II «t r| t r | i ri r ] | a| ¡si IIt r
J tt sIs ;t!-I!, ta rrt r I|¡ r t I tt tt rt 1 | ¡ m ar ¡ 1 ra ] j |ar s
J tt r Irai r 1 i taIt 1 i r j rt ]r ar I «t m t r ar 1 i r «t m t r j |ar r i r ] It ]t I j rt ]r ar I i r I| t r t tI 1 m t r I| s
DEVELOPMENTAL MILESTONES
Table 4. De ve lopme ntal Mile s tone s
Age Gros s Motor Fine Motor Spe e ch and Adaptive and
Language Social Skills
t «t t |s j rt r t -|i IIs t| i r st ti a| sm i |t
i r It rm i IIt r I|¡
I m t r I| s j rt r t -arm s j a ||s aI t|t I| t s tt t s
t tIt r 1 t 1 It r«ar1
\ m t r I| s j rt r t -rai st s | t a1 rt at| ar 1 ]rasj , rt sj t r 1 s It
t| t sI, rt ||s t tt r t | }t tIs It m t a I| tt i tt
| —- | , r t | t a1 |a]
t m t r I| s j rt r t -«t i ]| I t r a |r ar ]rasj | t ]i r s It | a| | |t , sIrar ]t r ar ti t I¡
| ar 1 s, Iri j t 1 si I rt sj t r 1 s It r am t
1 m t r I| s j a ||s It sIar 1 Ii r ]t r-I| a m | ]rasj m am a, 1 a1 a - j |a¡s ]am t s
aj j rt j ri aIt , st j araIi t r ar ti t I¡
i m i IaIt s ¡ «t r1
¡ I m t r I| s «a||s «i I| sa j j t rI, j i r tt r ]rasj , I| rt «s I «t r1 s «i I| j |a¡s j t t |-a-| t t ,
“ tra i st s” m t ar i r ] | t si 1 t s 1 ri r |s «i I| ta j
m am a, 1 a1 a
¡ ! m t r I| s «a||s «i I| t a I sa j j t rI 1 ra«s a |i r t }ar]t r j t i r Is It r t t 1 s
¡ î m t r I| s a j sIt j s «i I| | t |j It «t r t I 1 ta | t s, ¡ 1 «t r1 s, It ||t «s a st s sj t t r ,
stri | | |i r ] si m j |t tt m m ar 1 s j t i r Is It | t 1 ¡
j arIs
I\ m t r I| s a j I It t IIsIt j , It «t r t I t ta | t s, I-1 «t r1 s j | rast s j ara||t | j |a¡,
ra r s, |i t|s | a|| a r 1 rt sst s a st s “ | ” , “ M t ” , “ ¡t a ” | t |j s It 1 rt ss
I!X i r It ||i ]i | |t
1 ¡t ars Iri t¡t|t , a j ¡ It t IIsIt j , tt j i t s a ti rt|t ar 1 j rt j t si Ii t r s, 1 rt ssIa r 1 rt ss
1 t «r I It t IIsIt j , a trt ss, j a Is t r s| t t s j |a ra|s, Ia ||¡ t ttt j I
sIar 1 s t r t r t It t I, I!X i r It ||i ]i | |t , | a IIt r s,
}a m j s |r t «s st t, a]t tt a r Is It ¡ 1
\ ¡t ars | t j s t r ¡ It t I, tt j i t s a s| a art , It ||s sIt r¡, tt t j t raIi tt j |a¡,
1 t «r ¡ It t IIsIt j a st s sti sst rs r t rm a| 1 ¡sI|a t r t¡, It i |t I Irai r t 1 ,
sj t t t| i r It ||i ]i | |t | a IIt r s t|t I| t s
! ¡t ars s|i j s, tt j i t s a Iri ar ]|t , I|a t r I sj t t t| , |r t «s \ tt |t a rs
ri 1 t s | i t¡t|t j ri r Is r am t , Ia Ia rt It r st ,
Ii t s s| t t |att s a|j | a| t I
Table 5. Primitive Re fle xe s
Re fle x Appe ars Dis appe ars
]rasj | i rI| ¡ -\ m t r I| s
M t rt | i rI| 1-\ m t r I| s
rt t Ii r ]Isa t|i r ] | i rI| 1-\ m t r I| s
sIt j j i r ]Ij |ati r ] | i rI| I-! m t r I| s
| a|ar I | i rI| I-1 m t r I| s
It r i t r t t| “ It r ti r ]” | i rI| I-1 m t r I| s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 1
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
Moro Re fle x
J t |i ti It 1 | ¡ j |ati r ] i r Iar I sa j i r t , | t a1 sa j j t rIt 1 | ¡ t tam i r t rs | ar 1 ,
sa 1 1 t r «i I| 1 ra«a| t I sa j j t rI, | t a1 a||t «t 1 It Ia|| | at|«ar1
J rt I|t t i s a| 1 a tIi t r ar 1 t tIt r si t r t I I| t arm s, t j t r i r ] t I I| t | ar 1 s,
It ||t «t 1 | ¡ a1 1 a tIi t r t I I| t arm s as i I i r ar t m | ratt
J a| st r tt t I M t rt sa ]]t sIs | K ä i r }a r¡
J as¡m m t Ir¡ t I M t rt sa ]]t sIs It ta| m t It r |t si t r s, t .]. | rat| i a|
j |t ta s i r }a r¡ t r IratIa rt t I t|ati t|t t r | a m t ra s
Galant’s Re fle x
J sIrt |i r ] t r t si 1 t t I I| t | at| a|t r ] j aratt rIt | ra| |i r t rt sa |Is
i r |aIt ra| ta rtaIa rt t I I| t Ira r | It «ar1 I| t sIi m a |aIt 1 si 1 t
NORMAL PHYSICAL GROWTH
J r t «| t rr si tt i r I|a t r tt 1 | ¡ m aIt rr a| IatIt rs j |att r Ia, i r a It rt
t r ti rt r m t r I
J j rt m aIa rt i r Iar Is. a st tt rrt tIt 1 a]t a r Ii | I ¡t ars
J r t I |i r t ar. m t sI raj i 1 ]rt «I| 1 a ri r ] Ii rsI I«t ¡t ars, ]rt «I| sj a rI aI j a | t rI¡
J 1 i IIt rt r I Ii ssa t ]rt «I| aI 1 i IIt rt r I Ii m t s
• Ii rsI I«t ¡t ars. | K ä
• m i 1 -t| i |1 | t t 1 . |¡m j | t i 1 Ii ssa t
• j a | t rI¡. ]t r i Ia| Ii ssa t s
J | t 1 ¡ j rt j t rIi t r s. a j j t rI|t «t r st ]m t r I raIi t
• r t «| t rr ¡ .I, a1 a |I m a|t 1.1I, It m a|t ¡ .1
• i r trt ast 1 raIi t . at| t r 1 rt j |asi a, s| t rI |i m | s, | ¡j t I| ¡rt i 1 i sm
• 1 t trt ast 1 raIi t . M arIar ä ¡r 1 rt m t
We ight Gain
J | i rI| «t i ]| I. 1-\.! |]
J st m t «t i ]| I |t ss aIIt r | i rI| m ati m a m ¡ 1X , | i rI| «t i ]| I rt ]ai r t 1 | ¡ ¡ 1 1 a¡s
J It | i rI| «t i ]| I | ¡ \-! m t r I| s, 1t | i rI| «t i ]| I | ¡ ¡ ¡t ar, \t | i rI| «t i ]| I | ¡ I ¡t ars
J | a|I a1 a |I «t i ]| I aI ¡ 1 ¡t ars
Line ar Growth
J | i rI| |t r ]I| . !1 tm
J I! tm aI ¡ ¡t ar, îI tm aI I ¡t ars | a|I a1 a |I | t i ]| I , 11 tm aI 1 ¡t ars
J m t asa rt |t r ]I| a r Ii | I ¡t ars t I a]t , I| t r m t asa rt | t i ]| I
He ad Circumfe re nce
J | i rI| 1 | . 1! tm
J i r trt ast I tm Im t r I| It r Ii rsI 1 m t r I| s, I| t r ¡ tm Im t r I| It r
1-t m t r I| s, I| t r 1.! tm Im t r I| It r t-¡ I m t r I| s
De ntition
J j ri m ar¡ 1 t r Ii Ii t r I1 It t I|
• Ii rsI It t I| aI !-1 m t r I| s |t «t r i r ti st r , I| t r ¡ j t r m t r I| It I1 It t I|
• t-î tt r Ira| It t I| | ¡ ¡ ¡t ar
J st tt r 1 ar¡ 1 t r Ii Ii t r 1I It t I|
• Ii rsI a1 a |I It t I| i s ¡ sI m t |ar aI t ¡t ars
• Ir 1 m t |ars aI ¡ I ¡t ars, 1r1 m t |ars aI ¡ î ¡t ars
FAILURE TO THRIVE (FTT)
J 1 t Ii r i Ii t r . «t i ]| I - 1r1 j t rtt r Ii |t , t r Ia||s atrt ss I«t m a}t r j t rtt r Ii |t
ta rtt s, t r - î1X t I t tj t tIt 1 «t i ]| I It r | t i ]| I ar 1 a]t
J !1X t r]ar i t, !1X r t r -t r]ar i t
J i r a1 t | a aIt ta|t ri t i r Ia|t m t sI i m j t rIar I IatIt r i r j t t r «t i ]| I ]ai r
J t r t r]¡ rt | a i rt m t r Is
• 1-¡ 1 |]. ¡ 11 |ta|I|]I1 a¡
• ¡ 1-I1 |]. ¡ 111 ta| !1 ta|I|]I1 a¡ It r t at| |] - ¡ 1
• I1 |]. ¡ !11 ta| I1 ta|I|]I1 a¡ It r t at| |] - I1
J m a¡ | att t I| t r r a Iri Ii t r a| 1 t Ii ti t r ti t s, t .]. j rt It i r , i rt r , ti Iam i r | 1 t Ii ti t r t¡
Approach to a Child with FTT
J | i sIt r¡
• 1 t Iai |t 1 1 i t Iar¡ ar 1 It t 1 i r ] | i sIt r¡
• j rt ]r ar t¡, | i rI| , ar 1 j t sIj arIa m | i sIt r¡
• 1 t tt |t j m t r Ia| ar 1 m t 1 i ta| | i sIt r¡, i r t|a 1 i r ] m t 1 i taIi t r s
• st ti a| ar 1 Iam i |¡ | i sIt r¡ j art r Ia| | t i ]| I ar 1 «t i ]| I
| t 1 i aIri ts ¡ 1 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
• asst ss \ art as t I Ia r tIi t r i r ]. t| i |1 ’ s It m j t ram t r I, t| i |1 -j art r I
i r It ratIi t r , It t 1 i r ] | t | ati t a r ar 1 j art r Ia| j s¡t| t st ti a| sIrt sst rs
J j | ¡si ta| t tam i r aIi t r
• | t i ]| I, «t i ]| I, 1 | , arm sj ar , a j j t r.|t «t r st ]m t r I raIi t
• asst ssm t r I t I r a Iri Ii t r a| sIaIa s, 1 ¡sm t rj | i sm , j a | t rIa| sIaIa s
• t | st rtaIi t r t I a It t 1 i r ] st ssi t r ar 1 j art r I-t| i |1 i r It ratIi t r
• si ]r s t I r t ]|t tI t r a| a st
J |a| t raIt r¡ i r tt sIi ]aIi t r s. as i r 1 i taIt 1 | ¡ t|i r i ta| j rt st r IaIi t r
• | | | , sm t ar, t |t tIrt |¡It s, a rt a, | ä | , ¡ \, ¡ ä 1 , a ri r a|¡si s
• | t r t a]t t-ra¡
• |ar¡t I¡j t i r a|| s| t rI ]i r|s ar 1 i r s| t rI | t ¡s «| t rt aj j rt j ri aIt
• ar ¡ t I| t r It sIs i r 1 i taIt 1 Irt m | i sIt r¡ ar 1 j | ¡si ta| t tam . t .].
rt r a| t r |i tt r Ia r tIi t r It sIs, tt r t a s | |t t 1 ]ast s, It rri Ii r ,
i m m a r t ]|t | a |i r s, s«t aI t| |t ri 1 t , It ta| IaI
J t r]ar i t taa st . a sa a||¡ aj j art r I t r Ia || | i sIt r¡ ar 1 j | ¡si ta| t tam
J r t r -t r]ar i t taa st . t IIt r r t t | ti t a s 1 i a]r t si s Irt m | i sIt r¡ ar 1
j | ¡si ta| t tam
Caus e s of Organic FTT
J i r a1 t | a aIt i r Ia|t
J i r a1 t | a aIt a| st rj Ii t r
J i r aj j rt j ri aIt a Ii |i taIi t r t I r a Iri t r Is
J i r trt ast 1 t r t r]¡ rt | a i rt m t r Is
J 1 t trt ast 1 ]rt «I| j t It r Ii a|
Caus e s of Non-Organic FTT
J i r a1 t | a aIt r a Iri Ii t r , j t t r It t 1 i r ] It t| r i | a t , t rrt rs i r m a|i r ] It rm a |a
J t m t Ii t r a| 1 t j ri taIi t r , j t t r j art r I-t| i |1 i r It ratIi t r , 1 ¡sIa r tIi t r a| | t m t
J t| i |1 a| a st ar 1 It r r t ]|t tI
J j art r Ia| j s¡t| t st ti a| sIrt ss, t| i |1 | t t 1 a| a st ar 1 It r r t ]|t tI
J Irt aIm t r I. m t sI art m ar a]t 1 as t a Ij aIi t r Is «i I| m a |Ii 1 i sti j |i r ar¡ aj j rt at|
• j ri m ar¡ tart j | ¡si ti ar , 1 i t Ii Ii ar , j s¡t| t |t ]i sI, st ti a| «t r|, t| i |1
j rt It tIi t r st rti tt s
SHORT STATURE
As s e s s me nt of Short Stature
J | t i ]| I - - 1r1 j t rtt r Ii |t , | t i ]| I trt sst s I m a}t r j t rtt r Ii |t |i r t s, |t «
]rt «I| tt |t ti I¡ - I!I| j t rtt r Ii |t
J | i sIt r¡. j t ri r aIa| | i sIt r¡, ]rt «I| j aIIt rr , m t 1 i ta| | i sIt r¡, j art r Ia|
| t i ]| I ar 1 a]t t I j a | t rIa| ]rt «I| sj a rI
J j | ¡si ta| t tam . ]rt «I| tt |t ti I¡ t tt r t m t r I| j t ri t 1 , st ta a|
1 t tt |t j m t r I st t | ai |a rt It ¡ | ri tt ä t tIi t r
J ta|ta |aIt M i 1 -| art r Ia| 1 t i ]| I j rt 1 i tIt 1 a1 a |I | t i ]| I I– î tm It r I ä | rar ]t
• | t ¡ = IaI| t r | t i ]| I tm m t I| t r | t i ]| I tm ¡ 1 tm II
• ]i r| = IaI| t r | t i ]| I tm m t I| t r | t i ]| I tm – ¡ 1 tm II
J Ira t ]rt «I| | t rm t r t 1 t Ii ti t r t¡ i s rart , asst ti aIt 1 «i I| t I| t r
tt r ]t r i Ia| ar t m a|i t s m i 1 |i r t 1 t It tIs, tt ta| a| r t rm a|i Ii t s,
m i trt j t r i s, | t i ]| I aIIt tIt 1 m t rt I| ar «t i ]| I
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts ¡ ¡
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
Table 6. Short Stature
NORMAL GROWTH VELOCITY DECREASED GROWTH VELOCITY
r t r -j aI| t |t ]i ta| s| t rI sIaIa rt j aI| t |t ]i ta| s| t rI sIaIa rt
J tt r sIi Ia Ii t r a| 1 t |a¡t 1 | t r t a]t , 1 t |a¡t 1 J j ri m t r1 i a| | t i ]| I, «t i ]| I, ar 1 1 | art aIIt tIt 1
a1 t |t stt r tt ar 1 m a¡ | att Iam i |¡ | i sIt r¡ - t| rt m t st m a| t .]. ¡a rr t r, | t «r s¡r 1 rt m t , 1 ¡sm t rj | i t It aIa rt s
t I 1 t |a¡t 1 j a | t rI¡, m a¡ rt | a i rt Irt aIm t r I - s|t |t Ia| 1 ¡sj |asi as
«i I| ar 1 rt ]t r It sIrt ]t r s| t rI-It rm - | | | | It raIt ]t r , j |att r Ia, i r It tIi t r
J Iam i |i a| r t rm a| | t r t a]t J t r 1 t tri r t | t i ]| I m t rt aIIt tIt 1 I| ar «t i ]| I
r t Irt aIm t r I | t |j Ia | - “ s| t rI ar 1 IaI”
- ]rt «I| | t rm t r t 1 t Ii ti t r t¡
- | ¡j t I| ¡rt i 1 i sm
- | a s| i r ]’ s s¡r 1 rt m t
- | ¡j t j i Ia i Iari sm
J t| rt r i t 1 i st ast «t i ]| I m t rt aIIt tIt 1 I| ar | t i ]| I
- “ s| t rI ar 1 s|i r r ¡”
- | t |i at 1 i st ast , | | | , | |
- t| rt r i t i r It tIi t r s
- t| rt r i t rt r a| Iai |a rt t IIt r | t i ]| I m t rt aIIt tIt 1
J j s¡t| t st ti a| r t ]|t tI j s¡t| t st ti a| 1 «arIi sm
- a sa a||¡ 1 t trt ast 1 | t i ]| I ar 1 «t i ]| I ar 1 1 | i I st tt rt
Inve s tigations
J | t r t a]t t-ra¡
J |ar¡t I¡j t i r ]i r|s It ra |t t a I ¡a rr t r s¡r 1 rt m t
J t I| t r It sIs as i r 1 i taIt 1 | ¡ | i sIt r¡ ar 1 j | ¡si ta|
Manage me nt
J r t Irt aIm t r I It r I| t s| t rI r t rm a| t| i |1
J tri It ri a It r ]rt «I| | t rm t r t | 1 I| t raj ¡.
• | 1 | as | t t r s| t «r It | t 1 t Ii ti t r I | ¡ j | ¡si t |t ]i ta| ar 1
j | arm att |t ]i ta| It sIs I rt | a i rt 1
• j aIi t r I i s s| t rI | t |t « 1r1 j t rtt r Ii |t ar 1 r t I ]rt «i r ]
• t-ra¡s s| t « I| aI I| t rt i s sIi || ]rt «I| j t It r Ii a|, «i I| |t «
]rt «I| tt |t ti I¡
• r t t Ii t |t ]i ta| IatIt r It a r 1 I| aI tar | t Ii tt 1
• si ]r s ar 1 s¡m j It m s t I | 1 1 t Ii ti t r t¡ - t .]. i r Iar Ii |t It aIa rt s
ar 1 IaI 1 i sIri | a Ii t r , | ¡j t ]|¡tt m i a, j rt |t r ]t 1
| ¡j t r| i |i ra | i r t m i a i r I| t r t «| t rr j t ri t 1 , 1 t |a¡t 1 j a | t rI¡
J t I| t r t r 1 t tri r t a| r t rm a|i Ii t s I| aI art tt r Iri | a Ii r ] It s| t rI sIaIa rt
s| t a |1 | t tt rrt tIt 1 t .]. I| ¡rt i 1 | t rm t r t It r | ¡j t I| ¡rt i 1 i sm , i r sa |i r
It r 1 i a| t It s
TALL STATURE
J a|st tt r sIi Ia Ii t r a| ar 1 Iam i |i a| tari ar Is
J asst ssm t r I
• | i sIt r¡ ar 1 j | ¡si ta| t tam i r aIi t r . 1 i IIt rt r Ii aIt Iam i |i a| Irt m
t I| t r taa st s
• ta|ta |aIt M i 1 -| art r Ia| 1 t i ]| I j rt 1 i tIt 1 a1 a |I | t i ]| I
• |t t | It r asst ti aIt 1 a| r t rm a|i Ii t s t .]. | ¡j t rt tIt r si | |t }t i r Is i r
M arIar s¡r 1 rt m t
J t Ii t |t ]¡
• tt r sIi Ia Ii t r a|. m t sI tt m m t r , a1 tar tt 1 | t r t a]t Ij | ¡si ta|
1 t tt |t j m t r I i r t| i |1 | t t 1 | a I r t rm a| t r tt a1 a |I| t t 1 rt at| t 1
• t r 1 t tri r t . t .]. | ¡j t j | ¡st a| j i Ia i Iar¡ ]i ]ar Ii sm , j rt tt ti t a s
j a | t rI¡, I| ¡rt It ti tt si s, | t t|«i I| -wi t 1 t m ar s¡r 1 rt m t
• ]t r t Ii t. t .]. M arIar , | |i r t It |It r s¡r 1 rt m t s
J Irt aIm t r I. 1 t j t r 1 s t r t Ii t |t ]¡
• t sIrt ]t r a st 1 i r It m a|t s It taa st t j i j | ¡st a| Ia si t r
| t 1 i aIri ts ¡ I M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
PRIMARY CARE PEDIATRICS . . . CONT.
OBESITY
J «t i ]| I - I1X ]rt aIt r I| ar t tj t tIt 1 It r a]t ar 1 | t i ]| I
J | i sIt r¡. 1 i t I, atIi ti I¡, Iam i |¡ | t i ]| Is ar 1 «t i ]| Is, ]rt «I| ta rtt s
J j | ¡si ta| t tam i r aIi t r . m a¡ sa ]]t sI st tt r 1 ar¡ taa st , t .]. | a s| i r ]s s¡r 1 rt m t
• ta|i j t r 1 t It rm i r aIi t r t I IaI i s m t rt st r si Ii tt I| ar «t i ]| I
J t r]ar i t taa st s art rart - !X
• ]t r t Ii t, t .]. | ra1 t r-wi ||i , | arj t r It r, ¡a rr t r s¡r 1 rt m t
• t r 1 t tri r t , t .]. | a s| i r ]s, | ¡j t I| ¡rt i 1 i sm
J tt m j |i taIi t r s
• |t « tt rrt |aIi t r | t I«t t r t | t st t| i |1 rt r ar 1 t | t st a1 a |Is
• st m t asst ti aIi t r «i I| . | ¡j t rIt r si t r , i r trt ast 1 | | | , i r trt ast 1
ata It rt sj i raIt r¡ i r It tIi t r , s|i j j t 1 taj i Ia| It m t ra| t j i j | ¡si s
• m a¡ j rt 1 i sj t st It a1 a |I | ¡j t rIt r si t r , 1 i a| t It s, tar1 i t tasta |ar
1 i st ast
• | t ¡s. ]¡r t tt m asIi a
• ]i r|s. j t |¡t¡sIi t t tari ar 1 i st ast , t ar|¡ m t r art| t
• j s¡t| t |t ]i ta|. 1 i stri m i r aIi t r , It asi r ], i st |aIi t r , 1 t trt ast 1
st |I-t sIt t m , Irt aIt 1 as sIa j i 1 t r i r It ri t r
J m ar a]t m t r I
• t r tt a ra]t m t r I ar 1 rt assa rar tt
• 1 i t I. | a a|i IaIi tt t| ar ]t s, 1 t r t I t r tt a ra]t «t i ]| I |t ss | a I
a||t « It r |i r t ar ]rt «I| It taIt| a j «i I| «t i ]| I
• t ti 1 t r tt a]ai r sI tt r¡ |t « |i |t }t a |t 1 i t Is It r j rt a1 t |t stt r Is
• | t | ati t r m t 1 i Ii taIi t r . i r trt ast atIi ti I¡, t| ar ]t m t a| j aIIt rr s
• i r sa IIi ti t r I t ti 1 t r tt It r t r a]ai r sI t tt rti st , Iam i |¡ j rt ]ram s It r
t | t st t| i |1 rt r
• t 1 a taIi t r . m a |Ii 1 i sti j |i r ar¡ aj j rt at| , 1 i t Ii Ii ar , tt a r st ||i r ]
CHILD ABUSE AND NEGLECT
De finition
J ar i r It r Ii t r a| atI t I tt m m i ssi t r t r t m i ssi t r j | ¡si ta|, st ta a|, t r
t m t Ii t r a| | ¡ ar t I| t r j t rst r I| aI | arm s a t| i |1 i r a si ]r i Ii tar I «a¡
Le gal Obligation to Re port
J a j t r sa sj i ti t r t I a| a st , j | ¡si ti ar s i r | ar a1 a art rt | a i rt 1 | ¡ |a« It
ta|| I| t | | i |1 rt r s ki 1 ä t ti t I¡ | kä
Ris k Factors
J Iam i |¡ IatIt rs
• st ti a| i st |aIi t r
• j t tt rI¡
• sIrt ssIa | |i It t tt r Is t r si Ia aIi t r
• 1 t m t sIi t ti t |t r tt
J tart ]i tt r IatIt rs
• j art r Is «t rt a| a st 1 as t| i |1 rt r m t sI tt m m t r |¡ asst ti aIt 1
• j s¡t| t |t ]i ta| 1 ¡sIa r tIi t r I j s¡t| i aIri t i ||r t ss
• sa | sIar tt a| a st
• j art r Ii r ] sI¡|t
• j t t r st ti a| ar 1 tt taIi t r a| s|i ||s, | t |t « att ra]t i r It ||i ]t r tt
J t| i |1 IatIt rs
• 1 i IIi ta |I t| i |1 It m j t ram t r I
• | ar 1 i taj t r 1 i sa| i |i I¡
• sj t ti a| r t t 1 s, t .]. m t r Ia| rt Iar1 aIi t r
Phys ical Abus e
J | i sIt r¡ i r tt r si sIt r I «i I| j | ¡si ta| Ii r 1 i r ]s
J “ 1 t tIt r s| t j j i r ]” , m a |Ii j |t ti si Is It 1 i IIt rt r I | t sj i Ia|s
J 1 t |a¡ i r st t |i r ] m t 1 i ta| aIIt r Ii t r
J i r }a ri t s t I tari t 1 a]t s, rt ta rrt r I t r m a |Ii j |t i r }a ri t s
J 1 i sIi r tIi tt m ar|s. t .]. | t |I | a t||t , ti ]art IIt | a rr s, | ar 1
J aI¡j i ta| j aIIt rr s t I i r }a ri t s. Iatt , a| 1 t m t r , | a IIt t|s, i r r t r I| i ]| s,
a j j t r | at|, s¡m m t Iri ta| j aIIt rr
J a|It rt 1 m t r Ia| sIaIa s. | t a1 i r }a r¡, 1 ra ] i r ]t sIi t r , j t i st r i r ]
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts ¡ 1
CHILD ABUSE AND NEGLECT . . . CONT.
J s| a|t r | a| ¡ s¡r 1 rt m t
• m t sI tt m m t r taa st t I st tt rt t|t st 1 | t a1 i r }a r¡ i r i r Iar Is
- ¡ ¡t ar t |1
• ti t |t r I s| a|i r ] t I i r Iar I rt sa |Ii r ] i r i r Iratrar i a| | t m aIt m as ar 1
rt Ii r a| | t m t rr| a]t s
• 1 i a]r t si s tt r Ii rm t 1 | ¡ | ¡ t r M | |
• j t t r j rt ]r t si s It r i r Iar Is j rt st r Ii r ] i r tt m a. !1X 1 i t , I!X | att
si ]r i Ii tar I r t a rt |t ]i t 1 am a]t
Se xual Abus e
J j rt ta|t r tt . ¡ i r \ It m a|t s, ¡ i r ¡ 1 m a|t s
J j t a| a]t s aI I-t ar 1 ¡ I-¡ t ¡t ars
J m t sI j t rj t IraIt rs art |r t «r It t| i |1
• m t sI tt m m t r . IaI| t r, sIt j IaI| t r, a r t|t
J 1 i a]r t si s a sa a||¡ 1 t j t r 1 s t r t| i |1 It ||i r ] st m t t r t
J t|i r i ta| si ]r s
• sj t ti Ii t t r ]t r t ra|i tt 1 It ars, 1 t j rt ssi t r
• st ti a| «i I| 1 ra«a|, |at| t I Ira sI
• j s¡t| t st m aIi t s¡m j It m s, st| t t | Iai |a rt
• st ta a| j rt t tta j aIi t r , j |a¡
• | t | ati t r. st 1 a tIi tt , atIi r ] t a I, a]]rt ssi tt , j st a 1 t m aIa rt
• rt ta rrt r I | ¡ | s, j rt ]r ar t¡, ä ¡ | s, ta]i r i Ii s, ta]i r a| | |t t 1 i r ],
]t r i Ia| i r }a r¡
J i r tt sIi ]aIi t r s 1 t j t r 1 t r j rt st r IaIi t r , a]t , st t, ar 1 m aIa ri I¡ t I t| i |1
• a j It II | t a rs. raj t |i I
• | I1 ä ¡ | , | ¡ | , j rt ]r ar t¡ tt r si 1 t r ä ¡ | j rt j | ¡|ati s t r
m t rr i r ] aIIt r j i ||
• | I1 t I| t r i r }a ri t s
Ne gle ct
J Iai |a rt It I| ri tt , 1 t tt |t j m t r Ia| 1 t |a¡
J i r a1 t | a aIt t r 1 i rI¡ t|t I| i r ], t| rt r i t |at| t I
j t rst r a| | ¡]i t r t
J t| i |1 t t| i | i Is j t t r aIIat| m t r I It j art r Is
Manage me nt of Child Abus e and Ne gle ct
J | i sIt r¡. Irt m t| i |1 ar 1 tart ]i tt r s
J j | ¡si ta| t tam . | t a1 It It t 1 t r t I It rtt , t m t Ii t r a| sIaIt ,
1 t tt |t j m t r I
J 1 t ta m t r I a|| i r }a ri t s. I¡j t , |t taIi t r , si tt , s| aj t , tt |t a r, j aIIt rr
J rt j t rI a|| sa sj i ti t r s It | kä ar 1 It r j t |i tt
J ata It m t 1 i ta| tart , | t sj i Ia|i tt i I i r 1 i taIt 1 t r i I tt r tt rr s a| t a I Ia rI| t r
t r t r ]t i r ] a| a st
J i r tt sIi ]aIi t r s. | |t t 1 «t r|, I| rt aI ar 1 It r ]t r i Ia| s«a| s, s|t |t Ia| sa rtt ¡,
| t r t star , | ¡ IM | | , j | t It s
J arrar ]t tt r sa |IaIi t r It st ti a| «t r|, j s¡t| i aIr¡
J arrar ]t aj j rt j ri aIt It ||t «-a j
J | I| 1 i rt tI|¡ It | kä t r It rt sj t r si | |t ]a ar1 i ar
a r 1 t r | kä sa j t rti si t r
K t It s
| t 1 i aIri ts ¡ \ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
DEVELOPMENTAL AND
BEHAVIORAL PEDIATRICS
DEVELOPMENTAL DELAY
Diffe re ntial Diagnos is
J t| rt m t st m a|. | t «r s¡r 1 rt m t , Iri st m ¡ ¡ 1, Iri st m ¡ ¡ î
J m t Ia| t |i t. ¡a¡-ä at| s, | | | , a1 rt r t |t a |t 1 ¡sIrt j | i t s
J tt rt | ra| 1 t ]t r t raIi tt . 1 a r Ii r ]It r s t| t rt a, ä ä | |
J j rt r aIa| i r It tIi t r . ¡ 1 | | 1 ä , 1 | V
J j t sIr aIa| i r It tIi t r . m t r i r ]i Ii s, t r tt j | a|i Ii s, 1 | V
J It ti t a]t r IsI1 ra ]s. a|tt | t |, sIrt t I 1 ra ]s
J Iraa m aI| ¡j t ti a. | i rI| Iraa m a, i r Iratt rt | ra| | t m t rr| a]t
J t I| t r s¡r 1 rt m t s. tt rt | ra| m a|It rm aIi t r s, r t a rt Ii | rt m aIt si s, aa Ii sm
J st r st r¡ 1 t It tIs. ti si t r , | t ari r ]
LANGUAGE DELAY
Diffe re ntial Diagnos is
J | t ari r ] i m j ai rm t r I
• r t I rt sj t r si tt It st a r 1 s t a I t I si ]| I
• j rt |i r ]a i sIi t s|i ||s t .]. tt t i r ], | a| | |i r ] m a¡ i r i Ii a||¡
1 t tt |t j r t rm a||¡ | a I m a¡ 1 t trt ast 1 a t It |at| t I It t 1 | at|
• r t i m j ai rm t r I i r st ti a| i r It ratIi t r
• taa st s
• ]t r t Ii t 11-!1X
• tt r ]t r i Ia| i r It tIi t r t .]. ra | t ||a, | M V
• m t r i r ]i Ii s
• t It It ti t m t 1 i taIi t r s t .]. am i r t ]|¡tt si 1 t s
J tt ]r i Ii tt 1 i sa| i |i I¡
• ]|t | a| 1 t tt |t j m t r Ia| 1 t |a¡, m t r Ia| rt Iar1 aIi t r
• | t I| rt tt j Ii tt ar 1 t tj rt ssi tt |ar ]a a]t tt m j t r t r Is aIIt tIt 1
• t| i |1 t IIt r | as i r It rt sI i r tt m m a r i taIi t r
J j t rtasi tt 1 t tt |t j m t r Ia| 1 i st r1 t r i r t|a 1 i r ] aa Ii sm
• j t t r st ti a| i r It ratIi t r ar 1 |ar ]a a]t i m j ai rm t r I, t sj t ti a||¡ t tj rt ssi tt
st t | t rtasi tt | t tt |t j m t r Ia| | i st r1 t r ä t tIi t r
J st |t tIi tt m a Ii sm
• t r |¡ sj t a|s i r tt rIai r si Ia aIi t r s, a sa a||¡ aI | t m t
• a sa a||¡ sIarIs aI a]t !-t ¡t ars «| t r t| i |1 ]t t s It st| t t |
• | t a|I| ¡ t| i |1 rt r «i I| r t | t ari r ] i m j ai rm t r I
• t IIt r a| t tt att ra]t i r It ||i ]t r tt
J | ar 1 aa -| |t IIr t r s¡r 1 rt m t at| a i rt 1 t j i |t j Ii t aj | asi a
• j rt st r Is i r |aIt j rt st| t t | It t ar|¡ st| t t | a]t ¡t ars
• t| i |1 | t ]i r s It 1 t tt |t j |ar ]a a]t r t rm a||¡, I| t r sa 1 1 t r
rt ]rt ssi t r t I |ar ]a a]t
• t| i |1 | as st tt rt aj | asi a «i I| | | | t| ar ]t s
• t IIt r | as t tt rI st i ta rt atIi ti I¡
• i r i Ii a| j rt st r IaIi t r m a¡ | t si m i |ar It aa Ii sm
J m t t| ar i ta| j rt | |t m s
• t|t II j a|aIt
• trar i a| r t rtt j a|s¡
J st ti a| 1 t j ri taIi t r
PERVASIVE DEVELOPMENTAL DISORDER (PDD)
J | rt a1 ]t r t ri t It rm «| i t| 1 t stri | t s a sj t tIra m t I rt |aIt 1 1 i st r1 t rs,
i r t|a 1 i r ] aa Ii sm , ksj t r]t rs s¡r 1 rt m t , t| i |1 1 i si r It ]raIi tt 1 i st r1 t r,
ar 1 | | | r t I t I| t r«i st sj t ti Ii t 1
J aa Ii sm
• j rt ta|t r tt M .| = \.¡
• ri s| i r si | |i r ] î-1X
• t r st I j ri t r It 1 ¡t ars t I a]t
J ksj t r]t rs s¡r 1 rt m t
• j rt ta|t r tt M - |
• i m j ai rt 1 st ti a| i r It ratIi t r
• |ar ]a a]t ar 1 tt ]r i Ii t r | t IIt r I| ar i r aa Ii sm
• rt sIri tIt 1 , rt j t Ii Ii tt , sIt rt t I¡j t 1 j aIIt rr s t I | t | ati t a r,
i r It rt sIs ar 1 atIi ti Ii t s
• | t IIt r j rt ]r t si s I| ar i r aa Ii sm
J \ m ai r art as t I Ia r tIi t r i r ] aIIt tIt 1
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts ¡ !
DEVELOPMENTAL AND
BEHAVIORAL PEDIATRICS . . . CONT.
J ¡ |at| t I rt ti j rt ta| st ti a| i r It ratIi t r
• |at| t I i r It rt sI i r j t t rs ar 1 j t t r ]rt a j j arIi ti j aIi t r
• | i ]| t r Ia r tIi t r i r ] i r 1 i ti 1 a a|s «i I| | | | |at| 1 t j I| i r I| t i r
i r It ratIi t r s «i I| j t t j |t . i r I|t ti | i |i I¡, |at| t I rt ti j rt ti I¡ ar 1
t m j aI| ¡
J I j rt | |t m s «i I| tt r| a| ar 1 r t r -tt r| a| tt m m a r i taIi t r
• 1 t |a¡ i r t r st I t I t tj rt ssi tt ar 1 rt tt j Ii tt |ar ]a a]t
• t| aratIt ri sIi ts t I aa Ii sm . t t| t |a|i a, j t rst tt raIi t r ,
a| r t rm a|i Ii t s i r tt |a m t , j i It| ar 1 raIt t I sj t t t|
J 1 rt sIri tIt 1 ar 1 rt j t Ii Ii tt | t | ati t a rs
• sIt rt t I¡j i t. | ar 1 -I|aj j i r ], | t a1 -| ar ]i r ], rt t|i r ], rt j t Ii Ii tt
Ii r ]t r m t tt m t r Is, sj i r r i r ], t It.
• ri Ia a|i sIi t. t| t t|i r ], It a t| i r ]
J \ a| r t rm a| tt ]r i Ii tt Ia r tIi t r
• m a}t ri I¡ t t| i | i I m t r Ia| rt Iar1 aIi t r
• m a¡ | att ]t t 1 m t m t r¡ ar 1 ti sa t sj aIi a| Ia r tIi t r
• j t t r s¡m | t |i taIi t r ar 1 a r 1 t rsIar 1 i r ] t I a| sIratI i 1 t as ar 1
I| t t rt Ii ta| tt r tt j Is
• | i ]| t r Ia r tIi t r i r ] | | | t| i |1 rt r m a¡ | att tt r sa m i r ] i r It rt sI i r
t r t It j i t It I| t t tt|a si t r t I t I| t r It j i ts
FETAL ALCOHOL SYNDROME (FAS) AND
FETAL ALCOHOL EFFECTS (FAE)
J j rt ta|t r tt
• |kä . ¡ i r !11-t11
• |k| . ¡ i r 111-1!1
J r t I |r t «r | t « m a t| a|tt | t | i s | arm Ia | 1 a ri r ] j rt ]r ar t¡
J r t saIt |t tt | t I a|tt | t | tt r sa m j Ii t r 1 a ri r ] j rt ]r ar t¡
Crite ria for Diagnos is of Fe tal Alcohol Syndrome
J k. | rt «I| 1 t Ii ti t r t¡
• |t « «t i ]| I ar 1 It r s| t rI |t r ]I| aI | i rI| I| aI tt r Ii r a t s I| rt a ]| t| i |1 | t t 1
J | . k| r t rm a| trar i t Iati a| It aIa rt s
• sm a|| | t a1 , sm a|| t ¡t s, |t r ] sm t t I| j | i |Ira m , I| i r a j j t r |i j ,
m ati ||ar¡ | ¡j t j |asi a
J | . | t r Ira| r t rtt a s s¡sIt m 1 ¡sIa r tIi t r
• m i trt tt j | a|¡ ar 1 It r r t a rt | t | ati t ra| 1 ¡sIa r tIi t r
t .]. | ¡j t ratIi ti I¡, m t It r j rt | |t m s, aIIt r Ii t r 1 t Ii ti Is, |t arr i r ]
1 i sa| i |i Ii t s, tt ]r i Ii tt 1 i sa| i |i Ii t s
J | . ä Irt r ] t ti 1 t r tt t I m aIt rr a| 1 ri r |i r ] 1 a ri r ] j rt ]r ar t¡
Fe tal Alcohol Effe cts
J t| i |1 | t rr It a m t I| t r «| t «as |r t «r It | t 1 ri r |i r ] | t ati |¡ 1 a ri r ] j rt ]r ar t¡
J t| i |1 | as st m t | a I r t I a|| t I j | ¡si ta| t| aratIt ri sIi ts t I |kä
CHRONIC RECURRENT ABDOMINAL PAIN
J j rt ta|t r tt . ¡ 1X t I st| t t | t| i |1 rt r
• tt m m t r i r t ar|¡ t| i |1 | t t 1 ar 1 t ar|¡ a1 t |t stt r tt
J - ¡ 1X | att t r]ar i t 1 i st ast
J t| aratIt ri sIi ts t I j s¡t| t ]t r i t a| 1 t m i r a| j ai r
• st |1 t m «a|t s t| i |1
• j t t r|¡ |t ta|i tt 1 , j t ri a m | i |i ta|, tt r sIar I
• a]]rataIt 1 | ¡ t tt rti st , a||t ti aIt 1 | ¡ rt sI
• st| t t | att i 1 ar tt
• j s¡t| t st ti a| IatIt rs rt |aIt 1 It t r st I ar 1 It r m ai r It r ar tt t I j ai r
• a| st r tt t I t r]ar i t i ||r t ss
J j s¡t| i aIri t tt m t r| i 1 i I¡. ar ti t I¡, st m aIt It rm , m t t 1 , |t arr i r ]
1 i st r1 t rs, st ta a| a| a st , t aIi r ] 1 i st r1 t rs, t |i m i r aIi t r 1 i st r1 t rs
J asst ssm t r I. i r It rti t « t| i |1 a|t r t ar 1 «i I| j art r Is, | I1 t r]ar i t i ||r t ss
J m ar a]t m t r I
• i 1 t r Ii I¡ j s¡t| t st ti a| sIrt sst rs
• i r 1 i ti 1 a a| ar 1 Iam i |¡ j s¡t| t I| t raj ¡
K t It s
| t 1 i aIri ts ¡ t M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
DEVELOPMENTAL AND
BEHAVIORAL PEDIATRICS . . . CONT.
ELIMINATION DISORDERS
ENURESIS
J i r tt |a r Iar¡ a ri r ar¡ i r tt r Ii r t r tt | ¡ 1 a¡ ar 1 It r r i ]| I i r a t| i |1
- ! ¡t ars t |1
J r t I 1 a t It r t a rt |t ]i ta| 1 i st r1 t r rt sa |Ii r ] i r j t t r | |a1 1 t r tt r Irt |,
t j i |t j s¡, t r sIra tIa ra| a| r t rm a|i I¡ t I I| t a ri r ar¡ IratI
J j rt ta|t r tt . ¡ 1X t I t ¡t ar t |1 s, 1X t I ¡ I ¡t ar t |1 s, ¡ X t I ¡ î ¡t ar t |1 s
Primary Nocturnal Enure s is (90%)
J «t I t r |¡ aI r i ]| I 1 a ri r ] s|t t j
J 1 t tt |t j m t r Ia| 1 i st r1 t r t r m aIa raIi t r a| |a] i r | |a1 1 t r tt r Irt | «| i |t as|t t j
J m t rt tt m m t r i r | t ¡s, Iam i |¡ | i sIt r¡ tt m m t r
J i r tt sIi ]aIi t r s. a ri r a|¡si s
J Irt aIm t r I
• Ii m t ar 1 rt assa rar tt ¯ I1X rt st |tt sj t r Iar t t a s|¡ t at| ¡t ar
• | |a1 1 t r rt It r Ii t r t tt rti st s
• tt r 1 i Ii t r i r ]. «t I a|arm «a|t s t| i |1 a j t r tt i 1 i r ] \1-I!X sa ttt ss raIt
• m t 1 i taIi t r s. | | kV|
Se condary Enure s is
J 1 t tt |t j s aIIt r t| i |1 | as sa sIai r t 1 1 m t r I| s t r m t rt j t ri t 1 t I
| |a1 1 t r tt r Irt |
J r t r sj t ti Ii t rt ]rt ssi t r i r I| t Iatt t I sIrt ss t r ar ti t I¡, t .]. | i rI| t I
si | |i r ], si ]r i Ii tar I |t ss, Iam i |¡ 1 i stt r1
J m a¡ | t st tt r 1 ar¡ It | ¡ | , | M , | | , r t a rt ]t r i t | |a1 1 t r, | |, si t||t tt ||
1 i st ast , st i ta rt s, j i r «t rm s
J m a¡ t tta r i I t r ]rt sst 1 i r t I| t r atIi ti Ii t s
Diurnal Enure s is
J 1 a¡Ii m t «t IIi r ] t1-î1X a|st «t I aI r i ]| I
J Ii m i 1 , s| ¡, It m j t ram t r Ia| j rt | |t m s
J | I1 sIra tIa ra| ar t m a|¡, t .]. t tIt j i t a rt It ra| si It , r t a rt ]t r i t | |a1 1 t r
J Irt aIm t r I 1 t j t r 1 s t r taa st
• rt m i r 1 t| i |1 It ]t It It i |t I
• m t r Ia| | t a|I| Irt aIm t r I
• It ta s t r tt r| a| t tj rt ssi t r t I It t |i r ]s
ENCOPRESIS
J It ta| i r tt r Ii r t r tt i r a t| i |1 aI |t asI \ ¡t ars t I a]t
J j rt ta|t r tt . ¡ -¡ .!X t I st| t t | a]t 1 t| i |1 rt r rart i r a1 t |t stt r tt
J M .| = t.¡
J m a sI t tt|a 1 t m t 1 i ta| taa st s, t .]. 1 i rst| sj ra r ]’ s 1 i st ast ,
| ¡j t I| ¡rt i 1 i sm , | ¡j t rta|tt m i a, sj i r a| tt r1 |t si t r s, ar t rt tIa| m a|It rm aIi t r s
Re te ntive Encopre s is (ps ychoge nic me gacolon)
J taa st s
• j | ¡si ta|. ar a| Ii ssa rt j ai r Ia | sIt t |i r ]
• t m t Ii t r a|. 1 i sIa r| t 1 j art r I-t| i |1 rt |aIi t r s| i j , tt t rti tt It i |t I
Irai r i r ]
• ]t r t Ii t. I!X | att t r a rt Ii t rt |aIi tt , M l - | l I«i r s
J | i sIt r¡
• t| i |1 «i I| | t |1 s | t «t | m t tt m t r I, 1 t tt |t j s tt r sIi j aIi t r ,
|t a1 i r ] It It ta| i m j atIi t r ar 1 st t j a]t t I st II t r |i | a i 1 sIt t |
• trt sst s |t ]s It rt si sI a r]t It 1 t It taIt
• 1 i sIrt sst 1 | ¡ s¡m j It m s, st i |i r ] t I t|t I| t s
• It i |t I Irai r i r ]. tt t rti tt t r |at|a1 ai si ta|
J j | ¡si ta| t tam
• rt tIa| t tam . |ar]t It ta| m asst s i r rt tIa| taa |I
J Irt aIm t r I
• t|t ar t a I | t «t | tt m j |t It |¡ t .]. | t |¡It |¡, I|t t I t r t m as
• sIt t | st IIt r t rs t .]. ä t r t |t I, | ar st ¡| aI | t 1 Ii m t
• t r t m as ar 1 sa j j t si It ri t s
• rt ]a |ar st| t 1 a |t It 1 t It taIt
• j t si Ii tt rt i r It rtt m t r I
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts ¡ I
DEVELOPMENTAL AND
BEHAVIORAL PEDIATRICS . . . CONT.
Non-Re te ntive Encopre s is
J tt r Ii r a t a s. j rt st r I Irt m | i rI| r t tt r ]ai r t 1 j ri m ar¡ tt r Irt | t I | t «t | Ia r tIi t r
• | t «t | m t tt m t r I rar 1 t m |¡ 1 t j t si It 1 «i I| t a I rt ]ar1 It st ti a| r t rm s
• Iam i |¡ sIra tIa rt a sa a||¡ 1 t t s r t I t r tt a ra]t t r]ar i taIi t r ar 1
s|i || Irai r i r ]
• t| i |1 | as r t I | a1 a1 t | a aIt tt r si sIt r I | t «t | Irai r i r ]
• Irt aIm t r I. tt r si sIt r I, Ii rm ar 1 |i r 1 It i |t I Irai r i r ]
J 1 i stt r Ii r a t a s. j rt ti t a s | i sIt r¡ t I r t rm a| | t «t | tt r Irt |
• | t «t | m t tt m t r Is as ar t tj rt ssi t r t I ar ]t r t r «i s| It | t st t r
as a ¡t a r ]t r t| i |1
• | rt a|1 t «r t tta rs i r Iatt t I sIrt ssIa | t tt r I, rt ]rt ssi t r
• 1 i sj |a¡s rt |aIi tt i r 1 i IIt rt r tt It s¡m j It m s
• Irt aIm t r I. j s¡t| t I| t raj ¡ i I j t rsi sIs It r m ar ¡ «t t |s
Toile t Phobia
J rt |aIi tt |¡ ¡t a r ] t| i |1
J ti t «s It i |t I as a Iri ]| It r i r ] sIra tIa rt
J t| i |1 I| i r |s I| t ¡ m a¡ | t s«t j I a«a¡ | ¡ It i |t I
J Irt aIm t r I
• ]ra1 a a| st ri t s t I sIt j s «i I| rt «ar1 s
• 1 t st r si Ii taIi t r
GENETICS
APPROACH TO THE DYSMORPHIC CHILD
J 1I¡ 11 i r Iar Is art | t rr «i I| a tt r ]t r i Ia| 1 t It tI, m ar ¡ art asst ti aIt 1
«i I| a 1 t ]rt t t I 1 t tt |t j m t r Ia| 1 i sa| i |i I¡
J ]t r t Ii t 1 i st r1 t rs ar 1 | i rI| 1 t It tIs attt a r I It r aj j rt ti m aIt |¡ \1X t I
t| i |1 | t t 1 1 t aI| s
J | i sIt r¡
• j rt r aIa|It | sIt Iri ta| | i sIt r¡. m aIt rr a| a]t ar 1 j asI | t a|I| ,
a|tt | t |I1 ra ]Im t 1 s a st , 1 i IIi ta |Ii t s 1 a ri r ] j rt ]r ar t¡I|a| t a rI1 t |i tt r¡,
i r tt sIi ]aIi t r s 1 t r t ar 1 rt sa |Is st t 1 | sIt Iri ts K t It s
• tt m j |t It 1 ]t r t raIi t r Iam i |¡ j t 1 i ]rt t . tt r sar ]a i r i I¡, sIi ||| i rI| s,
r t t r aIa| 1 t aI| s, sj t ti Ii t i ||r t sst s, m t r Ia| rt Iar1 aIi t r ,
m a |Ii j |t m i starri a]t s, t I| r i ti I¡ I| a|asst m i a, ¡a¡-ä at| s
• 1 t tt |t j m t r Ia| m i |t sIt r t s ar 1 ]rt «I| i r ar t |1 t r t| i |1
J j | ¡si ta| t tam i r aIi t r
• tart Ia | t | st rtaIi t r
• ]rt «I| j aram t It rs | t i ]| II«t i ]| II| t a1 ti rta m It rt r tt
• tt m j art t| i |1 s It aIa rt s «i I| j art r Is ar 1 si | s
J i r tt sIi ]aIi t r
• as| It r st ri a| j | t It ]raj | s i I t| i |1 i s t |1 t r
• t-ra¡s i I | t r ¡ a| r t rm a|i Ii t s t r i I sa sj t tI a tt r ]t r i Ia| i r It tIi t r
• t¡It ]t r t Ii tIt| rt m t st m t sIa 1 i t s I– s|i r Ii | rt | |asIs
• | i t t| t m i sIr¡. sj t ti Ii t t r t¡m t assa¡s
• m t |t ta |ar | i t |t ]¡ It r sj t ti Ii t It sIi r ]
• ]t r t Ii t j rt | t s r t « atai |a| |t t .]. | ra]i |t X
J tt a r st ||i r ] ar 1 rt ta rrt r tt ri s| asst ssm t r I
Patte rns of Inhe ritance
J aa It st m a| 1 t m i r ar I
• !1X ri s| «i I| ar aIIt tIt 1 j art r I
• t .]. K t a rt Ii | rt m aIt si s | ar 1 | | , M arIar s¡r 1 rt m t , kt| t r 1 rt j |asi a
J aa It st m a| rt tt ssi tt
• ri s| i s I!X «| t r | t I| j art r Is tarr¡ I| t aIIt tIt 1 ]t r t
• tarri t r sIaIt s tar st m t Ii m t s | t 1 t It tIt 1 , tt r sar ]a i r i I¡ i r trt ast s t| ar tt
• t .]. si t||t tt || ar t m i a, | |, ¡a¡-ä at| s
J X-|i r |t 1 rt tt ssi tt
• ]t r t It r I| t 1 i st ast tarri t 1 t r X t| rt m t st m t , i r | t ri It 1
I| rt a ]| m t I| t r, m t sI art rt tt ssi tt «i I| | t m t t¡]t a s It m a|t s | t i r ] rart
• It m a|t tarri t rs m a¡ st m t Ii m t s | t 1 t It tIt 1 , t .]. | t| | 1 t Ii ti t r t¡
• tar r t I | att m a|t It m a|t Irar sm i ssi t r
• t .]. | a t| t r r t M | , | ra]i |t X, | t| | , 1 t m t j | i |i a k ar 1 |
| t 1 i aIri ts ¡ î M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GENETICS . . . CONT.
J m a |Ii IatIt ri a|
• ]t r t Ii t j rt 1 i sj t si Ii t r «i I| t r ti rt r m t r Ia| IatIt rs rt | a i rt 1 It r
1 i st ast It | t t tj rt sst 1
• rt ta rrt r tt ri s| \-¡ 1X 1 i st ast sj t ti Ii t , i I m t I| t r ar 1 t r t
t| i |1 aIIt tIt 1 , ri s| i s a j It ¡ !X
• t .]. r t a ra| Ia | t 1 t It tIs, t|t II |i j ar 1 j a|aIt
J m i It t| t r 1 ri a|
• ]t r t s Irt m m t I| t r t r |¡, M = |
• t .]. | t | t r t j Ii t r t a rt j aI| ¡, M | | kä
J sj t r Iar t t a s m a IaIi t r s
DOWN SYNDROME
J i r | a m ar s, I| t m t sI tt m m t r a| r t rm a|i I¡ t I aa It st m a| t| rt m t st m t s
J Iri st m ¡ I¡
• î1-11X r t r 1 i s}a r tIi t r
• !X Irar s|t taIi t r s
• 1X m t sai ts m a¡ | t |t ss r t Ii tt a| |t I|t ss st tt rt
J i r ti 1 t r tt . m t sI tt m m t r aa It st m a| t| rt m t st m a| a| r t rm a|i I¡,
¡ i r t11-î11 |i tt | i rI| s, ri st s «i I| a1 tar tt 1 m aIt rr a| a]t It
¡ i r I1 | ¡ a]t \! ¡t ars
J aIIt tIt 1 It Ia st s | att i r trt ast 1 ri s| t I sj t r Iar t t a s a| t rIi t r
J t|i r i ta| It aIa rt s
• | ¡j t It r i a aI | i rI| î1X , |t « | â , 1 t tt |t j m t r Ia| 1 t |a¡
• r t a rt |t ]i t. | ¡j t It r i a, j rt m aIa rt st r i |i I¡, k|t| t i m t rs t r st I i r \1’ s
• Iati t s. I|aI t tti j a I, m i trt tt j | a|¡, sm a|| m i 1 Iatt , sm a|| m ar 1 i | |t
ar 1 m ati ||at , a j s|ar Ii r ] j a|j t | ra| Ii ssa rt s, t j i tar I| a| It |1 s,
| ra s| Ii t |1 s sj t Is i r i ri s
• | K ¡. Ia rrt «t 1 j rt m i r t r I It r ]a t , | i ]| art| t 1 j a|aIt , t ar ar t m a|i t s,
Irt | a t r I ata It t Ii Ii s m t 1 i a
• | Vä . \1X | att tt r ]t r i Ia| tar1 i at 1 t It tIs, j arIi ta |ar|¡
t r 1 t tar1 i a| ta s| i t r 1 t It tIs
• | | . 1 a t 1 t r a|, ar a| aIrt si a ar 1 ¡ | Ii sIa |a
• M ä | . |at }t i r Is i r t|a 1 i r ] 1 ¡sj |asIi t | i j s, tt rIt | ra| ar t m a|i t s,
aI|ar It ati a| i r sIa| i |i I¡
• s|i r . ä i m i ar j a|m ar trt ast , a| r t rm a| 1 t rm aIt ]|¡j | i ts
• | t m aIt |t ]i t. |t a |t m i as ¡ X |i It Ii m t ri s|
• t r 1 t tri r t . | ¡j t I| ¡rt i 1 i sm
J j rt ]r t si s. s| t rIt r |i It t tj t tIar t¡
J m ar a]t m t r I
• rt tt m m t r 1 t 1 It sIi r ]. t t| t , I| ¡rt i 1 It sIs, aI|ar It -t tti j i Ia|
t-ra¡ aI I ¡t ars tt r Irt tt rsi a|
• Irt aI ar ¡ |i It -I| rt aIt r i r ] 1 t It tIs i m m t 1 i aIt |¡
t .]. 1 a t 1 t r a| aIrt si a
• m ai r |¡ s¡m j It m aIi t
• «i 1 t rar ]t t I st tt ri I¡, t ar|¡ i r It rtt r Ii t r j rt ]ram s It | t |j
t| i |1 rt r rt at| Ia || j t It r Ii a|
OTHER TRISOMIES
Tris omy 13
J i r ti 1 t r tt ¡ .!111 |i tt | i rI| s
J i r trt ast 1 ri s| t I sj t r Iar t t a s a| t rIi t r s
J It aIa rt s. st i ta rt s, 1 t aIr t ss, m i trt tt j | a|¡, t|t II |i j Ij a|aIt ,
j t |¡1 atI¡|¡, rt Ii r a| ar t m a|i t s, si r ]|t a m | i |i ta| arIt r¡, tar1 i at
1 t It tIs, sta|j 1 t It tIs
J m i 1 |i r t ar t m a|i t s. sta|j , j i Ia i Iar¡, j a|aIt , | t arI, a m | i |i ta s, ar a s
J j rt ]r t si s. \\X 1 i t i r ¡ m t r I|
- ¡ 1X sa rti tt j asI ¡ ¡t ar j rt It a r 1 M | i r sa rti tt rs
Tris omy 18
J i r ti 1 t r tt . ¡ Iî111 |i tt | i rI| s, It m a|t . m a|t = 1.¡
J i r trt ast 1 ri s| t I sj t r Iar t t a s a| t rIi t r
J It aIa rt s. j rt m i r t r I t tti j a I, m i trt ]r aI| i a, t ta |ar a| r t rm a|i Ii t s, t|t II
|i j ar 1 j a|aIt , |t « st I t ars, rt t|t r | t IIt m It t I, s| t rI sIaIa rt , t|t r t| t 1
Ii sI «i I| t tt r|aj j i r ] 1 i ]i Is, | ¡j t j |asIi t r ai |s, t|i r t 1 atI¡|¡, j t |¡1 atI¡|¡,
tar1 i at 1 t It tIs, | t rr i a, st tt rt | K ä m a|It rm aIi t r , a rt ]t r i Ia|
a| r t rm a|i Ii t s tr¡j It rt| i 1 i sm , j t |¡t¡sIi t |i 1 r t ¡s
J |t ¡ j t i r I. sm a|| | a| i t s ä | k, m i trt tt j | a|¡, s| t rI
J j rt ]r t si s t I st tt rt | ¡ ¡. 11X 1 i t i r ¡ m t r I| , !1X | ¡ I m t r I| s,
11X | ¡ ¡ I m t r I| s, j rt It a r 1 M | i r sa rti tt rs
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts ¡ 1
K t It s
GENETICS . . . CONT.
TURNER SYNDROME
J m t sI tt m m t r ]t r t I¡j t i s \!X, m t sai t a|st j t ssi | |t «i I| m t sI
tt m m t r | t i r ] \!XI\tXX
J i r ti 1 t r tt ¡ .I,!11 |i tt It m a|t | i rI| s
J ri s| r t I i r trt ast 1 «i I| a1 tar tt 1 m aIt rr a| a]t
J t|i r i ta| It aIa rt s
• i r It ||i ]t r tt a sa a||¡ r t rm a|, m a¡ | att m i |1 |t arr i r ] 1 i sa| i |i Ii t s
• |¡m j | t 1 t m a, t¡sIi t | ¡]rt m a i r I| t r t «| t rr «i I|
j t |¡| ¡1 ram r i t s, |a r ] | ¡j t j |asi a
• s| t rI sIaIa rt , «i 1 t tarr¡i r ] ar ]|t aI t || t «s
• s| t rI «t | | t 1 r t t|, |t « j t sIt ri t r | ai r |i r t
• | rt a1 t| t sI, «i 1 t sj att 1 r i j j |t s
• i r It rIi |i I¡, ]t r a1 a| 1 ¡s]t r t si s
• j ri m ar¡ am t r t rr| t a, |at| t I 1 t tt |t j m t r I t I st tt r 1 ar¡ st ta a| t| aratIt ri sIi ts
• | t arI 1 t It tIs. tt artIaIi t r t I I| t at rIa, | i ta sj i 1 at rIi t ta|tt
• rt r a| a| r t rm a|i Ii t s, i r trt ast 1 ri s| t I 1 ¡ K
J j rt ]r t si s. r t rm a| |i It t tj t tIar t¡ i I r t tt m j |i taIi t r s, ri s| t I X-|i r |t 1
1 i st ast s i r trt ast s It I| aI t I m a|t s
J m ar a]t m t r I
• It Iati |i IaIt ]rt «I| ar 1 1 t tt |t j m t r I t I st tt r 1 ar¡
st ta a| t| aratIt ri sIi ts
• | t rm t r t It sIrt ]t r rt j |att m t r I
• ]rt «I| | t rm t r t tt r Irt tt rsi a|
KLINEFELTER SYNDROME
J ¡ I¡ ,111 |i tt m a|t | i rI| s, \I XXY m t sI tt m m t r
J asst ti aIt 1 «i I| |aIt m aIt rr a| a]t
J 1 t t sr ’ I j rt st r I a r Ii | m a|t j t sI-j a | t rIa|
J m i |1 m t r Ia| rt Iar1 aIi t r , |t r ] |i m | s, | ¡j t ]t r a1 i sm , | ¡j t sj t rm i a
]¡r t tt m asIi a, |at| t I Iati a| | ai r
J Irt aIm t r I. It sIt sIt rt r t i r a1 t |t stt r tt
FRAGILE X
J m t sI tt m m t r ]t r t Ii t taa st t I 1 t tt |t j m t r Ia| 1 t |a¡ i r | t ¡s
J i r ti 1 t r tt ¡ I¡ I!1, X-|i r |t 1 rt tt ssi tt
J t|i r i ta| It aIa rt s
• t tt r]rt «I| . j rt m i r t r I }a«, It rt | t a1 , t ars, t |t r ]aIt 1 , r arrt « Iatt ,
m artrt t rt| i 1 i sm
• | ¡j t rt tIt r si | i |i I¡, | i ]| art| t 1 j a|aIt , m i Ira| ta|tt j rt |aj st
• t IIt r | ¡j t ratIi tt ar 1 It r aa Ii sIi t
• | â I¡j i ta||¡ 11-t! | a I I1X t I aIIt tIt 1 m a|t s | att r t rm a| i r It ||i ]t r tt
• It m a|t tarri t rs m a¡ s| t « st m t i r It ||t tIa a| i m j ai rm t r I
J 1 i a]r t si s
• t¡It ]t r t Ii t sIa 1 i t s. rt ]i t r t r X| «| i t| Iai |s It tt r 1 t r st
1 a ri r ] m i It si s
• m t |t ta |ar It sIi r ]. t tt ram j |i Ii taIi t r t I a Iri r a t|t t Ii 1 t
rt j t aI, |t r ]I| t I st ]m t r I i s j rt j t rIi t r a| It st tt ri I¡ t I
t|i r i ta| j | t r t I¡j t ]t r t Ii t ar Ii ti j aIi t r
MUSCULAR DYSTROPHY
J a ]rt a j t I i r | t ri It 1 1 i st ast s t| aratIt ri tt 1 | ¡ j rt ]rt ssi tt s|t |t Ia|
tar1 i at m a st|t 1 t ]t r t raIi t r
Duche nne Mus cular Dys trophy
J X |i r |t 1 rt tt ssi tt , ¡ I1111 m a|t s, ¡ I1 sj t r Iar t t a s m a IaIi t r s
J m i ssi r ] sIra tIa ra| j rt It i r 1 ¡sIrt j | i r , |t a1 s It m a st|t Ii | rt Ira]i |i I¡,
Ii | rt | rt a|1 t «r , r t trt si s ar 1 rt ]t r t raIi t r
J t|i r i ta| It aIa rt s
• | ¡ a]t 1, j rt ti m a| m a st|t «t a|r t ss, | t «t rs si ]r
• j st a 1 t -| ¡j t rIrt j | ¡ t I m a st|t s
• 1 t trt ast 1 rt I|t tt s
• m a¡ 1 t tt |t j m i |1 m t r Ia| rt Iar1 aIi t r , t | t si I¡
J 1 i a]r t si s
• j t 1 i ]rt t
• trt aIi r t j | t sj | t |i r ast , |atIaIt 1 t | ¡1 rt ]t r ast i r trt ast 1
• m a st|t | i t j s¡, | M |
J tt m j |i taIi t r s
• j aIi t r I a sa a||¡ «| t t |t| ai r | t a r 1 | ¡ ¡ I ¡t ars t |1
• t ar|¡ I|t ti t r tt r IratIa rt s, stt |i t si s
• 1 t aI| 1 a t It j r t a m t r i aIrt sj i raIt r¡ Iai |a rt t r tt r ]t sIi tt | t arI Iai |a rt
| t 1 i aIri ts I1 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GENETICS . . . CONT.
J Irt aIm t r I
• sa j j t rIi tt j | ¡si t I| t raj ¡, «| t t |t| ai rs, | ratt s , j rt tt r I t | t si I¡
• sa r]i ta| It r stt |i t si s
• a st t I sIt rt i 1 s t tj t ri m t r Ia|
• ]t r t I| t raj ¡ Iri a|s a r 1 t r«a¡
Be cke r's Mus cular Dys trophy
J 1 ¡sIrt j | i r ]t r t a| r t rm a|, s¡m j It m s si m i |ar It | a t| t r r t | a I t r st I
i s |aIt r ar 1 j rt ]rt ssi t r i s s|t «t r
CLEFT LIP AND PALATE
J m a |Ii -IatIt ri a| i r | t ri Iar tt
J st t | K ¡ st tIi t r
INBORN ERRORS OF METABOLISM
J ar i r | t ri It 1 1 i st r1 t r t I i r It rm t 1 i ar¡ m t Ia| t |i sm
J Irt aIm t r I i s st m t Ii m t s j t ssi | |t | t taa st I| t | i t t| t m i ta| | asi s t I I| t
1 i st r1 t r i s a r 1 t rsIt t 1
J j rt st r IaIi t r
• st i ta rt s, t r tt j | a|t j aI| ¡
• 1 t tt |t j m t r Ia| 1 t |a¡, | ¡ ¡
• rt r a| Ia | a |ar 1 i st ast , 1 i IIa st |i tt r 1 i st ast
• | ¡j t ]|¡tt m i a, | ¡j t ram m t r t m i a, «i 1 t ar i t r ]aj
m t Ia| t |i t ati 1 t si s
VACTERL ASSOCIATION
J r a m | t r t I tt r ]t r i Ia| ar t m a|i t s t tta ri r ] It ]t I| t r
J t= tt rIt | ra| ar t m a|i t s,a= i m j t rIt raIt ar a s,
t= tar1 i at a| r t rm a|i Ii t s, It = Irat| t t t st j | a]t a| Ii sIa |a,
r= ra1 i a| ar 1 rt r a| 1 ¡sj |asi a, |= |i m | 1 t It rm i I¡
NEONATOLOGY
INFANT MORTALITY
J 1-¡ 1I¡ ,111 | i rI| s
J taa st s
• tt r ]t r i Ia|
• j rt m aIa ri I¡ | | ä , i r Iratrar i a| | t m t rr| a]t
• asj | ¡ti a
• i r It tIi t r s
• sa 1 1 t r i r Iar I 1 t aI| s¡r 1 rt m t
NORMAL BABY AT TERM
J 1 | ¡ I1-¡ t1Ij t r m i r
J | | \1-t1Ij t r m i r
J «t i ]| I I!11-\!11 ]
J ]|a tt st - I.I
J | | s¡sIt |i t !1-î1, 1 i asIt |i t 11-\1 1 t j t r 1 t r I t r | k
GESTATIONAL AGE AND SIZE
De finitions
J ]t sIaIi t r a| a]t
• j rt -It rm . - 1I «t t |s
• It rm . 1I-\I «t t |s
• j t sI-It rm . - \I «t t |s
J ä | k. m t asa rt m t r Is - I ä | | t |t « m t ar It r ]t sIaIi t r a| a]t | k
J k| k. «i I| i r I ä | t I m t ar It r | k
J | | k. - I ä | a| t tt I| t m t ar It r | k
J | k tar | t t sIi m aIt 1 a si r ] I| t | a||ar1 ä tt rt
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I¡
K t It s
NEONATOLOGY. . . CONT.
Table 7. Infant Maturity
Site s < = 36 We e ks 37-38 We e ks > = 39 We e ks
s|i r j a|t , Irar s|a tt r I j i r |t r, sm t t I| t r j i r |, I| i t|
st |t trt ast s sm t t I| j rt ]rt sst s ar It ri t r j rt ]rt sst s i r trt asi r ] 1 t j I|
It ar It ri t r trt ast s It | t a| trt ast s t I st |t trt ast s
| rt asI r t 1 a |t ≤ I m m \ m m !-¡ 1 m m
1 i am t It r
sta|j | ai r Ii r t ar 1 Ia tt¡ Ii r t ar 1 Ia tt¡ I| i t| ar 1 si ||¡
t ar |t | t I|aI, j |i a| |t , st m t tarIi |a]t sIi IIt r t 1 | ¡ I| i t| tarIi |a]t
r t tarIi |a]t
It sIt s ar 1 It sIt s i r |t «t r i r It rm t 1 i aIt j t r 1 a |t a s,
strt Ia m tar a|, sm a|| strt Ia m Ia || tt tt rt 1 «i I| ra ]at
strt Ia m , It « ra ]at
|a| i a ar 1 j rt m i r t r I t|i It ri s, t|i It ri s r t ar|¡ t|i It ri s tt tt rt 1 | ¡ j rt j a tt
t|i It ri s sm a|| |a| i a tt tt rt 1 | ¡ j rt j a tt |ar]t |a| i a
Table 8. Abnormalitie s of Ge s tational Size and Maturity Fe ature s
Fe ature s Caus e s Proble ms
j rt -It rm i r Iar Is i r It tIi t r ¡ 1 | | 1 | | ä , rt sj i raIt r¡ 1 i st ast s
- 1I «t t |s m aIt rr a| j aI| t |t ]¡ rt ta rrt r I aj r t a
1 ra ]sI| I1 1 It t 1 i r ] 1 i IIi ta |Ii t s
t| rt m t st m a| | ¡j t ta|tt m i a, | ¡j t ]|¡tt m i a
sm t |i r ] ar t m i a
m a |Ii j |t j rt ]r ar t¡ }aa r 1 i tt
i r It tIi t r s i r Iratrar i a| | t m t rr| a]t , tt rt | ra| ar t ti a
j |att r Ia| taa st s | ¡j t I| t rm i a t 1 t m a K | |
rt Ii r t j aI| ¡ t I j rt m aIa ri I¡
ä | k i r Iar Is
• as¡m m t Iri t a r 1 t r]rt «I| . t tIri r si t taa st s.
|aIt t r st I, ]rt «I| arrt sI 1 i a| t It s, r a Iri Ii t r , asj | ¡ti a
| ¡j t rIt r si t r , m a |Ii j |t | ¡j t ]|¡tt m i a
j rt ]r ar ti t s, 1 ra ]s, | ¡j t ta|tt m i a
| I1 1 , sm t |i r ]
• s¡m m t Iri t a r 1 t r]rt «I| . i r Iri r si t taa st s.
t ar|¡ t r st I, |t «t r ]rt «I| i r It tIi t r s ¡ 1 | | 1 | ¡j t I| t rm i a
j t It r Ii a| m t tt r i a m asj i raIi t r , | ¡j t rti stt si I¡ j t |¡t¡I| t m i a
t| rt m t st m a|, ]t r t Ii t, K | |
tt r ]t r i Ia| a| r t rm a|i Ii t s, | | k
s¡r 1 rt m a|, i 1 i t j aI| i t
| | k i r Iar Is - |ar]t It aIa rt s m aIt rr a| | M , asj | ¡ti a, m t tt r i a m
rati a| t r Iam i |i a| IatIt rs asj i raIi t r , rt sj i raIt r¡ 1 i sIrt ss, ¡ ¡ K , | | 1
}aa r 1 i tt , | ¡j t ]|¡tt m i a, | ¡j t ta|tt m i a
j t |¡t¡I| t m i a, tt r ]t r i Ia| a| r t rm a|i Ii t s
j t sI-It rm i r Iar Is st tt rt asj | ¡ti a, m t tt r i a m asj i raIi t r
• «i st r t 1 |t t |i r ], |t aI| t r¡ s|i r | ¡j t ]|¡tt m i a
• m t tt r i a m sIai r i r ] | i rI| Iraa m a i I |ar]t i r Iar I
NEONATAL RESUSCITATION
J Ht « Rt a1 ¡ Is T| i s C| i |1 !
J ksst ss kj ]ar aI ¡ , ! m i r a It s, i I - I aI ! m i r I| t r | ! m i r
Table 9. Apgar Score
Sign 0 1 2
Ht arI | aIt a| st r I - ¡ 11Im i r a It - ¡ 11Im i r a It
Rt sj i raIt r¡ | IIt rI a| st r I s|t «, i rrt ]a |ar ]t t 1 , tr¡i r ]
Irri Ia| i |i I¡ r t rt sj t r st ]ri m att tt a ]| t r sr t t tt
Tt r t IM a st|t |i m j st m t I|t ti t r t I t tIrt m i Ii t s atIi tt m t Ii t r
Ct |t r | |a t , j a|t | t 1 ¡ j i r |, t tIrt m i Ii t s | |a t tt m j |t It |¡ j i r |
| t 1 i aIri ts II M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
NEONATOLOGY. . . CONT.
Initial Re s us citation
J a|«a¡s rt m t m | t r k| | s
J ar Ii ti j aIi t r - |r t « m aIt rr a| | i sIt r¡, | i sIt r¡ t I j rt ]r ar t¡, |a| t r, ar 1 1 t |i tt r¡
J a|| i r Iar Is
• j rt tt r I | t aI |t ss | ¡ 1 r¡i r ], «arm i r ] t r ra1 i ar I | t aIt r, rt m t tt
«t I It «t |s
• j t si Ii t r | t a1 ar 1 r t t| It t j t r ai r«a¡ It r sa tIi t r
• sIi m a |aIt i r Iar I
J ki r«a¡
• ]t r I|t sa tIi t r t I m t a I| I| t r r t st . - ¡ 11 m m 1 ], - ! st tt r 1 s
• «i I| I| i t| m t tt r i a m , sa tIi t r I| t r ast j | ar¡r t as I| t | t a1
i s 1 t |i tt rt 1 , I| t r i r Ia | aIt ar 1 sa tIi t r Irat| t a j ri t r It
Ii rsI | rt aI| i I j t ssi | |t
J | rt aI| i r ]
• t| t t| It r sj t r Iar t t a s rt sj i raIi t r s
• | a] ar 1 m as| i I aj r t i tI]asj i r ]I1 | - ¡ 11, | a] aI a raIt t I
\1-t1Im i r a It «i I| 11-¡ 11X 1 I
• i r Ia | aIi t r i s i r 1 i taIt 1 i I
• j rt |t r ]t 1 tt r Ii |aIi t r i s rt | a i rt 1
• | a] ar 1 m as| art r t I t IIt tIi tt
• Irat| t a| sa tIi t r i r ] i s r t t 1 t 1 I| i t| m t tt r i a m
• 1 | rt m ai r s - ¡ 11
• 1 i aj | ra]m aIi t | t rr i a i s sa sj t tIt 1
J | i rta |aIi t r
• | t arI raIt i s I| t m t sI i m j t rIar I i r 1 i taIt r t I I| t r t t 1 It r
i r It rtt r Ii t r
• î1 t r |t ss tt m j rt ss - i I | ra1 ¡tar1 i t aj t t - î1 ar 1 r t
i m j rt tt m t r I «i I| | a]]i r ] t r as¡sIt |i t, tt m j rt ssi t r s | t ]i r aI
raIt t I ¡ I1Im i r a It
• tt t r1 i r aIt 1 tt m j rt ssi t r s «i I| ¡ tt r Ii |aIi t r
¡ I1 tt m j rt ssi t r sIm i r a It , \1 tt r Ii |aIi t r sIm i r a It - t| t t| aIIt r 11 st tt r 1 s
• i I 1 | - î1 sIt j tt m j rt ssi t r s | a I tt r Ii r a t tt r Ii |aIi t r
J | ra ]s
• t j i r t j | ri r t - It r as¡sIt |t t r st tt rt | ra1 ¡tar1 i a
• 1 | 1 1 \.IX st |a Ii t r ]i tt r s|t «|¡
• | a| 1 1 - t |t tIri ta| a| r t rm a|i Ii t s
• K artar - i I m t I| t r ]i tt r t j i t i 1 s, ]t r t ra| ar t sI| t Ii t
ROUTINE NEONATAL CARE
J t ¡t tart - t r¡I| rt m ¡ti r t i r Im t r I It j rt tt r I t j | I| a|m i a r t t r aIt ra m -
]t r t rr| t a, t| |am ¡1 i a
J ti Iam i r | - It att i 1 | t m t rr| a]i t 1 i st ast t I r t «| t rr
J 1 | | | j |a s tatti r t i I m t I| t r i s 1 t j | tt
J strt t r i r ] It sI
• i r a|| r t t r aIt s. | | | , ¡ ä 1 a sa a||¡ aIIt r I\ | t a rs t I |i It
• i I i r 1 i taIt 1 . | |t t 1 ]rt a j , si t||t tt ||, | t| | 1 t Ii ti t r t¡ tari t s | ¡ j rt ti r tt
• | |t t 1 ]rt a j ar 1 1 i rt tI ar Ii ]|t | a |i r It sI i I m t I| t r | | -tt
RESPIRATORY DISTRESS IN THE NEWBORN
Pre s e ntation
J Iat| ¡j r t a - t1 I j t r m i r
J aa 1 i | |t ]ra r Ii r ]
J i r It rtt sIa| rt IratIi t r sIi r 1 ra«i r ]
J r asa| I|ari r ]
J 1 a s|i r t ssItt r Ira| t¡ar t si s
J 1 t trt ast 1 kI| t r aa sta |IaIi t r
J Iat| ¡tar1 i a - ¡ t1 I j t r m i r
Diagnos is
J t| t sI t-ra¡
J k| | , | | | , | |t t 1 ]|a tt st
J | |t t 1 ta |Ia rt s, | ram sIai r
Diffe re ntial Diagnos is
J j a |m t r ar¡
• rt sj i raIt r¡ 1 i sIrt ss s¡r 1 rt m t | | ä
• Irar si t r I Iat| ¡j r t a t I I| t r t «| t rr ¡ ¡ K
• m t tt r i a m asj i raIi t r ]rt a j | sIrt j ar 1 t I| t rs
• aIt |t tIasi s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I1
K t It s
NEONATOLOGY. . . CONT.
• j |t a ra| t IIa si t r s
• j r t a m t I| t rat
• tt r ]t r i Ia| |a r ] m a|It rm aIi t r s
J tar1 i at
• tt r ]t r i Ia| | t arI 1 i st ast t¡ar t Ii t, t | sIra tIi tt , | | s| a r I
• j t rsi sIt r I j a |m t r ar¡ | ¡j t rIt r si t r | | 1 K
J | t m aIt |t ]i t
• | |t t 1 |t ss
• j t |¡t¡I| t m i a
J i r It tIi t a s
J ar aIt m i t
• Irat| t t t st j | a]t a| Ii sIa |a
• tt r ]t r i Ia| 1 i aj | ra]m aIi t | t rr i a
J m t Ia| t |i t
• | ¡j t ]|¡tt m i a
• i r | t rr t rrt rs t I m t Ia| t |i sm
J r t a rt m a sta |ar
• | K ä 1 am a]t Iraa m a, | t m t rr| a]t
• m t 1 i taIi t r m aIt rr a| st 1 aIi t r
• ar t m a|i t s t .]. wt r1 r i ]-1 t IIm ar r 1 i st ast
• 1 ra ] «i I| 1 ra«a| s¡r 1 rt m t s
Uppe r Airway Obs truction
J | | t ar a| kIrt si a
J | i t rrt -| t | i r s¡r 1 rt m t
J |ar¡r ]t a| t | sIra tIi t r sIt r t si s, aIrt si a, m a|ati a
J Irat| t a| t | sIra tIi t r m ass, sIt r t si s, m a|ati a, tasta |ar ri r ]
J m a tt a s j |a ]
J t|t II j a|aIt
RESPIRATORY DISTRESS SYNDROME (RDS)
J a|st |r t «r as 1 ¡a|i r t M t m | rar t | i st ast
J m t sI tt m m t r taa st t I rt sj i raIt r¡ 1 i sIrt ss i r I| t j rt -It rm i r Iar I
Pathophys iology
J sa rIatIar I 1 t Ii ti t r t¡ —- j t t r |a r ] tt m j |i ar tt 1 a t It | i ]|
a|tt t |ar sa rIatt It r si t r ar 1 aIt |t tIasi s —- rt sj i raIt r¡
1 i sIrt ss—- | ¡j t ti a ati 1 t si s
J sa rIatIar I 1 t trt ast s a|tt t |ar sa rIatt It r si t r , |a r ] tt m j |i ar tt ar 1
Ia r tIi t r a| rt si 1 a a| taj ati I¡
J | ¡j t ti a, | ¡j t It r si t r , ar 1 | ¡j t I| t rm i a m a¡ i m j ai r sa rIatIar I
j rt 1 a tIi t r Ist trt Ii t r
Ris k Factors
J j rt m aIa rt | a| i t s !X ri s| µ 11 «t t |s, t!X ri s| µ I1 «t t |s
J i r Iar Is t I 1 i a| t Ii t m t I| t rs i r sa |i r i r | i | i Is I| t tt rIi st | sa r]t
r t tt ssar¡ It r sa rIatIar I s¡r I| t si s
J | -st tIi t r rt 1 a tt 1 «i I| ar It r aIa| sIt rt i 1 s It m t I| t r
J asj | ¡ti a, ati 1 t si s
J st tt r 1 t I I«i r s
J m a|t s.It m a|t s = I.¡
Clinical Fe ature s
J t r st I «i I| i r Ii rsI It « | t a rs t I |i It , «t rst r s t tt r r t tI I\-II | t a rs,
«i I| s¡m j It m s t I rt sj i raIt r¡ 1 i sIrt ss
J i r Iar Is m a¡ 1 t tt |t j t 1 t m a, aj r t a, rt sj i raIt r¡ Iai |a rt , ar 1 rt | a i rt tt r Ii |aIi t r
J t| t sI t-ra¡. 1 t trt ast 1 at raIi t r ar 1 |a r ] tt |a m t s, rt Ii ta |t ]rar a |ar
j aIIt rr I| rt a ]| t a I |a r ] Ii t |1 s «i I| ai r | rt r t| t ]ram s, aIt |t tIasi s,
m a¡ rt st m | |t j r t a m t r i a
Pre ve ntion
J m i r i m i tt j rt m aIa ri I¡
J m t r i It r | Iä raIi t
J sIt rt i 1 I| t raj ¡ | t |t sIt r t It r m t I| t rs I\ | t a rs j ri t r It 1 t |i tt r¡
t I j rt m aIa rt i r Iar Is
Tre atme nt
J sa j j t rIi tt . 1 I, assi sI tt r Ii |aIi t r «i I| | | | | t r | |k|, I|a i 1 s, r a Iri Ii t r
J sa rIatIar I a1 m i r i sIraIi t r | t ti r t t r s¡r I| t Ii t
| t 1 i aIri ts I\ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
NEONATOLOGY. . . CONT.
Prognos is
J st |I-|i m i It 1 1 i st ast , It r 1 s It i m j rt tt aIIt r II | t a rs «i I| t a I tt m j |i taIi t r s
J i r st tt rt j rt m aIa ri I¡ ar 1 It r j rt |t r ]t 1 tt r Ii |aIi t r , i r trt ast 1 ri s|
t I | rt r t| t j a |m t r ar¡ 1 ¡sj |asi a
Complications
J | | k
J | rt r t| t j a |m t r ar¡ 1 ¡sj |asi a
J rt Ii r t j aI| ¡ t I j rt m aIa ri I¡
J j a |m t r ar¡ ai r |t a|s j r t a m t I| t rat
J i r Iratt rt | ra|Ii r Iratt r Iri ta |ar | t m t rr| a]t
TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)
J a|st |r t «r as
• j t rsi sIt r I j t sIr aIa| j a |m t r ar¡ t 1 t m a
• «t I |a r ] s¡r 1 rt m t
• rt sj i raIt r¡ 1 i sIrt ss s¡r 1 rt m t I¡j t | |
Pathophys iology
J 1 t |a¡t 1 rt st rj Ii t r t I It Ia| |a r ] I|a i 1 —- atta m a |aIi t r t I I|a i 1 i r
j t ri | rt r t| i a| | ¡m j | aIi ts ar 1 tasta |ar sj att s —- Iat| ¡j r t a
Incre as e d Ris k In
J Ia || It rm t r s|i ]| I|¡ j rt m aIa rt i r Iar Is
J | -st tIi t r | a| i t s «| t st |a r ]s art r t I tt m j rt sst 1 1 a ri r ] j assa]t
I| rt a ]| I| t j t |ti t I|t t r
J m a|t s
Clinical Fe ature s
J Iat| ¡j r t a «i I| i r I| t Ii rsI It « | t a rs t I |i It a sa a||¡ «i I| i r I| t Ii rsI
11 m i r a It s , m i |1 rt IratIi t r s, ]ra r Ii r ], «i I| t a I si ]r s t I st tt rt
rt sj i raIt r¡ 1 i sIrt ss
J a sa a||¡ rt st |tt s i r I\-II | t a rs
J t| t sI t-ra¡. | at¡ |a r ]s, I|a i 1 i r Ii ssa rt s, i r trt ast 1 tasta |ari I¡,
s|i ]| I tar1 i t m t ]a|¡
Tre atme nt
J sa j j t rIi tt . 1 I, I|a i 1 s, r a Iri Ii t r
MECONIUM ASPIRATION SYNDROME (MAS)
J ¡ 1-¡ !X t I a|| | i rI| s art m t tt r i a m sIai r t 1 , ¯ !X t I m t tt r i a m
sIai r t 1 i r Iar Is ]t I M kä
J a sa a||¡ asst ti aIt 1 «i I| It Ia| 1 i sIrt ss i r a It rt , t r j t sI-It rm i r Iar I
J | i ]| t r i r ti 1 t r tt «i I| I| i t| m t tt r i a m
J rt sj i raIt r¡ 1 i sIrt ss «i I| i r | t a rs t I | i rI| - Iat| ¡j r t a,
| ¡j t rtar| i a, sm a|| ai r«a¡ t | sIra tIi t r , t| t m i ta| j r t a m t r i Ii s
J t| t sI t-ra¡. | ¡j t ri r I|aIi t r , sIrt a|¡ aIt |t tIasi s, j aIt| ¡ i r Ii |IraIt s
J tt m j |i taIi t r s. | ¡j t tt m i a, ati 1 t si s, | | 1 K , ¡ ¡ X j r t a m t I| t rat,
11X m t t| ar i ta| tt r Ii |aIi t r , \X m t rIa|i I¡
J Irt aIm t r I. sa j j t rIi tt tart ar 1 tt r Ii |aIi t r , m a¡ | t r t Ii I Irt m sa rIatIar I
rt j |att m t r I as sa rIatIar I Ia r tIi t r i s i r | i | i It 1 | ¡ m t tt r i a m
J j rt tt r Ii t r . tart Ia | i r a It rt m t r i It ri r ], sa tIi t r r ast It rt j | ar¡r t aI
j t ri r t a m , I| t r i r Ia | aIt ar 1 sa tIi t r | t |t « tt r1 s aI | i rI|
PNEUMONIA
J tt r si 1 t r i r i r Iar Is «i I| j rt |t r ]t 1 ra j Ia rt t I m t m | rar t s t r
m aIt rr a| It tt r
J sa sj t tI i I It m j t raIa rt a r sIa| |t , w| | t |t taIt 1 , t r r t a Irt j t r i t
J t| t sI t-ra¡. | at¡ |a r ] as i r ¡ ¡ K 1 i sIi r tI i r Ii |IraIt s, r t rm a| |a r ] tt |a m t
DIAPHRAGMATIC HERNIA
J | t sIt rt |aIt ra| t r kr It rt m t 1 i a|
J t|i r i ta| It aIa rt s
• rt sj i raIt r¡ 1 i sIrt ss, t¡ar t si s
• staj | t i 1 a| 1 t m t r
• aIIt tIt 1 si 1 t 1 a || It j t rta ssi t r ar 1 | rt aI| st a r 1 s a| st r I,
m a¡ | t ar | t «t | st a r 1 s i r sIt a1
• as¡m m t Iri t t| t sI m t tt m t r Is, Irat| t a 1 t ti aIt 1 a«a¡ Irt m aIIt tIt 1 si 1 t
• m a¡ j rt st r I t a Isi 1 t t I r t t r aIa| j t ri t 1
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I!
K t It s
NEONATOLOGY. . . CONT.
J t| t sI t-ra¡. j t rIi t r t I | | IratI i r I| t rat a sa a||¡ |t II si 1 t ,
1 i sj |att 1 m t 1 i asIi r a m
J Irt aIm t r I. sa r]i ta|
J j rt ]r t si s. !1X sa rti ta| t tt ra||
• asst ti aIt 1 «i I| a | i ]| i r ti 1 t r tt t I j a |m t r ar¡ tasta |ar
ar t m a|i t s, | ¡j t j |asIi t |a r ]s
PERSISTENT PULMONARY HYPERTENSION
(PPHN)
J | —- | s| a r I I| rt a ]| | | k I It ram t r t ta|t I i r Iraj a |m t r ar¡
t| ar r t |s, 1 t trt ast 1 j a |m t r ar¡ | |t t 1 I|t « trt aIt s | ¡j t tt m i a
|t a1 i r ] It Ia rI| t r j a |m t r ar¡ tast tt r sIri tIi t r
J ri s| IatIt rs. a| ra j Ii t r I j |att r Ia j rt ti a, asj | ¡ti a, M kä , | | ä ,
st j si s, sIra tIa ra| a| r t rm a|i Ii t s | t IIt rs I 1 i aj | ra]m aIi t | t rr i a
J Irt aIm t r I. 1 I ]i tt r t ar|¡, Iaj t rt 1 s|t «|¡, m i r i m i tt sIrt ss I
| ¡j t ti a, i I m t t| ar i ta| tt r Ii |aIi t r i s a r sa ttt ssIa |, t tIratt rj rt a|
m t m | rar t t t¡]t r aIi t r | | M 1 m a¡ | t rt | a i rt 1
BRONCHOPULMONARY DYSPLASIA (BPD)
J a sa a||¡ aIIt r j rt |t r ]t 1 i r Ia | aIi t r Itt r Ii |aIi t r «i I| | i ]| t t¡]t r
tt r tt r IraIi t r i r ti 1 t r tt «i I| m aIa ri I¡
J j t rsi sIt r I rt sj i raIt r¡ 1 i sIrt ss
• 1 t trt ast 1 tt m j |i ar tt , i r trt ast 1 rt si sIar tt , j a |m t r ar¡
t 1 t m a
• | ¡j t tt m i a, | ¡j t rtaj r i a, m a¡ | att aj r t a ar 1
| ra1 ¡tar1 i a
J m a¡ | att tar1 i at tt m j t r t r I tt r ]t sIi tt | t arI Iai |a rt
J Irt aIm t r I. ]ra1 a a| «t ar i r ] Irt m tt r Ii |aIt r, It t 1 ar 1 ]rt «, att i 1
sIrt ss, 1 t tam t I| ast r t m a¡ | t |j 1 t trt ast i r I|am m aIi t r ar 1
t r tt a ra]t «t ar i r ]
J ¡ !X m t rIa|i I¡ i r st tt rt tast s
CYANOSIS OF THE NEWBORN
J tt r Ira| t¡ar t si s m t ar s j t t r t t¡]t r aIi t r - 1 t trt ast 1 ä a1 I
1 t trt ast 1 | a1 I
J j t ri j | t ra| t¡ar t si s tar | t r t rm a|, t r i I tt a |1 m t ar st j si s,
It m j t raIa rt i r sIa| i |i I¡, tt r ]t sIi tt | t arI Iai |a rt , tt sst |
a| r t rm a|i Ii t s
J | t k| | s i I t¡ar t si s st t r i r rt sIi r ] sIaIt Is|t t j aIIt r 11 m i r t I |i It
J ä a1 I - 11X t r | a1 I - t1 m m 1 ] = t m t r]t r t¡
J | t m t ]|t | i r a| r t rm a|i Ii t s taa st 1 t trt ast 1 ä a1 I, r t rm a| | a1 I
J a|«a¡s t| t t| I| t j 1 I t r ¡ 11X t t¡]t r t ¡ 1-¡ ! m i r | ¡j t rt ti t It sI
• i I - ¡ 11 I| i r | tt r ]t r i Ia| | t arI 1 i st ast st t | t 1 i aIri t
| ar1 i t |t ]¡ ä t tIi t r
• i I - ¡ 11 I| i r | rt sj i raIt r¡ ai r«a¡, t| t sI, |a r ]s , | rai r t r | |t t 1
Table 10. Diffe re ntial Diagnos is of Cyanos is in
the Ne wborn
Pulmonary
• st t K t t r aIt |t ]¡ | t sj i raIt r¡ | i sIrt ss ä t tIi t r
Cardiovas cular
• st t | t 1 i aIri t | ar1 i t |t ]¡ ä t tIi t r
Ce ntral Ne rvous Sys te m
• m aIt rr a| st 1 aIi tt 1 ra ]s
• asj | ¡ti a
• i r Iratrar i a| | t m t rr| a]t , i r Iratt r Iri ta |ar | t m t rr| a]t
• r t rtt -m a st|t 1 i st ast
He matologic
• ata It | |t t 1 |t ss
• t| rt r i t | |t t 1 |t ss
• j t |¡t¡I| t m i a
• m t I| t m t ]|t | i r t m i a
Me tabolic
• | ¡j t ]|¡tt m i a
• a1 rt r t ]t r i Ia| s¡r 1 rt m t
• s| t t|
| t 1 i aIri ts It M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
NEONATOLOGY. . . CONT.
Diffe re ntial
J j i r | a j j t r, | |a t |t «t r m t rt tt m m t r
• | | 1 K
• |t II | t arI t | sIra tIi t r I| ¡j t j |asi a
• tt artIaIi t r t I at rIa j t sI sa | t|ati ar Ii r It rra j It 1 at rIi t art|
J | |a t a j j t r, j i r | |t «t r
• ¡ | k «i I| | It | s| a r I atrt ss | | k
APNEA
De finition
J a| st r tt t I rt sj i raIt r¡ ]as I|t « It r I1 st tt r 1 s i r I| t j rt It rm i r Iar I
ar 1 ¡ ! st tt r 1 s i r I| t It rm i r Iar I |t ss i I asst ti aIt 1 «i I| | ra1 ¡tar1 i a
t r t¡ar t si s
J tt r Ira|. r t t| t sI «a|| m t tt m t r I
J t | sIra tIi tt . t| t sI «a|| m t tt m t r I tt r Ii r a t s
J m i tt 1 . tt m | i r aIi t r t I tt r Ira| ar 1 t | sIra tIi tt aj r t a
Diffe re ntial Diagnos is
J aj r t a - I\ | rs – sIrt r ]|¡ asst ti aIt 1 «i I| st j si s
J aj r t a - I\ | rs – i I r t I j aI| t |t ]i ta|, aj r t a t I j rt m aIa ri I¡
J i r It rm i r Iar I aj r t a a|«a¡s rt | a i rt s Ia || wI|
J | K ä
• aj r t a t I j rt m aIa ri I¡ j rt st r Is i r I| t Ii rsI «t t | t I |i It 1 a t
It j rt m aIa ri I¡ t I | K ä ar 1 rt st |tt s | ¡ 1t «t t |s | k.
• st i ta rt s
• i r Iratrar i a| | t m t rr| a]t
J st j si s
J | | . | | rt I|a t, t st j | a]i Ii s
J m t Ia| t |i t. |t « ]|a tt st , |t « ta|ti a m , |t « K a
J tar1 i t tasta |ar
• |t « ar 1 | i ]| | |t t 1 j rt ssa rt
• ar t m i a, | ¡j t tt |t m i a, | | k
J 1 ra ]s. 1 t m t rt |, m t rj | i r t
Tre atme nt
J tt rrt tI a r 1 t r|¡i r ] taa st
J IatIi |t sIi m a |aIi t r , rt 1 a tt «arm i r ] t I Iatt
J m t r i It ri r ]
J t t¡]t r , | |k|, tt r Ii |aIi t r
• m t 1 i taIi t r s. m t I| ¡|tar I| i r t s taIIt i r t , I| t t j | ¡||i r t «| i t|
sIi m a |aIt | K ä ar 1 1 i aj | ra]m ,
• 1 t taj ram 1 i rt tI | K ä sIi m a |ar I a st 1 i r st m t tt r Irt s
JAUNDICE
J tt r¡ tt m m t r - t!X t I r t «| t rr s
J î!-¡ 1I a m t |I| !-t m ]I1 | | i |i ra | i r i r | |t t 1 It | t ti si | |t
J |t t | aI st|t ra, m a tt a s m t m | rar t s, j a|m trt ast s
Ris k Factors
J j rt m aIa ri I¡
J ati 1 t si s
J st j si s
J | ¡j t a|| a m i r t m i a
J 1 t | ¡1 raIi t r
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts II
K t It s
NEONATOLOGY. . . CONT.
Figure 2. Approach and Diffe re ntial for Ne onatal Jaundice
< 24 Hours of Age
J a|«a¡s j aI| t |t ]i t ar 1 rt | a i rt s i r tt sIi ]aIi t r
• | |t t 1 ]rt a j , | t t m | s, | t m t ]|t | i r , j t ri j | t ra| sm t ar
J | t m t |¡si s
• | | t r k| 1 i r tt m j aIi | i |i I¡
• i r It rr a| | t m t rr| a]t
J st j si sItt r ]t r i Ia| i r It tIi t r . ¡ 1 | | 1
> 24 Hours of Age
J j | ¡si t |t ]i t
• i m m aIa rt |i tt r t r t¡m t s, i r trt ast 1 | t m aIt tri I «i I|
1 t trt ast 1 | | | |i It sj ar t tt r|t a1 I| t |i tt r
• t r st I 1 a¡ I-! i r Ia ||It rm , t-I i r j rt It rm i r Iar Is, a sa a||¡
j t a|s I 1 a¡s aIIt r t r st I
• 1 t t sr ’ I i r trt ast IasIt r I| ar î! a m t |I| I1 a¡, 1 t t sr I t ttt t 1 II1 a m t |I|
J i I r t I j | ¡si t |t ]i t, I| t r i r tt sIi ]aIt . | |t t 1 ]rt a j , | t t m | s,
| t m t ]|t | i r , j t ri j | t ra| sm t ar
J tt r si 1 t r st j Ii t «t r|a j | | | , 1 i II, | & ä a ri r t ar 1 | |t t 1 , | ä |,
t| t sI t-ra¡
J i r trt ast 1 | t m t |¡si s
• | t| | 1 t Ii ti t r t¡, j ¡ra taIt |i r ast , sj | t rt t¡It si s
J | ra i si r ], | t m t rr| a]t , | t m aIt m a, tt j | a|t | t m aIt m a
J j t |¡t¡I| t m i a
J 1 ra ]s
J st j si sItt r ]t r Ii a| i r It tIi t r . ¡ 1 | | 1 ä
J 1 t | ¡1 raIi t r
Prolonge d Ne onatal Jaundice (> 1 We e k of Age )
J | rt asI m i ||
• ¡ II11 | rt asI It 1 i r Iar Is
• i r | i | i Ii t r t I ]|a ta rt r ¡| Irar sIt rast atIi ti I¡
• m a¡ j t rsi sI a j It \-t «t t |s
J | ¡j t I| ¡rt i 1 i sm
J r t t r aIa| | t j aIi Ii s
J tt r }a ]aIi t r 1 ¡sIa r tIi t r t .]. | i || t rIs 1 i st ast , | ri ]|t r-K a}}ar ä ¡r 1 rt m t
J i r | t rr t rrt r t I m t Ia| t |i sm t .]. ]a|atIt st m i a
J i m j ai rt 1 t ttrt Ii t r t .]. | i |i ar¡ aIrt si a, t| t |t 1 t t| a| t¡sI
• tt r }a ]aIt 1 | ¡j t r| i |i ra | i r t m i a
• j a|t sIt t |s, 1 ar| a ri r t
• Iai |a rt It I| ri tt , m a|a| st rj Ii t r
Unconjugate d
pathologic phys iologic
he molytic non-he molytic
• | t m aIt m a tt j | a|t | t m aIt m a
immune non-immune • j t |¡t¡I| t m i a
k| 1 Extrins ic • st j si s
| | • sj |t r t m t ]a|¡ • | rt asI m i ||
| t ||, | a II¡, t It • st j si s • | ¡j t I| ¡rt i 1
• kV m a|It rm • i r trt ast 1 t r It rt | t j aIi t ti rt
Me mbrane • | i || t rIs
• t ||i j It t¡It si s • | a tt ¡ | ri stt ||
• j t i |i |t t¡It si s
• sj | t rt t¡It si s
Intrins ic
• | t| |
• | | 1 t Ii ti t r t¡
• a|j | a I| a|
• 1 | ä a sa a||¡ |aIt r
Conjugate d
he patic pos t he patic
• | t j aIi Ii s • | i |i ar¡ arIt rsi a
• i r It tIi t r • t| t |t 1 t t| a| t¡sI
1 t j | , ¡ 1 | | 1 • | i |t -1 a tI t | sIra tIi t r
• m t Ia| t |i t • sIt r t s a r tt m m t r
• ]a|atIt st m i a t ttt j I «i I| j rt m . ¡ | K
• Ir¡t st i r t si s
• Ira tIt st m i a
• | ¡j t rm t I| i t r t m i a
• 1 ra ]s
• st j si s
• m t Ia| t |it
• ]a|atIt st m ia
• I¡rt sir t m ia
• Ira tIt st m ia
• | ¡j t rm t I| it r t m ia
• 1 ra ]s
• st j sis
| ri]|t r-K a}}ar
• | i|iar¡ aIrt sia
| t 1 i aIri ts Iî M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
NEONATOLOGY. . . CONT.
Ke rnicte rus
J | K ä It ti ti I¡ asst ti aIt 1 «i I| i r trt ast 1 a r tt r }a ]aIt 1 | i |i ra | i r
saIa raIi t r t I a|| a m i r t r t j t r | |t t 1 | rai r | arri t r, | asa|
]ar ]|i a Iar]t It 1
J t|i r i ta| It aIa rt s i r t|a 1 t | t ari r ] |t ss, | | aI| t It i 1 , m t It r
1 ¡sIa r tIi t r , st tt rt m t r Ia| rt Iar1 aIi t r , 1 t aI|
Tre atme nt
J m ai r Iai r ]t t 1 | ¡1 raIi t r ar 1 r t rm a| ati 1 -| ast sIaIa s
J ¡ sI |i r t I| t raj ¡. j | t It I| t raj ¡ - j | t It i st m t ri taIi t r | |a t |i ]| I m t sI t IIt tIi tt
J t tt| ar ]t Irar sIa si t r , 1 t j t r 1 i r ] t r |t tt | t I | i |i ra | i r , a]t , «t i ]| I
J Irt aI ar ¡ a r 1 t r|¡i r ] taa st
J 1 t r t I i r It rra j I | rt asIIt t 1 i r ] i r | t a|I| ¡ It rm r t «| t rr s
NECROTIZING ENTEROCOLITIS (NEC)
J i r It sIi r a| i r I|am m aIi t r asst ti aIt 1 «i I| It ta| t r 1 i IIa st a |tt raIi t r ar 1
r t trt si s j ri m ari |¡ aIIt tIi r ] It rm i r a| i |t a m ar 1 tt |t r
Etiology
J m a |Ii IatIt ri a| asst ti aIi t r s
J j rt m aIa ri I¡ —- i m m aIa rt 1 t It r st s
J asj | ¡ti a, ati 1 t si s ar 1 | ¡j t ti a |t a1 i r ] It | t «t | i st| t m i a
J i r It tIi t r . | . difficileIt ti r , tt a]a |ast r t ]aIi tt sIaj | i r K | | |
J | ¡j t rIt r i t It t 1 i r ]s I t r It ra| a|i m t r IaIi t r
J | ¡j t tt |t m i a, | ¡j t I| t rm i a
J m i || sa | sIraIt !tt «s m i || j rt It i r , !t sm t |a|i I¡
Clinical Fe ature s
J 1 i sIt r 1 t 1 a| 1 t m t r ar 1 si ]r s t I t | sIra tIi t r tt m i Ii r ]
J i r trt ast 1 am t a r I | i |t sIai r t 1 ]asIri t asj i raIt Itt m i Ia s
J Irar | t r t tta |I | |t t 1 i r sIt t |
J It t 1 i r ] i r It |t rar tt
J 1 i m i r i s| t 1 | t «t | st a r 1 s
J si ]r s t I | t «t | j t rIt raIi t r - st j si s, s| t t|, j t ri It r i Ii s
Inve s tigation
J a| 1 t m t r t-ra¡. i r Iram a ra| ai r, j t rIt raIi t r , Ii tt 1 |t t j s,
I| i t|t r t 1 | t «t | «a||
J | i ]| w| | , |t « j |I, t |t tIrt |¡It i m | a|ar tt s, ati 1 t si s, | ¡j t ti a, | ¡j t rtar| i a
Tre atme nt
J K | 1 , ti ]t rt a s | V I|a i 1 rt sa sti IaIi t r , K | 1 t tt m j rt ssi t r
J ¡ | K
J ar Ii | i t Ii ts It r i r It tIi t r
J st ri a| a| 1 t m i r a| t-ra¡s 1 t It tI t ar|¡ j t rIt raIi t r
J sa r]t r¡ It r tt m j |i taIi t r s t .]. j t rIt raIi t r
SUDDEN INFANT DEATH SYNDROME (SIDS)
J sa 1 1 t r ar 1 a r t tj t tIt 1 1 t aI| t I ar i r Iar I - ¡ I m t r I| s t I a]t i r «| i t|
I| t taa st t I 1 t aI| tar r t I | t It a r 1 | ¡ | i sIt r¡, t tam i r aIi t r ar 1 a
I| t rt a ]| j t sIm t rIt m
J ¡ -II¡ ,111 |t a1 i r ] taa st t I 1 t aI| | t I«t t r ¡ -¡ I m t r I| s t I a]t
J Irt | a t r t¡ tari t s «i 1 t |¡ i r 1 i IIt rt r I j t j a |aIi t r s
Epide miology
J m t rt tt m m t r i r t| i |1 rt r j |att 1 i r j rt r t j t si Ii t r ! taa st ts. asst ti aIi t r
J r a m | t r t I 1 t aI| s j t a| aI a]t I m t r I| s
J i r trt ast i r 1 t aI| s 1 a ri r ] j t a| rt sj i raIt r¡ ti ra s st ast r
J m t sI 1 t aI| s t tta r | t I«t t r m i 1 r i ]| I ar 1 î.11 am
J m t rt tt m m t r i r j rt m aIa ri I¡, sm t |i r ] i r | t a st | t |1 , m i r t ri Ii t s,
st ti a||¡ 1 i sa1 tar Ia]t 1
J 1.I m a|t j rt 1 t m i r ar tt
J ri s| t I ä | | ä i s i r trt ast 1 1-!X i r si | |i r ]s t I i r Iar Is «| t | att 1 i t 1 t I ä | | ä
Pre ve ntion
J 1 t r t I j |att i r Iar I i r j rt r t j t si Ii t r
J a|arm sIt I| t r m t r i It rs r t I rt tt m m t r 1 t 1 ¯ i r trt ast ar ti t I¡ ar 1
1 t r t I j rt tt r I |i It -I| rt aIt r i r ] t tt r Is
J att i 1 t tt r| t aIi r ] ar 1 t tt r1 rt ssi r ] | a| i t s
J aj j rt j ri aIt i r Iar I | t 1 1 i r ]
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I1
K t It s
NEUROLOGY
SEIZURE DISORDERS
Clas s ification and de s cription – s e e Ne urology s e ction
Childhood Epile ptic Syndrome s
J i r Iar Ii |t sj asm s
• t r st I \-î m t r I| s
• | ri t I, rt j t aIt 1 tt r IratIi t r s t I r t t|, Ira r | ar 1 t tIrt m i Ii t s
I|t ti t r ar 1 t tIt r si t r |asIi r ] ¡ 1-11 st tt r 1 s
• t tta r i r t|a sIt rs, t IIt r asst ti aIi t r «i I| 1 t tt |t j m t r Ia| 1 t |a¡
• \1X a r |r t «r t Ii t |t ]¡ | a I asst ti aIi t r «i I| s¡r 1 rt m t s
t .]. Ia | t rt a s st|t rt si s
• Irt aIm t r I i r t|a 1 t s k| ¡ 1 , t ra| sIt rt i 1 s, | t r tt 1 i att j i r t s,
ta|j rt aIt , ti ]a| aIri r
J | t r r t t-| asIaa I
• j rt st| t t | t| i |1 rt r
• m a |Ii j |t st i ta rt I¡j t s tt m m t r «i I| Irt | a t r I sIaIa s t j i |t j Ii ta s
• st t r «i I| j rt ti t a s t r tt j | a|t j aI| ¡ ar 1 | rai r m a|It rm aIi t r s
• Irt aIm t r I i r t|a 1 t s ta|j rt i t ati 1 , | t r tt 1 i att j i r t s ar 1
|t It ]t r i t 1 i t I, | t «t tt r, rt sj t r st s t IIt r j t t r
J !a tt r i |t m ¡t t|t r i t t j i |t j s¡
• a1 t |t stt r I t r st I ¡ I-¡ t ¡t ars t I a]t , aa It st m a| 1 t m i r ar I
• m ¡t t|t r a s j arIi ta |ar|¡ i r m t rr i r ] ]t r t ra|i tt 1 ¡-|
• rt | a i rt s |i It |t r ] ta|j rt i t ati 1 , j rt ]r t si s t ttt ||t r I
J | t r i ]r t| i |1 | t t 1 t j i |t j s¡ «i I| rt |ar 1 i t sj i |t s
• t r st I j t a|s aI 1-¡ 1 ¡t ar t I a]t
• It ta| m t It r st i ta rt s i r tt |ti r ] It r ]a t , m t a I| ar 1 Iatt
• rt m ai r s tt r sti t a s | a I aj | asi t j t sI-i tIa||¡
• rt m i Is sj t r Iar t t a s|¡ i r a1 t |t stt r tt , r t st | a t ||at
Ge ne ralize d Tonic Clonic Se izure s
J m t sI tt m m t r I¡j t t I r t r It | ri |t st i ta rt s i r t| i |1 | t t 1
J ]t r t ra|i tt 1 Irt m t r st I 1 t t s r t I i r t|a 1 t j arIi a| st i ta rt s I| aI
| t tt m t ]t r t ra|i tt 1
J t IIt r asst ti aIt 1 «i I| It r ]a t | i Ii r ] ar 1 i r tt r Ii r t r tt
| i 1 I| t t| i |1 | att a st i ta rt !
K 1 Y| ä
| rt aI| | t |1 i r ] | r tt sIi ]aIi t r . | |t tIrt |¡It s, | | K , trt aIi r i r t
K i ]| I Irt m t r | a|ti a m , m a]r t si a m , ]|a tt st
| t r i ]r j art t¡sm a| tt rIi ]t | | | , | ä |, | ¡, k| |
| t a ]| s¡r 1 rt m t 1 ¡j t ti t i st| t m i t t r tt j | a|t j aI| ¡ “ as| j ¡ti a”
| am i |i a| t| t rt t aI| t It si s | r Iratrar i a| | t m t rr| a]t , Iraa m a t ]. s| a|t r | a| ¡ s¡r 1 rt m t
1 t rt 1 i Iar¡ t| i r Irt m | |i r ] | r ]t sIi t r sI1 ra ] «i I| 1 ra«a|
K artt |t j s¡ M t Ia| t |i t taa st s
| st a 1 t st i ta rt s | K ä i r It tIi t r s
| 1 i t j aI| i t t j i |t j s¡
K t a rt ta Iar t t a s s¡r 1 rt m t s
| t r i ]r It | ri |t st i ta rt s
¡a m t a rIkV m a|It rm aIi t r
Figure 3. An Approach to the Child with a Sus pe cte d Convuls ive Dis orde r
Table 11. Anticonvuls ive Tre atme nt by Se izure Type
Se izure Type Tre atme nt
a| st r tt t I| t sa ti m i 1 t t r ta|j rt i t ati 1 i I - I ¡t ars
]t r t ra|i tt 1 It r i t-t|t r i t j | t r t | ar| i Ia| i r Ii rsI ¡ I m t r I| s, tar| am att j i r t aIIt r
m ¡t t|t r i t t I| t sa ti m i 1 t , ta|j rt i t ati 1 , j ri m i 1 t r t , t|t r att j am
j arIi a| st i ta rt s tar| am att j i r t t r j | t r ¡It i r | a| aj t r Ii r , | am t Iri ]i r t , Vi ]a| aIri r
as a1 1 -t r I| t raj ¡
| t 1 i aIri ts 11 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
NEUROLOGY. . . CONT.
Tre atme nt
J Irt aI «i I| 1 ra ] aj j rt j ri aIt It t|i r i ta| si Ia aIi t r
J sIarI «i I| t r t 1 ra ] ar 1 i r trt ast 1 t sa]t a r Ii | st i ta rt s tt r Irt ||t 1
J i I r t t IIt tI, s«i It| t tt r It ar t I| t r | t It rt a1 1 i r ] a st tt r 1 ar Ii tt r ta |sar I
J t 1 a taIi t r It r j aIi t r I ar 1 j art r Is
• j ri ti |t ]t s ar 1 j rt taa Ii t r s i r 1 ai |¡ |i It t .]. | a 1 1 ¡ s¡sIt m
J tt r Ii r a t ar Ii tt r ta |sar I Irt aIm t r I a r Ii | j aIi t r I Irt t t I st i ta rt s It r
I ¡t ars t r m t rt
BENIGN FEBRILE SEIZURES
J m t sI tt m m t r taa st t I st i ta rt i r t| i |1 rt r
J 1-!X t I a|| t| i |1 rt r , M - |
Crite ria
J a]t t m t r I| s - t ¡t ars
J I| t a ]| I It | t asst ti aIt 1 «i I| i r i Ii a| raj i 1 ri st i r It m j t raIa rt
J r t i r It ri tIa| r t a rt |t ]i t a| r t rm a|i Ii t s
J r t t ti 1 t r tt t I | K ä i r It tIi t r Ii r I|am m aIi t r t r ata It s¡sIt m i t
m t Ia| t |i t 1 i st r1 t r
J r t | i sIt r¡ t I r t r -It | ri |t st i ta rt s
J m t sI tt m m t r st i ta rt I¡j t i s ]t r t ra|i tt 1 It r i t-t|t r i t, | t «t tt r m a¡
| t ar ¡ I¡j t
J ri s| IatIt rs i r t|a 1 t
• Iam i |¡ | i sIt r¡ t I It | ri |t st i ta rt s \1X j t si Ii tt
• | i ]| It tt r
• s|t « 1 t tt |t j m t r I t I t| i |1
Simple Fe brile Se izure
J 1 a raIi t r - ¡ ! m i r a It s 1!X - ! m i r a It s
J ]t r t ra|i tt 1 , s¡m m t Iri t
J 1 t t s r t I rt ta r i r a I\ | t a r j t ri t 1
Atypical Fe brile Se izure
J It ta| t ri ]i r
J - ¡ ! m i r a It 1 a raIi t r , m a |Ii j |t - ¡ i r I\ | t a rs
J It ||t «t 1 | ¡ Irar si t r I r t a rt |t ]i t 1 t Ii ti I
Ris k Factors for Re curre nce
J 11X t| ar tt t I rt ta rrt r tt
J a]t t I t r st I - ¡ ¡t ar
• !1X t| ar tt t I rt ta rrt r tt i I - ¡ ¡t ar
• IîX t| ar tt t I rt ta rrt r tt i I - ¡ ¡t ar
J ri s| t I t j i |t j s¡ i s - !X , ri s| IatIt rs i r t|a 1 t a| r t rm a| 1 t tt |t j m t r I t I t| i |1
j rt ti t a s It st i ta rt s, Iam i |¡ | i sIt r¡ t I aIt | ri |t st i ta rt s ar 1 a tt m j |t t
i r i Ii a| st i ta rt
Workup
J | i sIt r¡. 1 t It rm i r t It ta s t I It tt r, 1 t stri j Ii t r t I st i ta rt , m t 1 s, Iraa m a | i sIt r¡,
1 t tt |t j m t r I, Iam i |¡ | i sIt r¡
J t tam . | 1 | , si ]r s t I m t r i r ]i Ii s, r t a rt |t ]i t t tam
J | I1 m t r i r ]i Ii s – 1 t | | i I si ]r s ar 1 s¡m j It m s t I m t r i r ]i Ii s
J | | | r t I «arrar It 1 a r |t ss aI¡j i ta| It | ri |t st i ta rt t r a| r t rm a|
r t a rt |t ]i t Ii r 1 i r ]s
J i r tt sIi ]aIi t r s a r r t tt ssar¡ t ttt j I It r 1 t It rm i r i r ] It ta s t I It tt r
Manage me nt
J | 1 | K ä | | | | K | kK | | | kä ä | | kK | | ¡ 1 |k¡ | | K ¡ kK | |k| | K ¡ ä
J ar Ii j ¡rt Ii ts t .]. att Iam i r t j | t r , It j i 1 | aI| s, I|a i 1 s It r tt m It rI
«i || r t I j rt tt r I st i ta rt
J j rt j | ¡|ati s r t I ]i tt r t ttt j I i r tt r¡ a r a sa a| ti rta m sIar tt s
J i I | i ]| ri s| It r rt ta rrt r I t r j rt |t r ]t 1 st i ta rt s tarr¡ rt tIa| kIi tar aI | t m t
FLOPPY BABY (HYPOTONIA)
J 1 t trt ast 1 rt si sIar tt It m t tt m t r I
J j rt j t r asst ssm t r I t I It r t rt | a i rt s atta raIt 1 t It rm i r aIi t r t I ]t sIaIi t r a| a]t
J | i sIt r¡ – t | sIt Iri ta|Ij t ri r aIa|, Iam i |¡, t tj t sa rt s, rt ]rt ssi t r i r m i |t sIt r t s
J t ta|a aIt
• sj t r Iar t t a s j t sIa rt sj t r Iar t t a s m t tt m t r I! a]ai r sI ]rati I¡!
i m j t rIar I i r t ta|a aIi t r t I m a st|t «t a|r t ss
• }t i r I m t | i |i I¡ | ¡j t rt tIt r si | i |i I¡!
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 1¡
K t It s
NEUROLOGY. . . CONT.
• s| a|i r ] t I |i m | s
• j t sIa ra| m ar t t a trt s
J j t sIa ra| m ar t t a trt s i r t|a 1 t
• IratIi t r rt sj t r st – j a || It si I ar 1 |t t | It r I|t ti t r t I arm s It
tt a r It ratI IratIi t r , r t rt sj t r st aI - 11 «t t |s ]t sIaIi t r
• ati ||ar¡ sa sj t r si t r – sa sj t r 1 i r Iar I | ¡ | t |1 i r ] aI ati ||a ar 1
|i IIi r ], | ¡j t It r i t | a| i t s «i || s|i j I| rt a ]| I| t ]rasj | t taa st t I
|t « s| t a |1 t r ]i r1 |t It r t
• tt r Ira| sa sj t r si t r – i r Iar I i s j rt r t ar 1 sa j j t rIt 1 a r 1 t r I| t
a| 1 t m t r | ¡ t r t | ar 1 , i r Iar I s| t a |1 | t a| |t It | t |1 a j
t tIrt m i Ii t s, i r tt rIt 1 “ | ” j t sIa ri r ] 1 t m t r sIraIt s | ¡j t It r i a, I| aI
i s, | a| ¡ «i || 1 raj t st |I t tt r t tam i r t rs arm
J i r tt sIi ]aIi t r s
• | I1 s¡sIt m i t 1 i st r1 t rs
• |¡It s, | |t t 1 ]|a tt st , | a
I
, M ], trt aIi r i r t
• t r | ar tt 1 | ¡ t I | rai r
• j t ri j | t ra| | | , | M | , m a st|t | i t j s¡
• t| rt m t st m t ar a|¡si s, ]t r t Ii t It sIi r ]
J 1 i IIt rt r Ii a| 1 i a]r t si s t I
• | ¡j t It r i a «i I| asst ti aIt 1 «t a|r t ss
• tt rt | ra| – m a|It rm aIi t r , i r It tIi t r s, |t rr i tIt ra s, | ¡j t ti a
• It ti r s ti a m t I| t r – r artt Ii ts, | t r tt 1 i att j i r t s, ]t r t ra|
ar at sI| t Ii t, m a]r t si a m sa |j | aIt
• sj i r a| tt r1 – Iraa m a, Ia m t a r, m ¡t |t 1 ¡sj |asi a,
i r It tIi t r , tasta |ar |t si t r
• ar It ri t r | t rr tt || – sj i r a| m a sta |ar aIrt j | i t s
• j t ri j | t ra| r t rtt – j t sI-i r It tIi t a s r t a rt j aI| ¡
• r t a rt m a sta |ar }a r tIi t r – | t Ia |i sm , i r Iar Ii |t m ¡asI| t r i a
• m a st|t – | a t| t r r t m a sta |ar 1 ¡sIrt j | ¡, m ¡t It r i t 1 ¡sIrt j | ¡
• | ¡j t It r i a «i I| t a I «t a|r t ss
• s¡sIt m i t – st j si s, | t arI Iai |a rt , t| rt m t st m a| | t «r ar 1
| ra1 t r-wi ||i s¡r 1 rt m t s
• tt r r t tIi tt Ii ssa t – M arIar s¡r 1 rt m t , | | |t r-| ar |t s
• tt rt | ra| – | i rI| Iraa m a, | t m m t r| a]t , i r Iraj arIa m | ¡j t ti a
• m t Ia| t |i t – r a Iri Ii t r a| ri t|t Is , rt r a| Ia | a |ar ati 1 t si s,
tt |i at 1 i st ast
CEREBRAL PALSY
J r t r j rt ]rt ssi tt tt r Ira| m t It r i m j ai rm t r I s¡r 1 rt m t 1 a t It
j rt r aIa|Ij t ri r aIa| t tt r Is Iraa m a, |t si t r s, m t Ia| t |i t a| r t rm a|i Ii t s
ar t m a|i t s t I | rai r , a s¡m j It m tt m j |t t, K 1 ¡ a 1 i st ast
J asst ti aIi t r «i I| |t « | i rI| «t i ]| I | a| i t s
J i r ti 1 t r tt ¡ .!-I.!I¡ 111 |i tt | i rI| s 1 t tt |t j i r ] tt a r Iri t s
J t tIt r I t I m t r Ia| rt Iar1 aIi t r tari t s
J |i It t tj t tIar tt ¡ i s 1 t j t r 1 t r I t r I| t 1 t ]rt t t I m t | i |i I¡ ar 1 m t r Ia|
rt Iar1 aIi t r , r t I t r st tt ri I¡ t I | |
Type s
J sj asIi t i .t . i r trt ast 1 It r t - 1 i j |t ]i a. |t «t r |i m | s - a j j t r |i m | s t IIt r
1 a t It i r It rtt r Iri ta |ar | t m t rr| a]t t r j t ri tt r Iri ta |ar |t a |t m a|ati a,
| t m i j |t ]i a. t r t -si 1 t 1 j ara|¡si s, | a a1 raj |t ]i a
J t tIraj ¡ram i 1 a| – t| t rt t aI| t It i 1 |t rr i tIt ra s , 1 ¡sIt r i t I|a tIa aIi r ]
| i ]| I|t « It r t
J | ¡j t It r i t
J aIati t
J m i tt 1
Etiology
J t IIt r t | sta rt t r m a |Ii j |t
J r t 1 t Ii r i It t Ii t |t ]¡ i 1 t r Ii Ii t 1 i r ¡ I1 t I tast s
J ¡ 1X 1 a t It j t sIr aIa| i r sa |I - i r It tIi t r s, asj | ¡ti a ar 1 Iraa m a
Othe r Signs
J s«a||t «i r ] i r tt t r1 i r aIi t r - asj i raIi t r
J m i trt tt j | a|¡ I!X
J st i ta rt s
J m t r Ia| rt Iar1 aIi t r , |t arr i r ] 1 i sa| i |i Ii t s
J 1 t |a¡ i r m t It r m i |t sIt r t s
| t 1 i aIri ts 1I M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
NEUROLOGY. . . CONT.
Inve s tigations
J i r t|a 1 t m t Ia| t |i ts, t| rt m t st m t sIa 1 i t s, Ii ssa t t tam , st rt |t ]¡,
r t a rt i m a]i r ], t tt |t 1 j t It r Ii a|s, | | | i I st i ta rt s , t j | I| a|m t |t ]¡,
aa 1 i t |t ]¡
Tre atme nt
J m ati m i tt j t It r Ii a| I| rt a ]| m a |Ii 1 i sti j |i r ar¡ st rti tt s, i m j t rIar I It r
Iam i |¡ It | t tt r r t tIt 1 «i I| tari t a s sa j j t rI s¡sIt m s
J t rI| t j t 1 i t m ar a]t m t r I t .]. 1 i s|t taIi t r s, tt r IratIa rt s, r| i tt It m ¡
HYDROCEPHALUS st t K t a rt sa r]t r¡ K t It s
J t ttt ssi tt atta m a |aIi t r t I | ä | asst ti aIt 1 «i I| j rt ]rt ssi tt tt r Iri ta |ar 1 i |aIaIi t r
J j aI| t j | ¡si t |t ]¡It Ii t |t ]¡
• i r trt ast 1 j rt 1 a tIi t r t r | ä | t .]. t| t rt i 1 j |t ta s j aj i ||t m a
• 1 t trt ast 1 a| st rj Ii t r t I | ä | t .]. | ¡j t rj |asi a t I arat| r t i 1 ti ||i ,
i r It tIi t r I| t m t rr| a]t 1 t sIrt ¡i r ] arat| r t i 1 ti ||i
• t | sIra tIi t r It I|t « t I | ä | t .]. tt r ]t r i Ia| m a|It rm aIi t r s
| ar 1 ¡-wa||t r, krr t |1 -| | i ari , m asst s, i r It tIi t r s, tt r ]t r i Ia| | t r t 1 t It tIs
Clinical Signs
J i r a It rt - |ar]t | t a1
J tt r Iri ta |ar 1 i sIt r Ii t r |t a1 s It sIrt It| i r ] t I I| t j aI| «a¡s sa rrt a r 1 i r ]
tt r Iri t|t s «| i t| m a¡ taa st aIati a, sj asIi ti I¡ |aIt ra| tt r Iri t|t ,
| ¡j t I| a|am i t 1 ¡sIa r tIi t r 1r1 , i m j ai rt 1 tt rIi ta| ]att \I|
J ata It i r trt ast 1 | | |
• i rri Ia| i |i I¡, |t I| ar]¡, |t ss t I aj j t Ii It , tt m i Ii r ]
• |ar]t It r Iar t ||t , sj |a¡t 1 sa Ia rt s
• | t a1 at| t
• trar i a| r t rtt 1 t Ii ti Is
• | t rr i aIi t r Itt m a
J t| rt r i t
• t r st I - I ¡t ars. m atrt tt j | a|¡ ar 1 t ttt ssi tt raIt t I | t a1 ]rt «I|
• aIati a, sj asIi ti I¡
• j aj i ||t 1 t m a, t j Ii t aIrt j | ¡, i m j ai rt 1 a j «ar1 ]att ,
• t r 1 t tri r t 1 ¡sIa r tIi t r j ri m ari |¡ taa si r ] ]rt «I| Iai |a rt
Diagnos is
J j rt r aIa| a |Irast a r 1
J j t sI r aIa| a |Irast a r 1 I| ¡ IM | |
Tre atme nt
J m t 1 i ta| – Irt aI a r 1 t r|¡i r ] taa st , att Iatt |am i 1 t Irar si t r I|¡ 1 t trt ast s
| ä | j rt 1 a tIi t r
J sa r]i ta| – rt m t tt |t si t r , tt r Iri ta |t j t ri It r t a| s| a r I
NEURAL TUBE DEFECTS
J 1 t It tIi tt t|t sa rt t I taa 1 a| r t a ra| Ia | t i r It a rI| «t t | ]t sIaIi t r It
tar¡i r ] 1 t ]rt t s
J sj i r a | i Ii 1 a t tta |Ia. tt rIt | rat t r |¡ | !, ä ¡ , m a¡ | att i 1 t r Ii I¡i r ]
1 i m j |t t r Ia II t I | ai r, ]t r t ra||¡ as¡m j It m aIi t
J m t r i r ]t tt |t . tt rIt | rat , m t r i r ]t s i r tt |tt 1 «| t rt as m ¡t |t m t r i r ]t tt |t a|st i r t|a 1 t s
sj i r a| tt r1 , r t a rt |t ]i t 1 t Ii ti Is 1 t j t r 1 t r |t tt | t I |t si t r i r t|a 1 t
| t «t |I| |a1 1 t r 1 ¡sIa r tIi t r , j ara|¡si s ar 1 st r st r¡ 1 t Ii ti Is
Etiology
J m t sI r t a ra| Ia | t 1 t It tIs art j t |¡]t r i t
J It |i t ati 1 a1 m i r i sIraIi t r j ri t r It tt r tt j Ii t r |t «t rs I| t ri s| t I K ¡ | s - I!X
Scre e ning
J ar It r aIa| strt t r i r ]. Iri j |t strt t r , am r i t Ii t I|a i 1 k| |
J | Iä Iri j |t strt t r «i || 1 t It tI 11X t I K ¡ | s
J t tam i r t | at|s t I a|| r t «| t rr s It r j i ]m t r It 1 sj t Is t r | ai r¡ j aIt| t s
Manage me nt
J t sst r Ii a| It | att m a |Ii 1 i sti j |i r ar¡ aj j rt at| It r I| t Iam i |¡
J t|t sa rt t I I| t s|i r 1 t It tI It j rt tt r I i r It tIi t r
J s| a r Ii r ] It a1 1 rt ss asst ti aIt 1 | ¡1 rt tt j | a|a s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 11
K t It s
NEUROLOGY. . . CONT.
J i r It rm i IIt r I taI| t It ri taIi t r It 1 t trt ast | ¡ | s, rt I|a t r t j | rt j aI| ¡
J t rI| t j t 1 i tsIt rI| t Ii ts ar 1 j | ¡si t I| t raj ¡ It | t |j «i I| j t sIa rt ar 1 am | a |aIi t r
J ar t sI| t Ii t s|i r tart t .]. | t 1 st rt s
J It I| t rt 1 tt r1 rt |t ast
J a|st i m j t rIar I It a1 1 rt ss st ti a| i ssa t s
NEUROCUTANEOUS SYNDROMES
J t| aratIt ri tt 1 | ¡ It r 1 t r t¡ It It rm Ia m t a rs t I | K ä , | K ä , ti stt ra ar 1 s|i r
J K t a rt Ii | rt m aIt si s I¡j t |
• taIt -aa -|ai I sj t Is, ati ||ar¡ Irt t||t s, | i st| r t 1 a |t s t I I| t i ri s,
r t a rt Ii | rt m as j rt ]rt ssi tt ar 1 j t It r Ii a| It i r ta1 t
• st i ta rt s, stt |i t si s, t j Ii t ]|i t m a
• I¡j t | | 1 t t s r t I | att a| t tt |t si t r s, asst ti aIt 1 «i I| | rai r
Ia m t a rs, | i |aIt ra| att a sIi t r t a rt m as art 1 i a]r t sIi t
J ä Ia r]t -wt | t rs. j t rI-«i r t r t ta s i r V-¡ 1 i sIri | a Ii t r «i I| asst ti aIt 1
ar ]i t m aIt a s m a|It rm aIi t r t I | rai r , st i ta rt s, tt r Ira|aIt ra| | t m i j art si s
J ¡a | t rt a s ä t|t rt si s. a1 t r t m a st | att a m , “ as| |t aI | ¡j t j i ]m t r IaIi t r ,
tar1 i at r| a| 1 t m ¡t m as, |i 1 r t ¡ ar ]i t |t i t m ¡t m as, m t r Ia| rt Iar1 aIi t r
ar 1 st i ta rt s
GASTROINTESTINAL DISEASE
VOMITING
Approach
J tt r si 1 t r. i r It tIi t r , i r I|am m aIi t r , m t t| ar i ta| t | sIra tIi t r ,
m t Ii |i I¡ 1 i st r1 t rs, t I| t rs t .]. t aIi r ] 1 i st r1 t r
J K t r | | taa st s. | K ä , | ¡ | , s¡sIt m i t i r It tIi t r s, t I| t rs
As s e s s me nt
J | i sIt r¡
• a]t t I t r st I, 1 a raIi t r , st tt ri I¡
• | a a|i I¡. | i |i t a s, | |t t 1 ¡, rt ]a r]i IaIi t r
• asst ti aIt 1 s¡m j It m s t .]. It tt r, a| 1 t m i r a| j ai r
• t IIt tI t r ]rt «I| ar 1 1 t tt |t j m t r I, tt r ta rrt r I 1 i st ast
J j | ¡si ta| t tam . asst ss | ¡1 raIi t r st t ¡a| |t ¡ \
J |a| i r tt sIi ]aIi t r
• | |t t 1 ¡ t m t si s. i r tt sIi ]aIt It r taa st s t I a j j t r | | | |t t 1
• | i |i t a s t m t si s. ra |t t a I t | sIra tIi t r a j j t r | | st ri t s, | Iä
• rt ]a r]i IaIi t r . t ta|a aIt It r rt I|a t | ari a m s«a||t « «i I|
I|a t rt stt j ¡, I\ | t a r t st j | a]t a| j 1 j rt | t
J a st Ia | It sIs | ast 1 t r | i sIt r¡ ar 1 j | ¡si ta| t tam
• | | | , |¡It s, | | K , | r, | ä |
• a ri r t , | |t t 1 , sIt t | | & ä
• am ¡|ast , |i j ast
• arIt ri a| | |t t 1 ]ast s
• a| 1 t m i r a| t-ra¡, a |Irast a r 1 , tt r IrasI ra1 i t |t ]¡
• t r 1 t stt j ¡
J m ar a]t m t r I
• Irt aI I| t a r 1 t r|¡i r ] taa st
• rt | ¡1 raIi t r
VOMITING IN THE NEWBORN
J tt r ]t r i Ia| ar t m a|i t s art a Irt | a t r I taa st , t .]. aIrt si a, 1 i rs| j ra r ]’ s
J 1 i IIt rt r Ii a| 1 i a]r t si s. ]asIrt t r It ri Ii s, ]asIrt t st j | a]t a| rt I|a t,
t tt rIt t 1 i r ], It t 1 a||t r]¡, m i || j rt It i r i r It |t rar tt
Trache oe s ophage al Fis tula
J i r ti 1 t r tt . ¡ .1111-¡ .\!11
J t|i r i ta| It aIa rt s tar¡ «i I| I¡j t
• tt m i Ii r ], tt a ]| i r ] ar 1 ]a]]i r ]
• t¡ar t si s «i I| It t 1 s
• rt sj i raIt r¡ 1 i sIrt ss
• m a¡ | att | i sIt r¡ t I m aIt rr a| j t |¡| ¡1 ram r i t s
• asst ti aIt 1 ar t m a|i t s. Vk¡ | | = Vt rIt | ra| ar t m a|i t s, kr a|
aIrt si a, ¡ | | ar 1 | t r a| 1 i st ast j |a s tar1 i at a| r t rm a|i Ii t s
ar 1 ra1 i a| 1 t It tIs t I I| t a j j t r |i m |
| t 1 i aIri ts 1\ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
J t-ra¡ —- j |ai r ar 1 tt r IrasI sIa 1 i t s s| t « ar aIt m i t a| r t rm a|i I¡,
K | Ia | t ta r|t 1 i r j t a t|
J Irt aIm t r I. t ar|¡ rt j ai r It j rt tt r I |a r ] 1 am a]t ar 1 m ai r Iai r r a Iri Ii t r
J tt m j |i taIi t r s
• j r t a m t r i a, |a r ] 1 am a]t , t| rt r i t rt atIi tt ai r«a¡s
• sIt r t si s ar 1 sIri tIa rt s aI rt j ai r si It
• ]asIrt t st j | a]t a| rt I|a t ar 1 j t t r s«a||t «i r ] It ||t «i r ] rt j ai r
Duode nal Atre s ia
J t|i r i ta| It aIa rt s
• | i |t -sIai r t 1 tt m i Ii r ] i I 1 i sIa| It | i |t 1 a tI
• a| 1 t m i r a| 1 i sIt r Ii t r , j t ri sIa|Ii t «att s
• 1 t | ¡1 raIi t r
• asst ti aIt 1 «i I| | t «r s¡r 1 rt m t
• m a¡ | att | i sIt r¡ t I m aIt rr a| j t |¡| ¡1 ram r i t s
J a| 1 t m i r a| t-ra¡ —- ai r-I|a i 1 |t tt |s t r a j ri ]| I Ii |m
• 1 t a | |t | a | | |t si ]r 1 i |aIt 1 sIt m at| ar 1 1 a t 1 t r a m
J 1 i IIt rt r Ii a| 1 i a]r t si s. ar r a |ar j ar trt as, a| t rrar I m t st r It ri t
tt sst |s, j ¡|t ri t sIt r t si s
J Irt aIm t r I
• 1 t tt m j rt ssi t r «i I| K | Ia | t
• tt rrt tIi t r t I m t Ia| t |i t a| r t rm a|i Ii t s
• sa r]i ta| tt rrt tIi t r
Pyloric Ste nos is
J i r ti 1 t r tt . m t sI tt m m t r i r Ii rsI-| t rr m a|t s, t IIt r Iam i |¡ | i sIt r¡
• M .| = !.¡
J t|i r i ta| It aIa rt s
• r t r -| i |i t a s j rt }t tIi |t tt m i Ii r ] I| aI t tta rs aIIt r It t 1 i r ]
• a sa a||¡ sIarIs aI I-t «t t |s t I a]t
• i r Iar I | a r ]r¡ ar 1 a|t rI, «i || rt -It t 1
• | ¡ ¡, «asIi r ]
• 1 t | ¡1 raIi t r , m a¡ |t a1 It j rt |t r ]t 1 }aa r 1 i tt
• ]asIri t j t ri sIa|si s ]t t s Irt m | | â It t j i ]asIri a m
• “ t |i tt si ]r ” t |i tt -s| aj t 1 m ass t r ri ]| I aI m ar]i r t I rt tIa s
a| 1 t m i r i s m a st|t
J |a| . | ¡j t t| |t rt m i t m t Ia| t |i t a||a|t si s
J 1 i a]r t si s. t|i r i ta|, a| 1 t m i r a| a |Irast a r 1
J Irt aIm t r I. j ¡|t rt m ¡t It m ¡
Malrotation of the Inte s tine
J 1 j rt st r IaIi t r s. rt ta rrt r I tt m i Ii r ] | i |i t a s i r It rm i IIt r I|¡ ,
| ¡ ¡ «i I| tt m i Ii r ], sa 1 1 t r t r st I a| 1 t m i r a| j ai r ar 1 I| t r s| t t|
J i I tt m i Ii r ] «i I| | i |i t a s m aIt ri a|, m a|rt IaIi t r «i I| tt |ta |a s
a r Ii | j rt tt r t I| t r«i st
J î1X t tj t ri t r tt s¡m j It m s i r Ii rsI I«t m t r I| s t I |i It
J t|i r i ta| It aIa rt s
• 1 i sIt r 1 t 1 a| 1 t m t r
• tt m i Ii r ] 1 a t It tt |ta |a s ar 1 | ar 1 s atrt ss 1 a t 1 t r a m
• tt ta m Irt t
J 1 i a]r t st 1 | ¡ a j j t r | | sIa 1 i t s. 1 a t 1 t r a m r t I Ii tt 1 ,
sj i ra| }t }t r a m , m t | i |t tt ta m m a¡ r t I | t i r | | â
J Irt aIm t r I. sa r]i ta|
Othe r
J m t tt r i a m i |t a s st t | ¡sIi t | i | rt si s ä t tIi t r
VOMITING AFTER THE NEWBORN PERIOD
J 1 isIir ]a is| Irt m rt ]a r]iIaIit r j assitt t }t tIit r t I ]asIrit tt r It r Is
st tt r 1 ar¡ It rt I|a t
Infe ctious
J | | taa st s. ]asIrt t r It ri Ii s, j t ri It r i Ii s, aj j t r 1 i ti Ii s, | t j aIi Ii s, a |tt rs,
j ar trt aIi Ii s
J r t r -| | taa st s. | ¡ | , t Ii Ii s m t 1 i a, | K ä i r It tIi t r , rai st 1 | | |,
a|m t sI ar ¡ i r It tIi t r , 1 ra ]s, It rt i ]r | t 1 ¡
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 1!
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
Anatomic
J | | IratI t | sIra tIi t r
• i r Ia ssa stt j Ii t r st t | t |t «
• It rt i ]r | t 1 ¡ t .]. | t tt ar
J ]asIrt t st j | a]t a| rt I|a t
• a sa a||¡ It m j t rar¡ rt |ataIi t r t I |t «t r t st j | a]t a| sj | i r tIt r
—- 1 t trt ast 1 ]asIri t t m j I¡i r ]
• j rt st r Is «i I| rt ta rrt r I tt m i Ii r ] aIIt r It t 1 s ar 1 | ¡ ¡
• m t sI t a I]rt « rt I|a t | ¡ ¡ î m t r I| s t I a]t
• tt r st rtaIi tt m ar a]t m t r I. I| i t|t r t 1 It t 1 s, t |t taIt | t 1 It 11 1 t ]rt t s
• t st j | a]t ]ram s m a¡ m i ss, j 1 sIa 1 i t s art j rt It rrt 1
• Irt aI t r |¡ i I s¡m j It m aIi t t r j t t r «t i ]| I ]ai r
• m t 1 i taIi t r t .]. ti saj ri 1 t , 1 I | |t t|t rs
• i I a r rt sj t r si tt It m t 1 i taIi t r . sa r]t r¡ - K i sst r Ia r 1 t j |i taIi t r
• tt m j |i taIi t r s. asj i raIi t r , t st j | a]t a| | |t t 1 i r ], sIri tIa rt
It rm aIi t r , aj r t a
Ce ntral Ne rvous Sys te m
J i r trt ast 1 | | |
• | ¡1 rt tt j | a|a s
• r t t j |asm
J 1 ra ]sIi r It ti tar Is
J m i ]rai r t
J m t r i r ]i Ii s, t r tt j | a|i Ii s
Othe r
J m t Ia| t |i tIt r 1 t tri r t t .]. | | k, i r | t rr t rrt rs, |i tt r Iai |a rt
J j t i st r sI1 ra ]s. t .]. |t a1 , 1 i ]t ti r , t r¡I| rt m ¡ti r , I| t t j | ¡||i r t
J j s¡t| t ]t r i t. t .]. ra m i r aIi t r s¡r 1 rt m t , | a |i m i a, ar t rt ti a, t¡t|i t tt m i Ii r ]
J It t 1 a||t r]¡
J rt ]a r]i IaIi t r , t tt rIt t 1 i r ]
ACUTE DIARRHEA
J ]t I a ]t t 1 | i sIt r¡ 1 a¡tart , Iratt |, 1 ra ]s, It t 1 s, t I| t r s¡m j It m s
Etiology
J ti ra| i r It tIi t r
• m t sI tt m m t r i r | ar a1 a, t .]. | t Iati ra s
• asst ti aIt 1 «i I| | | ¡ | s
• s|i ]| I It tt r, m a|ai st , tt m i Ii r ], ta]a t a| 1 t m i r a| j ai r
• rt st |tt s i r 1-I 1 a¡s
J | atIt ri a| i r It tIi t r
• ä a|m t r t ||a, | am j ¡|t | atIt r, ä | i ]t ||a, j aI| t ]t r i t | . coli, Yt rsi r i a
• m t rt st tt rt a| 1 t m i r a| j ai r , | i ]| It tt r, | |t t 1 ¡ 1 i arr| t a
J j arasi Ii t i r It tIi t r
• | i ar1 i a |am | |i a, | . | i sIt |¡Ii ta
J It ti r -i r 1 a tt 1 . sIaj | ¡|t tt tta| It t 1 j t i st r i r ], | . difficileIt ti r
J a||t r]i t. It t 1 i r It |t rar tt
J ar Ii | i t Ii t-i r 1 a tt 1
J r t r -sj t ti Ii t. asst ti aIt 1 «i I| ar ¡ r t r -| | i r It tIi t r , ]t r t ra|i tt 1 st j si s t r s| t t|
Complications
J 1 t | ¡1 raIi t r st t ¡a| |t ¡ \
J t |t tIrt |¡It 1 i sIa r| ar tt s. | ¡j t r t r | ¡j t r aIrt m i a, | ¡j t |a|t m i a,
m t Ia| t |i t ati 1 t si s
J st tt r 1 ar¡ 1 i satt| ari 1 ast 1 t Ii ti t r t¡ Irar si t r I, 1 a t It ti ||t a s 1 am a]t
| t 1 i aIri ts 1t M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
Table 14. Signs of De hydration
None Some Se ve re
de cre as e body we ight – 1-!X 1-¡ 1X
ne urological s tatus a|t rI, «t || i rri Ia| |t |t I| ar]i t t r
a r tt r sti t a s, I|t j j ¡
s unke n e ye s –
prolonge d s kin fold –
dry oral mucos a –
thirs t K , r t I I| i rsI¡ I| i rsI¡, 1 ri r |s 1 ri r |s j t t r|¡ t r
t a]t r|¡ r t I a| |t It 1 ri r |
te ars j rt st r I a| st r I a| st r I
urine output K 9 ar a ri a
HR K s|i ]| I8 8
BP K K 9
Inve s tigations
J sIt t | It r | & ä ar 1 1 & |, | |t t 1 ar 1 w| | , | . difficileIt ti r , | t Iat¡m t assa¡
Manage me nt
J rt | ¡1 raIi t r . m t sI t| i |1 rt r m ar a]t 1 «i I| t ra| I|a i 1 s t .]. 1 ra|
| t | ¡1 raIi t r ä t |a Ii t r | t 1 i a|¡It , | asIrt |¡It
J I|a i 1 rt j |att m t r I. tt r si 1 t r 1 t Ii ti I X t I | t 1 ¡ «t i ]| I ,
m ai r It r ar tt ar 1 t r ]t i r ] |t sst s
J m ai r It r ar tt I|a i 1 rt | a i rt m t r Is
• r t «| t rr . ¡ I1-¡ t1 ttI|]I1 a¡ m a¡ tar¡ «i I| «t i ]| I
• ¡ 11 ttI|]II\ | t a rs It r Ii rsI ¡ 1 |] t r \ ttI|]I|
• !1 ttI|]II\ | t a rs It r st tt r 1 ¡ 1 |] t r I ttI|]I|
• I1 ttI|]II\ | t a rs I| t rt aIIt r t r ¡ ttI|]I|
• | V I|a i 1 raIt j t r | t a r = It Ia| j t r 1 a¡ 1 i ti 1 t 1 | ¡ I\ t r a st \.I.¡ ra |t
J tt m m t r |¡ a st 1 | V I|a i 1 s
• Ii rsI «t t | t I |i It . | !w 1.I K ä
• II1 | !w ¡ I1 K ä
• K ä . as | t |a s It rt sIt rt ti rta |aIi t r i r tt r¡ 1 t | ¡1 raIt 1 t| i |1
J tt r Ii r a t | rt asI It t 1 i r ] «| t r j t ssi | |t
J | | | | ä K 1 ¡ | K | | | k¡ | | . |at |i r , j t tIi r , ar Ii t| t |i r t r]i ts,
ar Ii sj asm t Ii ts, t j i aIt 1 t ri taIi tt s
J ar Ii | i t Ii ts a st 1 i r . Salmonella sepsis, Shigella/Yersinia/enterotoxic
| . coli ä t j Ira , | . difficile t ra| | |a]¡|IVar tt m ¡ti r , Campylobacter
| r¡I| rt m ¡ti r
Table 15. Corre ction of Fluid and Ele ctrolyte De ficits
De hydration
1
5% 10% Rate
Is otonic K a \-! m m t |I|] K a î-¡ 1 m m t |I|] ¡ II 1 t Ii ti I t tt r ¡ sI î | t a rs,
| \-! m m t |I|] I| t r ¡ II t tt r ¡ t | t a rs
Hypotonic
2
K a !-t m m t |I|] K a ¡ 1-¡ I m m t |I|] | I K a ≥ ¡ 1!, tt rrt tI as a| t tt
K a - ¡ 11 m m t |I| | 1 m m t |I|] | ! m m t |I|] | I K a - ¡ 1!, tt rrt tI | ¡ I1 m m t |I| m ati m a m
t tt r 1.!-\ | t a r «i I| | ¡j t rIt r i t sa|i r t
Hype rtonic
K a - ¡ !1 m m t |I| K a I-\ m m t |I|] K a I-\ m m t |I|] | t rrt tI t tt r \î-II | t a rs
| I-\ m m t |I|] | I-\ m m t |I|] | t r t I a||t « st ra m K a It 1 rt j IasIt r
I| ar ¡ 1-¡ ! m m t |I| I1 a¡
1
K t It . ¡ . | t r a|| I¡j t s 1 t | ¡1 raIi t r , 1 I1 It r !X 1 t | ¡1 raIi t r = !1m |I|], It r ¡ 1X 1 t | ¡1 raIi t r = ¡ 11 m |I|]
I. ¡t ta|ta |aIt t tatI 1 t Ii ti I. K a 1 t Ii ti I = K aIar]t I – K aatIa a| t | t 1 ¡ «t i ]| I |] t It Ia| | t 1 ¡ 1 I1 | I|]
1. ¡t |t «t r st ra m K a | ¡ a j rt 1 i tIa| |t am t a r I, rt m t m | t r. \ m |I|] t I Irt t 1 I1 |t «t rs st ra m K a | ¡ ¡ m m t |I|
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 1I
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
CHRONIC DIARRHEA
Clinical As s e s s me nt
J - ¡ \ 1 a¡s
J t r st I, r aIa rt t I sIt t |
J r a Iri Ii t r a| sIaIa s t| rt r i t 1 i arr| t a «i I| | ¡ ¡ sa ]]t sIs m a|a| st rj Ii t r
J | i sIt r¡ t I i r It tIi t r
J | ¡1 raIi t r sIaIa s
Inve s tigations for Diarrhe a of Unknown Etiology
J st ri a| | t i ]| Is, «t i ]| Is, ]rt «I| j t rtt r Ii |t s
J sIt t |s It r | & ä , 1 & |, t tta |I | |t t 1 , | . difficile, j 1 , rt 1 a ti r ] sa | sIar tt s
J m a|a| st rj Ii t r «t r|-a j i I i r 1 i taIt 1 st t | | rt r i t | i arr| t a «i I| | ¡ ¡ | t |t «
J t-ra¡s
• a j j t r | | st ri t s
• | ari a m t r t m a
J m a tt sa| | i t j s¡
CHRONIC DIARRHEA WITHOUT FAILURE TO THRIVE
Infe ctious
J | atIt ri a| t .]. Campylobacter, Salmonella
J ar Ii | i t Ii t i r 1 a tt 1 . | . difficilett |i Ii s - t IIt r | |t t 1 ¡ sIt t |
J j arasi Ii t. Giardia lamblia
J j t sI-i r It tIi t a s. st tt r 1 ar¡ |atIast 1 t Ii ti t r t¡
Toddle r's Diarrhe a
J m t sI tt m m t r taa st t I t| rt r i t 1 i arr| t a 1 a ri r ] i r Iar t¡, | a I sIi ||
1 i a]r t si s t I t tt|a si t r i r I| ri ti r ] t| i |1
J t r st I | t I«t t r t-1t m t r I| s t I a]t , tt ast s sj t r Iar t t a s|¡ | t I«t t r I-\ ¡t ars
J sIt t | m a¡ tt r Iai r a r 1 i ]t sIt 1 It t 1 j arIi t|t s, \-t | M j t r 1 a¡
J t ttt ri aIt 1 1 i aj t r ras|
J 1 i t I | i sIt r¡. |t Is t I }a i tt t tt r«| t |m s sm a|| | t «t | rt sa |Ii r ] i r
1 i satt| ari 1 t m a|a| st rj Ii t r
J It a r | ’ s. a1 t | a aIt Ii | t r, r t rm a| I|a i 1 i r Ia|t , 1!-\1X IaI,
1 i stt a ra]t t ttt ss Ira i I }a i tt
J m ar a]t m t r I. rt assa rar tt , st |I-|i m i Ii r ]
Lactas e De ficie ncy (Lactos e Intole rance )
J t|i r i ta| It aIa rt s
• t| rt r i t, «aIt r¡ 1 i arr| t a
• a| 1 t m i r a| j ai r , | |t aIi r ], | t r| t r¡]m i
J I«t stt r ari t s
• j ri m ar¡ |atIt st i r It |t rar tt . tram j ¡ a| 1 t m i r a| j ai r «i I|
|t t st sIt t | i r t |1 t r t| i |1 rt r , a sa a||¡ i r 1 ri t r Ia|s, | |at|s
• st tt r 1 ar¡ |atIt st i r It |t rar tt . t |1 i r Iar I, j t rsi sIt r I 1 i arr| t a
j t sI ti ra|I| atIt ri a| i r It tIi t r , | t |i at 1 i st ast , t r i r I|am m aIt r¡
| t «t | 1 i st ast
J 1 i a]r t si s
• t|i r i ta| Iri a| t II m i ||
• «aIt r¡ sIt t |, ati 1 j 1 , j t si Ii tt rt 1 a ti r ] sa ]ars
• j t si Ii tt | rt aI| | ¡1 rt ]t r It sI i I - t ¡t ars
J m ar a]t m t r I
• |atIt st It |t rar tt It sI
• m i || Irt t 1 i t I, st ¡ It rm a |a
• | atIt t tt , | atIai 1 Ia| sI1 rt j s
CHRONIC DIARRHEA WITH FAILURE TO THRIVE
J sa ]]t sIs m a|a| st rj Ii t r «i I| Irt | a t r I | a ||¡, It a | sm t ||i r ] sIt t |s
J i r tt sIi ]aIi t r t I m a|a| st rj Ii t r
• sIt t | tt r si sIt r t¡, j 1 , rt 1 a ti r ] sa | sIar tt s, m i trt stt j ¡, t tta |I | |t t 1
• sIt t |. 1 & |, | & ä , | . difficileIt ti r , 1-1 a¡ It ta| IaI
• t| t sI t-ra¡
• a ri r a|¡si s
• | | | , 1 i IIt rt r Ii a|, | ä | , sm t ar, t |t tIrt |¡It s, It Ia| j rt It i r , i m m a r t ]|t | a |i r s
• a| st rj Ii tt ar 1 r a Iri Ii t r a| sIaIa s. a|| a m i r , tart It r t , | a
I
, | 1 \,
M ], l r , | t , It rri Ii r , It |aIt , IaI-st |a | |t ti Iam i r s, | ¡, | ¡ ¡
• s«t aI t| |t ri 1 t
| t 1 i aIri ts 1î M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
• i I i r 1 i taIt 1 , α-ar Ii Ir¡j si r |t tt |, I| ¡rt i 1 Ia r tIi t r It sIs, a ri r t
VM k ar 1 1 Vk, 1 | V It sI, |t a1 |t tt |s
• a j j t r | | st ri t s It ||t «-I| rt a ]|
• sj t ti a|i tt 1 It sIs. sm a|| | t «t | | i t j s¡, t r 1 t stt j ¡ ar 1 | i t j s¡
1. Inte s tinal Caus e s
Ce liac Dis e as e (Glute n-s e ns itive e nte ropathy)
J 1 t It tI aI I| t m a tt sa| |t tt |
| | 1 w. | ar|t ¡, r¡t , t aIs, «| t aI
J It ti t t r i m m a r t |t ]i t rt atIi t r
J t|i r i ta| It aIa rt s
• j rt st r Is aI ar ¡ a]t , a sa a||¡ t-¡ î m t r I| s
• | ¡ ¡ «i I| j t t r aj j t Ii It , i rri Ia| i |i I¡, aj aI| ¡
• ar t rt ti a, r aa st a, tt m i Ii r ], t 1 t m a
• «asIt 1 m a st|t s, 1 i sIt r 1 t 1 a| 1 t m t r ar 1 I|aI | a IIt t|s
• ar t m i a, | |t t 1 i r ]
• ri t|t Is
• t|a | | i r ] t I Ii r ]t rs
J 1 i a]r t si s
• IaI m a|a| st rj Ii t r sIa 1 i t s
• sm a|| | t «t | | i t j s¡. I|aI aIrt j | i t m a tt sa «i I| rt st |a Ii t r
aIIt r Iri a| t I ]|a It r -Irt t 1 i t I ti ||t a s aIrt j | ¡
• ar Ii ]|i a1 i r , ar Ii t r 1 t m ¡si a| ar Ii | t 1 i t s, |t « | -t¡|t st a| st rj Ii t r
J Irt aIm t r I
• ]|a It r -Irt t 1 i t I It r |i It
• att i 1 | | 1 w
J tt m j |i taIi t r s i I a r Irt aIt 1
• sm a|| | t «t | |¡m j | t m a
• m a|r a Iri Ii t r
Milk Prote in Alle rgy
J i m m a r t -m t 1 i aIt 1 m a tt sa| i r }a r¡
J tar | t asst ti aIt 1 «i I| st ¡ j rt It i r , ar t m i a, | ¡j t a|| a m i r t m i a
J t IIt r aIt j i t i r 1 i ti 1 a a|s
Othe r
J sj t ti Ii t t r t¡m t 1 t Ii ti t r ti t s
J |i tt r 1 i st ast , | i |i ar¡ aIrt si a
J a-â-|i j t j rt It i r t m i a
J s| t rI ]a I s¡r 1 rt m t
J | |i r 1 |t t j s¡r 1 rt m t
J j rt It i r -|t si r ] t r It rt j aI| ¡ | t |i at, | | | , | i ar1 i a
Inflammatory Bowe l Dis e as e
J st t | asIrt t r It rt |t ]¡ K t It s
J i r ti 1 t r tt . i r trt asi r ] i r K t rI| km t ri ta, m t sI|¡ t |1 t r t| i |1 rt r , It t r a]t rs
2. Pancre atic Ins ufficie ncy
Cys tic Fibros is st t | ¡sIi t | i | rt si s ä t tIi t r
J |t ss t I t tt tri r t j ar trt aIi t Ia r tIi t r
J t|i r i ta| It aIa rt s
• m t tt r i a m i |t a s i r I| t r t «| t rr
• | ¡ ¡ «i I| ]t t 1 aj j t Ii It
• rt tIa| j rt |aj st
• sIt aIt rr| t a
• rt sj i raIt r¡ s¡m j It m s, r asa| j t |¡j s
J 1 i a]r t si s. t |t taIt 1 s«t aI t| |t ri 1 t - t1 m | | I| , i r trt ast 1 It ta| IaI,
| K k m a IaIi t r
J m ar a]t m t r I | |
• j ar trt aIi t t r t¡m t rt j |att m t r I
• IaI st |a | |t ti Iam i r s k,| ,| ,|
Shwachman Syndrome
J j ar trt aIi t i r sa IIi ti t r t¡ aa It st m a| rt tt ssi tt
J t¡t|i t r t a Irt j t r i a
J s|t |t Ia| a| r t rm a|i Ii t s m t Iaj | ¡st a| 1 ¡sIt si s |t a1 i r ] It s| t rI sIaIa rt
J 1 r¡ s|i r , t ttt m aIt a s, i t| I| ¡t si It rm |t si t r s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts 11
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
3. Die t-Induce d
J It t 1 a||t r]¡
4. Othe r
J 1 i t Is ri t| i r st r| i It |, Ira tIt st j t t r|¡ a| st r| t 1 | 1 1
J m t Ia| t |i tIt r 1 t tri r t
• I| ¡rt It ti tt si s
• k1 1 i st r s 1 i st ast
• ]a|atIt st m i a
J i m m a r t 1 t It tIs
• | ]k 1 t Ii ti t r t¡, | ¡j t ]am m a]|t | a |i r t m i a
• ä | | |
• k| | ä
J r t t j |asIi t
• j | t t t| rt m t t¡It m a
• |¡m j | t m a t I sm a|| | t «t |
ACUTE ABDOMINAL PAIN
As s e s s me nt
J m t sI tt m m t r | | tt m j |ai r I
J atta raIt 1 t stri j Ii t r t I j ai r ar 1 i Is t| aratIt ri sIi ts
J tt m i Ii r ] | t It rt j ai r sa ]]t sIs ]asIrt t r It ri Ii s
J tt m i Ii r ] aIIt r j ai r sa ]]t sIs a sa r]i ta| tt r 1 i Ii t r
J j | ¡si ta| t tam i r aIi t r . rt | t a r 1 It r 1 t rr t ss, | t «t | st a r 1 s, rt tIa| t tam
J |a| s
• | | | ar 1 1 i IIt rt r Ii a|
• a ri r a|¡si s It ra |t t a I | ¡ |
Acute abdominal pain
(non-traumatic)
1 | sIra tIi tt s¡m j It m s
K 1 Y| ä
| t ri It r i Ii s! | r Ia ssa stt j Ii t r , tt |ta |a s,
i r tartt raIt 1 | t rr i a, t It...
Y| ä K 1
| t r si 1 t r M ass!
aj j t r 1 i ti Ii s
K 1 Y| ä
| r It tIi t a s | a1 i t |t ]i t
K t r -| | t ]. | ¡ | t ta|a aIi t r
| ra ]-rt |aIt 1
M t Ia| t |i t
Figure 4. Approach to Acute Abdominal Pain
Diffe re ntial Diagnos is
• ]asIrt t r It ri Ii s • tt |ta |a s
• i r tartt raIt 1 | t rr i a • 1 t r t t| -ä t| t r |t i r | a rj a ra
• | ¡ | • si t||t tt || tri si s
• aj j t r 1 i ti Ii s • j r t a m t r i a
• i r Ia ssa stt j Ii t r • | | k
• m a|rt IaIi t r • m t st r It ri t a1 t r i Ii s
| t 1 i aIri ts \1 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
1. Appe ndicitis
J m t sI tt m m t r i r I|am m aIt r¡ | t «t | 1 i st r1 t r Irt m ! ¡t ars t r
J t|i r i ta| It aIa rt s
• |t « ]ra1 t It tt r
• ar t rt ti a
• a| 1 t m i r a| j ai r . j t ri a m | i |i ta| I| t r | | â
• r aa st a, tt m i Ii r ] aIIt r t r st I t I j ai r
• j t ri It r t a| si ]r s
• ]t r t ra|i tt 1 j t ri It r i Ii s i s a tt m m t r j rt st r IaIi t r i r
i r Iar IsI¡t a r ] t| i |1 rt r
J Irt aIm t r I. sa r]i ta|
J tt m j |i taIi t r s
• j t rIt raIi t r
• a| stt ss
2. Intus s us ce ption
J 11X i 1 i t j aI| i t, t| i |1 rt r «i I| | | aI si ]r i Ii tar I|¡ aI ri s|
J !1X | t I«t t r 1 – ¡ I m t r I| s, I!X | t It rt I ¡t ars t I a]t
J It |t stt j i r ] t I st ]m t r I t I | t «t | i r It 1 i sIa| st ]m t r I
—- i st| t m i a ar 1 r t trt si s
• a sa a| si It . i |t t tt ta| }a r tIi t r
J |t a1 j t i r I m a¡ | t s«t ||t r | t ¡t rs j aIt| t s, M t t|t |s
1 i tt rIi ta |a m , j t |¡j , m a|i ]r ar t¡ i r t |1 t r t| i |1
J t|i r i ta| It aIa rt s
• sa 1 1 t r t r st I t I rt ta rrt r I, j art t¡sm a|, st tt rt
j t ri a m | i |i ta| j ai r
• j ai r -Irt t rt m i ssi t r s
• |aIt r tt m i Ii r ] ar 1 rt tIa| | |t t 1 i r ] “ rt 1 ta rrar I }t ||¡” sIt t |s
• saa sa]t -s| aj t 1 m ass t IIt r i r a j j t r It m i 1 a| 1 t m t r
• s| t t| ar 1 1 t | ¡1 raIi t r
• “ t|assi t Iri a1 ” t I a| 1 t m i r a| j ai r , j a|j a| |t saa sa]t -s| aj t 1
m ass ar 1 rt 1 ta rrar I }t ||¡ sIt t |s t r |¡ i r ¡ 1-¡ !X t I j aIi t r Is
J 1 i a]r t si s ar 1 Irt aIm t r I
• ai r t r t m a —- st t rt tt rst | si ]r
• | Iä
• rt 1 a tIi t r a r 1 t r | ¡1 rt sIaIi t j rt ssa rt , ai r t r t m a
• sa r]t r¡ rart |¡ r t t 1 t 1
CHRONIC ABDOMINAL PAIN
J ¡ 1-¡ !X t I t| i |1 rt r
J 1 t Ii r i Ii t r . I| rt t t r m t rt t j i st 1 t s t I j ai r st tt rt t r t a ]| It aIIt tI
atIi ti Ii t s, t tta rri r ] t tt r a j t ri t 1 t I 1 m t r I| s
As s e s s me nt
J 1 i sIi r ]a i s| t r]ar i t Irt m r t r t r]ar i t
J | i sIt r¡
• «t i ]| I |t ss, aj j t Ii It , t r t r]¡
• asst ti aIt 1 tt m i Ii r ], 1 i arr| t a
• t| aratIt ri sIi ts t I j ai r
• j s¡t| t st ti a| i ssa t s
J j | ¡si ta| t tam . a| r t rm a|i Ii t s sa ]]t sI t r]ar i t r aIa rt
J rt 1 I|a]s It r t r]ar i t t Ii t |t ]¡
• a]t - ! ¡t ars t |1 • It tt r
• j ai r a«a¡ Irt m m i 1 |i r t • ar t m i a
• |t ta|i tt 1 j ai r a«a|t r s t| i |1 aI r i ]| I • Iratt | | i sIt r¡
• j rt m i r t r I tt m i Ii r ], 1 i arr| t a • «t i ]| I |t ss t r Iai |a rt It
• }t i r I j ai r ]ai r «t i ]| I
Organic (< 10%)
J t| rt r i t i r It tIi t r
J | |
• tt r sIi j aIi t r - taa st t r t IIt tI!
• i r I|am m aIt r¡ | t «t | 1 i st ast
• ar aIt m i t ar t m a|i t s, m asst s
• t st j | a]i Ii s
• j t j Ii t a |tt r 1 i st ast , |atIt st i r It |t rar tt
• j ar trt aIi t, | t j aIt | i |i ar¡
J ]t r i It a ri r ar¡ 1 i st ast
J ]¡r t tt |t ]i ta|
J tar1 i t tasta |ar
J r t t j |asIi t
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts \¡
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
Functional, Re curre nt Abdominal Pain (RAP) (90%)
J st| t t | a]t , j t a| î-¡ 1 ¡t ars
J | - M
J ta]a t , tram j ¡ j t ri a m | i |i ta| t r t j i ]asIri t j ai r , ti ti 1 i m a]t r¡ It
1 t stri | t j ai r
J s| t a |1 r t I a«a|t r t| i |1
J r t j rt ti j i IaIi r ] t r rt |i t ti r ] IatIt rs, r t tt r si sIt r I j aIIt rr
J t| i |1 aj j t ars «t || «i I| r t rm a| ]rt «I|
J asst ti aIt 1 «i I| st| t t | a| st r It t i sm
J 1 i a]r t si s
• m a sI tt r si 1 t r |i 1 r t ¡ 1 i st ast , m a|rt IaIi t r t I | t «t |, | | |
• st| t t | j | t | i a!
J i r tt sIi ]aIi t r s as i r 1 i taIt 1
• | | | , | ä | , a ri r a|¡si s, sIt t |s It r 1 & |, | & ä , t tta |I | |t t 1
J Irt aIm t r I
• m ar a]t ar ¡ t m t Ii t r a| t r Iam i |¡ j rt | |t m s
• Iri a| t I | i ]| Ii | rt 1 i t I, Iri a| t I |atIt st -Irt t 1 i t I
• rt assa rar tt
CONSTIPATION
J as m ar ¡ as I1X t I t| i |1 rt r - ! ¡t ars t I a]t
As s e s s me nt
J | i sIt r¡
• a]t t I t r st I, 1 i t Iar¡ | i sIt r¡
• asst ti aIt 1 s¡m j It m s. a| 1 t j ai r , t r tt j rt si s, t tt rI|t « 1 i arr| t a
J j | ¡si ta| t tam
• t tam i r t |t «t r | at| It r t ti 1 t r tt t I t tta |I tt r1 |t si t r K ¡ |
• a| 1 t m i r a| t tam
• rt tIa| t tam
J m t sI t IIt r 1 i t I-rt |aIt 1 «i I| r t sj t ti Ii t 1 i st ast
J 1 i rst| sj ra r ]s 1 i st ast
Functional Cons tipation
J 11X t I tast s t I tt r sIi j aIi t r
J |at| t I | a || t r Ii | rt i r 1 i t I t r t| ar ]t i r 1 i t I
J j t t r I|a i 1 i r Ia|t
J i r t| i |1 rt r , tar t tta r 1 a ri r ] It i |t I Irai r i r ], t r 1 a t It j ai r t r
1 t It taIi t r , sIt t | «i I| t |1 i r ]
J i r i r Iar Is, t IIt r «| t r i r Irt 1 a ti r ] tt «s m i || aIIt r | rt asI m i ||
J Irt aIm t r I
• i r trt ast I|a i 1 s, i r trt ast 1 i t Iar¡ Ii | rt
J tt m j |i taIi t r s
• ar a| Ii ssa rt s ar 1 j ai r —- «i I| | t |1 j assi r ] sIt t |
—- t| rt r i t 1 i |aIaIi t r ar 1 t tt rI|t « i r tt r Ii r t r tt ,
t r tt j rt si s = | ai r | t It r Ii t r | ¡t|t
J Irt aIm t r I
• i r trt ast I|a i 1 s, i r trt ast 1 i t Iar¡ Ii | rt
• m a¡ r t t 1 m i r t ra| t i |, |ataIi tt s
• aj j rt j ri aIt It i |t I Irai r i r ] It t| r i | a t
Spe cific Organic Dis orde rs
1. Hirs chs prung's Dis e as e (conge nital aganglionic me gacolon)
J rt tIt si ]m t i 1 i r I!X t I tast s
J i r ti 1 t r tt . M .| = 1.¡ , ¡ I! 111 |i tt | i rI| s
J asst ti aIt 1 «i I| | t «r s¡r 1 rt m t
J t|i r i ta| It aIa rt s
• st tt ri I¡ 1 t j t r 1 s t r |t r ]I| t I i r tt |tt m t r I
• r t m t tt r i a m «i I| i r Ii rsI I\ | t a rs
• j a|j a| |t sIt t | t r a| 1 t m i r a| t tam «i I| t m j I¡ rt tIa m t r | | |
• i r It rm i IIt r I 1 i arr| t a, | M t r |¡ «i I| rt tIa| sIi m a |aIi t r
• tt r sIi j aIi t r
• a| 1 t m i r a| 1 i sIt r Ii t r
• tt m i Ii r ]
• | ¡ ¡
J tt m j |i taIi t r s
• t r It rt tt |i Ii s. m a¡ | t IaIa|, j t a| i r ti 1 t r tt I-1 m t r I| s t I a]t
• It ti t m t ]att |t r ar 1 j t rIt raIi t r
| t 1 i aIri ts \I M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
J 1 i a]r t si s
• | ari a m t r t m a. j rt ti m a| 1 i |aIaIi t r 1 a t It Ia r tIi t r a|
t | sIra tIi t r , t m j I¡ rt tIa m
• m ar t m t Iri t sIa 1 i t s. m a¡ | att Ia|st j t si Ii tt s
• rt tIa| | i t j s¡. 1 t Ii r i Ii tt 1 i a]r t si s a| st r I ]ar ]|i t r tt ||s
J Irt aIm t r I
• r t r sa r]i ta| i I s| t rI st ]m t r I
• sa r]t r¡. tt |t sIt m ¡ ar 1 rt -ar asIt m t si s
2. Othe r
J i r It sIi r a| t | sIra tIi t r
J t r 1 t tri r t
• | ¡j t I| ¡rt i 1 i sm
• 1 i a| t It s m t ||i Ia s
• | ¡j t rta|tt m i a
J r t a rt ]t r i t | t «t | i .t . sj i r a | i Ii 1 a
J ar a| Ii ssa rt IsIri tIa rt IsIt r t si s
J tt ||a]t r tasta |ar 1 i st ast
J 1 ra ]s. |t a1 , t| t m t I| t raj ¡, t j i t i 1 s
ABDOMINAL MASS
Table 16. Diffe re ntial Diagnos is of Abdominal Mas s
Be nign Malignant
Re nal | ¡1 rt r t j | rt si s r t j | rt | |asIt m a wi |m ’ s
j t |¡t¡sIi t |i 1 r t ¡ 1 i st ast rt r a| tt || tarti r t m a
| am arIt m a
Adre nal r t a rt | |asIt m a
Ovarian t tari ar t¡sIs t tari ar Ia m t rs
Othe r sj |t r t m t ]a|¡ |¡m j | t m a
j ¡|t ri t sIt r t si s rt Irt j t ri It r t a|
a| 1 t m i r a| | t rr i a r| a| 1 t m ¡t startt m a
It raIt m a
J !1X t I a| 1 t m i r a| m asst s i r I| t r t «| t rr art rt r a| i r t ri ]i r
GASTROINTESTINAL HEMORRHAGE
As s e s s me nt
J asst ss | t m t 1 ¡r am i t sIa| i |i I¡
J K | Ia | t It 1 t It rm i r t i I a j j t r t r |t «t r | |t t 1
J | i sIt r¡. ata It t r t| rt r i t, a]t t I t| i |1
• asst ti aIt 1 s¡m j It m s, t It...
J m ar a]t m t r I
• tt |a m t rt sa sti IaIi t r ar 1 sIa| i |i taIi t r
• Irt aI a r 1 t r|¡i r ] tt r 1 i Ii t r
Uppe r GI Ble e ding
J m a tt sa| |t si t r s
• ]asIri Ii sI]asIrt t r It ri Ii s
• t st j | a]i Ii s
• 1 a t 1 t r a|I]asIri t a |tt r
• M a||t r¡-wt i ss It ar
• t j i sIati s, It rt i ]r | t 1 ¡
J tasta |ar
• tt a]a |t j aI| ¡
• ti Iam i r | 1 t Ii ti t r t¡ | t m t rr| a]i t 1 i st ast t I I| t r t «| t rr
• t st j | a]t a| tari tt s
J t I| t r
• s«a||t «t 1 | |t t 1 , It t 1 tt |t a ri r ]
J i r tt sIi ]aIi t r s
• | | | , sIt t | 1 | , K | asj i raIt . | |t t 1 , j 1 , kj I It sI i r r t «| t rr
• t r 1 t stt j ¡, tt |t r stt j ¡ «| t r sIa| |t
J Irt aIm t r I
• a r 1 t r|¡i r ] taa st , m a¡ a st 1 I | |t t|t rs
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts \1
K t It s
GASTROINTESTINAL DISEASE. . . CONT.
Lowe r GI Ble e ding
1. Acute
J i r It tIi t r
• | atIt ri a|, j arasi Ii t, ar Ii | i t Ii t-i r 1 a tt 1 | . difficile
J ar aIt m i t
• m a|rt IaIi t r Itt |ta |a s
• i r Ia ssa stt j Ii t r “ rt 1 ta rrar I }t ||¡ sIt t |s
• M t t|t |s 1 i tt rIi ta |a m
• ar a| Ii ssa rt s
J tasta |arI| t m aIt |t ]i t
• 1 t r t t| -ä t| t r |t i r | a rj a ra
• | t m t |¡Ii t-a rt m i t s¡r 1 rt m t | . coli
• tt a]a |t j aI| ¡
2. Chronic
J ar a| Ii ssa rt s m t sI tt m m t r
J tt |i Ii s
• i r I|am m aIt r¡. | | |
• a||t r]i t m i || j rt It i r
J sIra tIa ra|
• j t |¡j s. m t sI art | am arIt m as
• r t t j |asm s. rart
J tt a]a |t j aI| ¡
INFECTIOUS DISEASES
| t tt r
- 1 m t r I| s 1 m t r I| s - 1 ¡t ars
J a1 m i I, | a || ä w|
¡
Irt aI j t r 1 i r ] rt sa |Is ¡ 1 X| | K 1 K -¡ 1 X| | ar 1 K 1 | 1 | | ä
or
IF J a]t Iî-11 1 a¡s J a1 m i I, ¡ - 11.!¸| ¡ - 11.!¸|
J r t r -It ti t ar 1 | a || ä w|
¡
ar 1
J rt |i a| |t | I|
I
ar 1 Irt aI J a ri r t | & M J a ri r t | & M
J |t « ri s|
1
tri It ri a J | | | J t | st rtaIi t r s
J | I|
I
i r I\ | t a rs
w| | - ¡ ! w| | - ¡ !
J | |t t 1 | & ä J t | st rtaIi t r
m a¡ tt r si 1 t r t | st rtaIi t r J a ri r t | & ä J att Iam i r t j | i r
t r t a I j aIit r I | asis It ||t «ir ] J att Iam i r t j | i r J | I|
I
i r I\ | t a rs
ä w| I– k| t J I– k| t
NOTES:
¡ . | a || st j Iit «t r|a j - | |t t 1 | &ä , | | | ar 1 1 iIIt rt r Iia|, a rir t | &M , | &ä , | |, t| t sI t-ra¡ iI rt sj iraIt r¡ ä ä t, sIt t | | &ä iI | | ä ä t
I. | t ||t «-a j is crucial - iI a1 t | a aIt | I| is r t I assa rt 1 , a m t rt a]]rt ssitt 1 ia]r t sIit ar 1 I| t raj t a Iit aj j rt at| m a¡ | t ir 1 itaIt 1
1. | t «-| is| | riIt ria - j rt tit a s|¡ | t a|I| ¡, r t rm a| j | ¡sita| t tam r t r -It tit , r t ]aIitt |a| strt t r w| | !-¡ !, - ¡ .! t ¡ 1
1
| ar 1 s,
a rir t - ¡ 1 w| | I| j I, sIt t | - ! w| | I| j I
\. |m j t rIar I | rir tij |t s - I| t ¡t a r ]t r I| t t| i|1 , I| t ]rt aIt r I| t 1 iIIita |I¡ It t|ir ita||¡ asst ss I| t 1 t ]rt t t I i||r t ss
Figure 5. Approach to the Fe brile Child
Clinical Pe arl
J Te e thing may caus e a te mpe rature e le vation >37.5ºC on the firs t day of the
e ruption in 50%of infants . Howe ve r, s ignificant te mpe rature e le vation
s hould ne ve r be attribute d s ole ly to te e thing!
| t 1 i aIri ts \\ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
INFECTIOUS DISEASES . . . CONT.
SEPSIS IN THE NEONATE
Table 17. Ne onatal Se ps is
Early Ons e t (birth-8 days ) Late Ons e t (8-28 days )
• | t ]i r s i r a It rt • at| a i rt 1 aIIt r | i rI|
• | i s| | atIt rs. • a sa a||¡ | t a|I| ¡, Ia ||-It rm
m aIt rr a| | ¡ | , | | ä j t si Ii tt , ¡ ¸ m aIt rr a| i r It tIi t r • sam t j aI| t ]t r s j |a s.
m aIt rr a| It tt rI |t a |t t¡It si sI t| t ri t am r i t r i Ii s pneumococcus, meningococcus, 1 ä V,
j rt |t r ]t 1 ra j Ia rt t I m t m | rar t s, Staphylococcus
j rt m aIa ri I¡, |ar]t i r t tta |a m
• | | ä , E. coli, Listeria,
Klebsiella
Signs of Se ps is
• rt sj i raIt r¡ 1 i sIrt ss, t¡ar t si s, aj r t a
• Iat| ¡tar1 i aI| ra1 ¡tar1 i a
• |t I| ar]¡, j t t r It t 1 i r ]
• | ¡j t It r i a, st i ta rt s, | a |]i r ] It r Iar t ||t
• }aa r 1 i tt
• It m j t raIa rt i r sIa| i |i I¡ | ¡j t I| ¡j t rI| t rm i a
Table 18. Antibiotic Tre atme nt of Se rious Bacte rial Infe ctions
Ne onate
j aI| t ]t r s. | | ä , E.coli, Listeria, ä . aureus am j i ti ||i r ]t r Iam i ti r
t r
am j i ti ||i r tt It Iati m t
I– t|t tati ||i r i I ri s| t I ä . aureus
1-3 months am j i ti ||i r tt It Iati m t
sam t j aI| t ]t r s as a| t tt ar 1 | t |t «
I– t|t tati ||i r i I ri s| t I ä . aureus
> 3 months tt Ia rt ti m t
j r t a m t tt tta s, 1 . influenzaeI¡j t | - ! ¡t ars ,
m t r i r ]t tt tta s tt IIri att r t t r tt It Iati m t , i I ri s| t I m t r i r ]i Ii s
tar tt m ¡ti r , i I j t r i ti ||i r I tt j | a|t sj t ri r -
rt si sIar I j r t a m t tt tti
1 i | | as 1 ram aIi ta||¡ 1 t trt ast 1 si r tt i r Irt 1 a tIi t r t I 1 i | tatti r t
MENINGITIS
J j t a| a]t . t-¡ I m t r I| s, 11X t tta rs - ! ¡t ars t |1
Ris k Factors
J tt m j rt m i st 1 i m m a r i I¡ t .]. 1 | V, asj |t r i a, j rt m aIa ri I¡
J r t a rt ar aIt m i ta| 1 t It tIs t .]. 1 t rm a| si r a s, r t a rt sa r]t r¡
J j aram t r i r ]t a| i r It tIi t r t .]. si r a si Ii s, m asIt i 1 i Ii s
J t r ti rt r m t r Ia| t .]. 1 a¡-tart tt r Irt s, | t a st | t |1 tt r IatI,
Iratt | It t r 1 t m i t rt ]i t r s
Pathophys iology
J | | ¡ | ––- | |t t 1 sIrt am i r tasi t r Irt m rt sj i raIt r¡ IratI ––- | t m aIt ]t r t a s
st t 1 i r ] t I m t r i r ]t s ––- m t r i r ]t a| ar 1 | K ä i r I|am m aIi t r
Clinical Fe ature s
J I– | | | j rt 1 rt m t
J It tt r, It ti t, |t I| ar]¡, i rri Ia| i |i I¡
J | t a1 at| t , j | t It j | t | i a, r aa st aItt m i Ii r ]
J ¡t a r ]t r i r Iar Is m a¡ r t I 1 t m t r sIraIt |t ta|i ti r ] si ]r s, m a¡ | att r t r -sj t ti Ii t
s¡m j It m s j t t r It t 1 i r ], i rri Ia| i |i I¡, |t I| ar]¡ | a |]i r ] It r Iar t ||t
J si ]r s t I m t r i r ]i sm a s. | ra 1 ti r s|i ’ s, | t rr i ]’ s, t j i sI| t It r t a s,
r a t| a| ri ]i 1 i I¡, | K | | | ar 1 | V j ara|¡si s
J i r trt asi r ] | t a1 ti rta m It rt r tt i I sa Ia rt s r t I t|t st 1
J st i ta rt i r I1-11X t I j aIi t r Is «i I| | atIt ri a| m t r i r ]i Ii s
J j t It t| i a| ras| m t r i r ]t tt tta s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts \!
K t It s
INFECTIOUS DISEASES . . . CONT.
Diagnos is
J | | It r | ä |
• rai st 1 t j t r i r ] j rt ssa rt r t rm s. rt ta m | t r I ar 1 rt |att 1 , |t ss I|t tt 1
j t si Ii t r - ¡ t1 m m 1 I1 , I|t tt 1 |aIt ra| 1 t ta | i Ia s j t si Ii t r = ¡ 11-Iî1 m m 1 I1
• t|t a 1 ¡ i r | atIt ri a| i r It tIi t r
J ti ra| m t r i r ]i Ii s
• | r It rt ti ra s, | | V, | r I|a t r ta, 1 t rj t s, k1 t r t ti ra s
• w| | - 111 t ¡ 1
t
I| a sa a||¡ |¡m j | t t¡It s ,
• ]|a tt st r t rm a|, j rt It i r r t rm a| It | i ]|
J | atIt ri a| m t r i r ]i Ii s
• w| | - ¡ 111 t ¡ 1
t
I| , i r trt ast 1 | M K s,
w| | m a¡ | t - ¡ 11 t ¡ 1
t
I| i r t ar|¡ 1 i st ast
• t |t taIt 1 j rt It i r - 1.\ ]I|
• 1 t trt ast 1 ]|a tt st - I.¡ m m t |I| - !1 X st ra m ]|a tt st
• | ram sIai r j t si Ii tt i r î1-11X t I tast s
• | ä | ta |Ia rt
• l i t | |-K t t |st r sIai r , i I ¡ | sa sj t tIt 1
• |aIt t a]]|a Ii r aIi t r It sIs i I j arIi a||¡ Irt aIt 1 m t r i r ]i Ii s
J | | | - I t ¡ 1
1
I| w| | = | a1 j rt ]r t sIi t m ar|t r
J | |t t 1 ]|a tt st
J | |t t 1 ta |Ia rt s j t si Ii tt i r 11X tast s
J t |t tIrt |¡It s ä | k| 1
J i I j arIi a||¡ Irt aIt 1 m t r i r ]i Ii s, | | m a¡ s| t « j t rsi sIt r I
a| r t rm a|i Ii t s, j |a s a j t si Ii tt | ä | ta |Ia rt
Complications
J m t rIa|i I¡. r t t r aIt ¡ !-I1X , t| i |1 rt r - ¡ 1X ,
j r t a m t tt tta s - m t r i r ]t tt tta s - 1 i |
J ata It
• ä | k| 1 ––- | ¡j t r aIrt m i a ––- | rai r t 1 t m a
• st i ta rt s
• sa | 1 a ra| | t m aIt m a
• | rai r a| stt ss, 1 i sst m i r aIt 1 i r It tIi t r t sIt t m ¡t |i Ii s, st j Ii t arI| ri Ii s, a| stt ss
• s| t t|I| | |
J t| rt r i t
• | t ari r ] |t ss
• m t r Ia| rt Iar1 aIi t r I |t arr i r ] 1 i sa| i |i I¡
• r t a rt |t ]i ta| 1 t Ii ti I, st i ta rt 1 i st r1 t r
• | ¡1 rt tt j | a|a s
Tre atme nt
J ar Ii | i t Ii ts st t ¡a| |t ¡ î s| t a |1 | t i m m t 1 i aIt , 1 t r t I «ai I It r
| | rt sa |Is
i I ti ra|. sa j j t rIi tt , at¡t|t ti r It r | t rj t s
J I|a i 1 rt sIri tIi t r i I ä | k| 1
J m t r i It r ]|a tt st , ati 1 -| ast ar 1 tt |a m t sIaIa s
sIt rt i 1 s i r 1 i | m t r i r ]i Ii s m a¡ rt 1 a tt r t a rt |t ]i t st | a t |at i I
]i tt r tt r¡ t ar|¡
J ar Ii tt r ta |sar Is m a¡ | t r t t 1 t 1 It Irt aI st i ta rt s
J i st |aIi t r
J j rt j | ¡|ati s
• atIi tt i m m a r i taIi t r
• 1 . influenzaeI¡j t | tatti r t - rt a Ii r t |¡
• m t r i r ]t tt tta| tatti r t - i I asj |t r i t, tt m j |t m t r I 1 t Ii ti t r I
t r It r t a I| rt a|s
• j r t a m t tt tta| tatti r t - i I i m m a r t tt m j rt m i st 1 Isj |t r t tIt m i tt 1
• | | | tatti r t - i I | t rr i r ¡ | -t r 1 t m i t art a
• t| t m t j rt j | ¡|ati s It r tt r IatIs ar 1 i r 1 t t tast
• 1 . influenzae- ri Iam j i r
• K . meningitidis- ri Iam j i r tt IIri att r t t r sa |Ii st tatt |t
J rt j t rI It j a | |i t | t a|I| i I 1 . influenzaet r K . meningitidis
K t It s
| t 1 i aIri ts \t M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
INFECTIOUS DISEASES . . . CONT.
HIV INFECTION
Epide miology
J ri s| t I i r It tIi t r I1-11X | t rr It a r Irt aIt 1 1 | V i r It tIt 1 «t m t r
J Irar sm i ssi t r
• i r Iar Is ar 1 t| i |1 rt r . Irar sj |att r Ia| m t sI tt m m t r ,
m aIt rr a| | |t t 1 , rart |¡ I| rt a ]| | rt asI m i ||
• a1 t |t stt r Is. st ta a| i r It rtt a rst , r t t 1 |t s, | |t t 1
j rt 1 a tIs
J i r ta | aIi t r j t ri t 1 . m t r I| s It ¡t ars s| t rI i r ta | aIi t r i r I!X
J si ]r s ar 1 s¡m j It m s t tta r t IIt r «i I| i r I| t Ii rsI ¡t ar, m t sI «i I| i r I«t ¡t ars
HIV Te s ting
J ti ra| r a t|t i t ati 1 | ¡ | | |
J ti ra| ta |Ia rt
J ti ra| ar Ii ]t r - j I\
J 1 | V ar Ii | t 1 ¡ - | | | ä k ar 1 wt sIt rr | |t I It tt r Ii rm
• m aIt rr a| 1 | V ar Ii | t 1 i t s tar j t rsi sI a j It ¡ î m t r I| s
• i I t| i |1 | rt asIIt t 1 i r ] rt j t aI It sI 1 m t r I| s aIIt r sIt j j i r ]
| rt asIIt t 1 i r ]
Clinical Fe ature s of AIDS in Infants and Childre n
st t | r It tIi t a s | i st ast s K t It s
J | ¡ ¡, | t j aIt m t ]a|¡, | ¡m j | a1 t r t j aI| ¡
J rt ta rrt r IIj t rsi sIt r I I| ra s|
J t| rt r i t i r It rsIi Ii a| j r t a m t r i Ii s rt |aIi tt |¡ tt m m t r , | | |
J t j j t rIa r i sIi t i r It tIi t r s
J t r tt j | a|t j aI| ¡
Manage me nt
J j rt m j I Irt aIm t r I t I i r It tIi t r s
J a1 t | a aIt r a Iri Ii t r
J j rt j | ¡|ati s
• ¡ M | Iä M X It r | | |
• I– | V| |
J r ¡sIaIi r , tt Iri m t tatt |t , |t It tt r att |t , at¡t|t ti r i I i r 1 i taIt 1
J sa j j rt ssi t r t I 1 | V
• l i 1 t ta 1 i r t , t I| t r t .]. 1 i 1 ar t si r t
J i m m a r i taIi t r s
• a|| rt a Ii r t i m m a r i taIi t r s i r t|a 1 i r ] M M | i I «t ||
• att i 1 1 | V ar 1 | | |
• j r t a m t tt tta|, i r I|a t r ta ar 1 tari tt ||a tatti r t s
PERIORBITAL/ORBITAL CELLULITIS
J m t 1 i ta| t m t r]t r t¡
J j t ri t r| i Ia| ts. t r| i Ia| j rt j It si s, tt m j rt m i st 1 ti sa a| ata i I¡, sIra| i sm a s
ar 1 t tIrat ta |ar m t tt m t r Is, 1 t t j t ¡t j ai r
Clinical Fe ature s
J a r i |aIt ra| t ¡t |i 1 s«t ||i r ] «i I| t r¡I| t m a
J tt r }a r tIi tt a sa a||¡ r t rm a|
J i I | atIt rt m i t, t I| t r s¡sIt m i t It aIa rt s j rt st r I It tt r, w| |
J t r| i Ia| tt ||a |i Ii s. j rt j It si s, t j | I| a|m t j |t ]i a, j ai r t r t ¡t
m t tt m t r I, 1 t trt ast 1 ti sa a| ata i I¡
Pathophys iology
J st tt r 1 ar¡ It si r a si Ii s, 1 t r Ia| st j si s, t ¡t t r s|i r i r It tIi t r
J j ri m ar¡ i r It tIi t r «i I| | t m aIt ]t r t a s sj rt a1 It t r| i I
J H.influenzae, S.pneumonia, S.aureus
Tre atme nt
J | |t t 1 | & ä
J a r]t r I | V ar Ii | i t Ii ts
• Iraa m aIi t, ar ¡ a]t . t|t tati ||i r t r tt Iatt |i r
• r t r Iraa m aIi t, - ! ¡t ars. tt It Iati m t t r tt Ia rt ti m t
• r t r Iraa m aIi t, - ! ¡t ars. t|t tati ||i r t r tt Iatt |i r
J m a¡ rt | a i rt a r]t r I 1 rai r a]t
• ri Iam j i r It r tt r IatIs i I 1 . influenzae
J m i |1 t ar|¡ tast s tar | t Irt aIt 1 as t a Ij aIi t r Is «i I| t|t st It ||t «-a j
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts \I
INFECTIOUS DISEASES . . . CONT.
Complications
J tatt rr t a s si r a s I| rt m | t si s
J m t r i r ]i Ii s
J | rai r a| stt ss
OTITIS MEDIA st t 1 It |ar¡r ]t |t ]¡ K t It s
Etiology
J ä . pneumoniae 11X
J r t r I¡j a| |t 1 . influenzae I1X
J M . catarrhalis I1X
J ]rt a j k ä Irt j !X
J ti ra| I1-I!X
Ris k Factors
J 1 a¡tart aIIt r 1 ar tt
J | t II|t It t 1 i r ] i r | t 1
J st tt r 1 -| ar 1 sm t |t
J It rm a |a-It 1 i r Iar Is
J t|t II |i j , | t «r s¡r 1 rt m t
J |t « st ti t t tt r t m i t sIaIa s
J | r a i I, k| t ri ]i r a|s
Clinical Fe ature s
J m a¡ It ||t « | | |
J j ai r Ia | t ar, Ia ]]i r ], Ii r r i Ia s, tt rIi ]t
J 1 i st| ar]t i I j t rIt raIt 1
J | t ari r ] |t ss
J It tt r, tt m i Ii r ], i rri Ia| i |i I¡ i r ¡t a r ]t r i r Iar Is
J Ii rsI sIa]t —- s|i ]| I|¡ rt IratIt 1 , rt 1 I¡m j ar i t m t m | rar t
J st tt r 1 sIa]t —- | a |]i r ], rt 1 ¡ M «i I| I|a i 1 |t tt |, j t rIt raIi t r
Tre atme nt
J ¡ sI |i r t . am t ti ti ||i r
J i I r t i m j rt tt m t r I aIIt r \î | t a rs t r t| i |1 rt tt i tt 1 am t ti ti ||i r i r |asI
\ «t t |s, tt r si 1 t r Ir 1 |i r t .
• t r¡I| rt m ¡ti r -sa |It r am i 1 t | t 1 i att |t
• Iri m t I| t j ri m Isa |Iam t I| t tatt |t
• am t ti ti ||i r It|ata |ar aIt
• tt Ii ti m t t r tt 1 ai |¡ rt ]i m t r
• tt Ia rt ti m t | 1
J ¡ 1 1 a¡ t ra| rt ]i m t r It r a r tt m j |i taIt 1 ata It t j i st 1 t s
J 1 ai |¡ j rt j | ¡|ati s i I rt ta rrt r I t j i st 1 t s
J I¡m j ar t sIt m ¡ Ia | t s I– a1 t r t i 1 t tIt m ¡
Complications
J | t ari r ] |t ss, t| rt r i t t IIa si t r
J t| t |t sIt aIt m a, m asIt i 1 i Ii s
J m t r i r ]i Ii s
STREPTOCOCCAL INFECTIONS
1. Pharyngitis and Tons illitis
J ti ra| t Ii t |t ]¡ m t rt tt m m t r I| ar | atIt ri a| i r - 1 ¡t ars t I
a]t ]rt a j
J | atIt ri a| t Ii t |t ]¡ | rt a j k ä Irt j
• - 1 ¡t ars t |1
• st rt I| rt aI, It tt r, t ta 1 aIt t r rt 1 It r si |s, It r 1 t r tt rti ta|
r t 1 t s, asst ti aIt 1 | t a1 at| t , a| 1 t m i r a| j ai r
• t ta 1 aIt t r rt 1 It r si |s a|st st t r i r | | V, a1 t r t ti ra s, 1 i j | I| t ri a
J ti ra| t Ii t |t ]¡ a1 t r t ti ra s, t r It rt ti ra s, ar 1 | | V i r t |1 t r a]t ]rt a j
• - 1 ¡t ars t |1
• ra r r ¡ r t st , tt a ]| , 1 i arr| t a, ras|
Manage me nt of Stre p throat
J s¡m j It m aIi t
J ar Ii | i t Ii ts It j rt tt r I r| t a m aIi t It tt r, s| t rIt r i ||r t ss 1 a raIi t r
K t It s
| t 1 i aIri ts \î M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
INFECTIOUS DISEASES . . . CONT.
J - 1 ¡t ars t |1 , ta |Ia rt | t It rt Irt aIm t r I t r 1 t raj i 1 ä Irt j kr Ii ]t r It sI
J raj i 1 ä Irt j It sI t r |¡ I1-11X st r si Ii tt , 1 t ta |Ia rt s i I r t ]aIi tt
J tar j rt tt r I r| t a m aIi t It tt r i I Irt aIt 1 «i I| i r 1-¡ 1 1 a¡s
J ar Ii | i t Ii ts 1 t r t I a|It r I| t ri s| t I ]|t m t ra |t r t j | ri Ii s
J ar Ii | i t Ii ts It r j rt tt r | atIt ri a| i r It tIi t r
• j t r i ti ||i r t r t r¡I| rt m ¡ti r t ¡ 1 1 a¡s
Indications for Tons ille ctomy
J j rt tt r , rt ta rrt r I ä Irt j It r si ||i Ii s
J j t ri It r si ||ar a| stt ss rart
J s¡m j It m aIi t It r si ||ar | ¡j t rIrt j | ¡
• s|t t j aj r t a
• | ¡j t ti a
• tt r j a |m t r a|t
J sa sj t tIt 1 Ia m t a r
2. Scarle t Fe ve r
J t r¡I| rt ]t r i t sIrai r t I | rt a j k | t m t |¡Ii t ä Irt j
J ata It t r st I t I It tt r, st rt I| rt aI, sIra«| t rr¡ It r ]a t
J I\-\î | t a rs aIIt r j | ar¡r ]i Ii s, ras| 1 t tt |t j s «| i t| | t ]i r s
i r I| t ]rt i r , ati ||at , r t t|, ar It ta | i Ia| It ssa
J «i I| i r I\ | t a rs, ras| | t tt m t s ]t r t ra|i tt 1 «i I| j t ri t ra| sj ari r ]
J ras| Ia1 t s aIIt r 1-\ 1 a¡s, m a¡ | t It ||t «t 1 | ¡ j t t |i r ]
J j t r i ti ||i r t r t r¡I| rt m ¡ti r
3. Pos t-Infe ctious Complications - Rhe umatic Fe ve r
J !t r t s | ri It ri a rt ti st 1
• rt | a i rt s I m a}t r 1 | ¡ m a}t r ar 1 I m i r t r | | | ä t ti 1 t r tt t I
j rt tt 1 i r ] ä Irt j i r It tIi t r i r trt ast 1 kä 1 ¡, I| rt aI s«a| , rt tt r I
star|t I It tt r
• m a}t r tri It ri a. ä |k| |
• sa | ta Iar t t a s r t 1 a |t s
• j ar tar1 i Ii s
• arI| ri Ii s m i ]raIt r¡
• t| t rt a ä ¡1 t r | am s
• t r¡I| t m a m ar]i r aIa m
• m i r t r tri It ra
• j rt ti t a s r| t a m aIi t It tt r t r r| t a m aIi t | t arI 1 i st ast
• j t |¡arI| ra|]i a
• It tt r
• t |t taIt 1 | ä | t r | rt atIi tt j rt It i r t r |t a |t t¡It si s
• j rt |t r ]t 1 | | i r It rta|
J Irt aIm t r I
• j t r i ti ||i r It r ata It tt a rst
• st tt r 1 ar¡ j rt j | ¡|ati s It r aI |t asI ! ¡t ars t r a r Ii | I¡ ¡t ars t |1
• ar Ii -i r I|am m aIt r¡ 1 ra ]s kä k
J tt m j |i taIi t r s
• m i Ira| i r sa IIi ti t r t¡IsIt r t si s
• at rIi t i r sa IIi ti t r t¡IsIt r t si s
4. Invas ive Group A Stre p
J | atIt rt m i a j t sI sIrt j It tt tta| 1 i st ast t I s|i r , rt sj IratI, rt tIa m , t r ta]i r a
J | | | , s| t t|, ar 1 j t ri j | t ra| ]ar ]rt r t tar t tta r
J | t m aIt ]t r t a s 1 i sst m i r aIi t r ––- m t r i r ]i Ii s, t sIt t m ¡t |i Ii s,
arI| ri Ii s, st II Ii ssa t a| stt sst s, j r t a m t r i a, t r t r 1 t tar1 i Ii s
J r t trt Ii ti r ] Iasti Ii s
J sIrt j It tt tta| It ti t s| t t|-|i |t s¡r 1 rt m t m a¡ t tta r aIIt r
sIrt j It tt tta| sa j t ri r It tIi t r t I tari tt ||a |t si t r s
J Irt aIm t r I. | V j t r i ti ||i r . | I a||t r]i t, t r¡I| rt m ¡ti r t r t|i r 1 am i ti r
5. Impe tigo st t | t rm aIt |t ]¡ ä t tIi t r
6. Group B Stre p
J tt m m t r taa st t I r t t r aIa| i r It tIi t r
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts \1
INFECTIOUS DISEASES . . . CONT.
Table 19. Fe ature s of GBS Infe ctions
Fe ature Early Ons e t Late Ons e t Late -late Ons e t
k]t rar ]t - I 1 a¡s I 1 a¡s - 1 m t r I| s - 1 m t r I| s
M t 1 i ar a]t t I t r st I ¡ | t a r II 1 a¡s a r |r t «r
| r ti 1 t r tt t I j rt m aIa ri I¡ 11X a r tt m m t r tt m m t r
| |i r i ta| j rt st r IaIi t r - st j si s si ]r s t I - st j si s si ]r s t I - i r V| | w, j rt m aIa rt
rt sj 1 i sIrt ss rt sj 1 i sIrt ss ar 1 i m m a r t tt m j rt m i st 1 .
- m t r i r ]i Ii s !-¡ 1X - m t r i r ]i Ii s 11X | atIt rt m i a, st j si s, st j Ii t arI| ri Ii s
- st II Ii ssa t , | t r t ,
}t i r I |t ta|i taIi t r
M t rIa|i I¡ raIt !-I1X I-tX |t «
J Irt aIm t r I
• i r i Ii a| sa sj t tIt 1 | | ä i r It tIi t r . | V am j i ti ||i r ar 1 ]t r Iam i ti r
a r Ii | | ä | t r | |t t 1 sIrt am sIt ri |i I¡ 1 t ta m t r It 1
• a j t r tt r Ii rm aIi t r t I | | ä . | V j t r i ti ||i r t ¡ \ 1 a¡s m t r i r ]i Ii s It
\ «t t |s t r 1 t tar1 i Ii s
• m t r i r ]i Ii s. rt j t aI | | aI I\ | t a rs aIIt r i r i Ii a| Irt aIm t r I tt r Irt tt rsi a|
PERTUSSIS/WHOOPING COUGH
J | t r1 t It ||a j t rIa ssi s
J i r ta | aIi t r . t-I1 1 a¡s
J tt m m a r i ta| |t Irt m ¡ «t t | | t It rt j art t¡sm s It 1 «t t |s aIIt r
J 1 t trt ast 1 i r ti 1 t r tt 1 a t It i m m a r i taIi t r s
J | i ]| |¡ tt r Ia]i t a s, ai r| t rr t ––- Irar sm i IIt 1 ti a ai r 1 rt j |t Is
rt |t ast 1 1 a ri r ] i r It r st tt a ]| i r ]
Clinical Fe ature s
J j rt 1 rt m a| taIarr| a| sIa]t
• ¡ -I «t t |s, m t sI tt r Ia]i t a s
• tt r¡ta, m i |1 tt a ]| , |t « ]ra1 t It tt r
J j art t¡sm a| sIa]t
• I-\ «t t |s
• j art t¡sm s t I tt a ]| , st m t Ii m t s It ||t «t 1 | ¡ i r sj i raIt r¡ «| t t j
• I– tt m i Ii r ] «i I| tt a ]| i r ] sj t ||s
• tar | att st tt rt s¡m j It m s It r t «t t |s, tt a ]| It r t m t r I| s
• j rt ssa rt t IIt tI - sa | tt r }a r tIi ta| | t m t rr| a]t , rt tIa| j rt |aj st , | t rr i as, t j i sIati s
J tt r ta|t stt r I sIa]t
• ¡ -I «t t |s, r t r i r It tIi t a s
• t ttasi t r a| j art t¡sm s t I tt a ]| | a I 1 t trt ast 1 Irt | a t r t¡ ar 1 st tt ri I¡
Complications
J rt sj i raIt r¡
• st tt r 1 ar¡ j r t a m t r i a m t sI tt m m t r , t Ii Ii s m t 1 i a
• aIt |t tIasi s
• aj r t a i r Iar Is
J r t a rt |t ]i ta|
• st i ta rt s
• t r tt j | a|t j aI| ¡ ¡ .¡ 11 111
• i r Iratrar i a| | t m t rr| a]t
Diagnos is
J t|i r i ta|. | | ¡ | s¡m j It m s It ||t «t 1 | ¡ j art t¡sm s t I tt a ]| i r ar aIt | ri |t t| i |1
J |¡m j | t t¡It si s
J ta |Ia rt t I r ast j | ar¡r ]t a| s«a| t r asj i raIt
J I|a t rt stt r I ar Ii | t 1 ¡ sIai r i r ] t I j | ar¡r ]t a| sj t ti m t r m t sI st r si Ii tt , | | |
Tre atme nt
J sa j j t rIi tt tart i s m ai r sIa¡ t I Irt aIm t r I
J | t sj i Ia|i tt i I j art t¡sm s t I tt a ]| art asst ti aIt 1 «i I| t¡ar t si s ar 1 It r aj r t a
J t r¡I| rt m ¡ti r t ¡ \ 1 a¡s
• i st |aIt a r Ii | ! 1 a¡s t I Irt aIm t r I
• Irt aIm t r I «i || 1 t trt ast i r It tIi ti I¡ | a I r t I t| ar ]t tt a rst
• s| t rIt r s j t ri t 1 t I tt m m a r i ta| i |i I¡
J t| t m t j rt j | ¡|ati s. t r¡I| rt m ¡ti r It r a|| | t a st | t |1 tt r IatIs
| t 1 i aIri ts !1 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
INFECTIOUS DISEASES . . . CONT.
INFECTIOUS MONONUCLEOSIS
J I| t “ ]rt aI i m i IaIt r
J | j sIt i r -| arr ti ra s | | V
J s¡sIt m i t ti ra| i r It tIi t r I| aI aIIt tIs m ar ¡ t r]ar s¡sIt m s
J Irar sm i ssi t r I| rt a ]| sa|i ta - “ |i ssi r ] 1 i st ast ”
Pre s e ntation
J It r si ||ar t ta 1 aIt
J |¡m j | a1 t r t j aI| ¡
J It tt r
J I– ras| - j aI| t ]r t m t r i t ras| «i I| am t ti ti ||i r Iam j i ti ||i r
J I– | t j aIt sj |t r t m t ]a|¡
J ar ¡ -i Ii s, i r t|a 1 i r ] arI| ri Ii s, | t j aIi Ii s, r t j | ri Ii s
Blood Picture
J aI¡j i ta| |¡m j | t t¡It s, |¡m j | t t¡It si s, | t «r t ¡ tt ||s
J ar t m i a
J I| rt m | t t¡It j t r i a
J | t It rt j | i | ar Ii | t 1 ¡ It sI M t r t sj t I It sI r t I st r si Ii tt i r t| i |1 rt r - \ ¡t ars
J | | V Ii Irt s
Tre atme nt
J I| rt aI ta |Ia rt It ra |t t a I sIrt j It tt tta| j | ar¡r ]i Ii s
J | t 1 rt sI, I|a i 1 s, sa|i r t ]ar]|t s It r st rt I| rt aI, att Iam i r t j | t r
J i I ai r«a¡ t | sIra tIi t r , a1 m i I - sIt rt i 1 s
J att i 1 tt r IatI sj t rIs i I t r]ar t m t ]a|¡ j rt st r I
J rt st |tt s t tt r I-1 «t t |s a|I| t a ]| IaIi ]a t m a¡ j t rsi sI
URINARY TRACT INFECTION
J st t | rt |t ]¡ K t It s
J i r r t «| t rr s - m t rt tt m m t r i r m a|t s
J i r t| i |1 rt r - m t rt tt m m t r i r It m a|t s 1 a t It sIrai ]| I s| t rI a rt I| ra
Ris k Factors
J It m a|t aIIt r I ¡t ars , r t a rt ]t r i t | |a1 1 t r, rt I|a t,
| | IratI a| r t rm a|i Ii t s, 1 i a| t It s, i m m a r t tt m j rt m i st 1 , st ta a|
i r It rtt a rst , a r ti rta m ti st 1 m a|t , j t t r | ¡]i t r t
Signs and Symptoms
J r t r -sj t ti Ii t - It tt r, tt m i Ii r ], i rri Ia| i |i I¡
J sj t ti Ii t - 1 ¡sa ri a, I|ar | j ai r
Diagnos is
J M ä | . - ¡ 1
!
tt |t r i t sIm | t I si r ]|t t r]ar i sm 1 | taI| t It r. - ¡ 1
1
tt |t r i t sIm | 1 |
J sa j raj a | i t. ar ¡ ]rt «I|
J a ri r t | & M 1 i a]r t sIi t st r si Ii ti I¡. w| | \1X , | atIt ri a t1X , w| |
| atIt ri a 11X
Tre atme nt
J | ¡1 raIi t r ar 1 ar Ii | i t Ii ts
J I-¡ 1 1 a¡s t ]. ¡ M | Iä M X, am t ti ti ||i r Ij i tam j i ti ||i r , r i Irt Ia rar It i r , ¡ M |
J i I It ti t, ]i tt | V i r i Ii a||¡ am j ]t r IItt IIri att r t Itt It Iati m t
J j rt j | ¡|ati s i I rt I|a t, r t a rt ]t r i t | |a1 1 t r, rt ta rrt r I | ¡ | s - 1 | ¡ | sI¡t ar
J |aIt r i r tt sIi ]aIi t r s
• | Iä ar 1 V| | | - It r ar aIt m i ta| a| r t rm a|i Ii t s, rt I|a t
• rt r a| r a t|t ar star s
J i r 1 i taIi t r s It r i r tt sIi ]aIi t r s. - ¡ ¡t ar t |1 «i I| s¡m j It m aIi t | ¡ | , a||
| t ¡s, a|| It | ri |t | ¡ | s «i I| si ]r i Ii tar I s¡sIt m i t s¡m j It m s
J j rt j | ¡|ati s i I rt I|a t, r t a rt ]t r i t | |a1 1 t r, rt ta rrt r I | ¡ | s - 1 | ¡ | sI¡t ar
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts !¡
K t It s
DERMATOLOGY
COMMON BENIGN NEONATAL CONDITIONS
J tasta |ar i r sIa| i |i I¡ ta Ii s m arm t raIa, j | |t | t tIasi a, atrt t¡ar t si s m a¡
| t r t rm a| j arIi ta |ar|¡ i r j rt m aIa rt i r Iar Is
J tt rr i t tast t sa i s a st II trt am ¡ «| i It |a¡t r «| i t| i s tt m m t r i r
j rt -It rm | a| i t s ar 1 1 i saj j t ars | ¡ It rm , i r tt r IrasI It j t sI-It rm i r
«| i t| j t t |i r ] t I t tIrt m t Ii t s i s tt m m t r
J M t r ]t |i ar sj t Is art | |a i s| | |at| m ata |t s t tt r |t «t r | at| ar 1
| a IIt t|s st t r tt m m t r |¡ i r K t ]rt i 1 , | r 1 i ar ar 1 ksi ar i r Iar Is m a¡
|t t | |i |t | ra i st s
J taj i ||ar¡ | t m ar ]i t m a i s a rai st 1 rt 1 |t si t r «| i t| i r trt ast s i r si tt
aIIt r | i rI| ar 1 ]t r t ra||¡ rt st |tt | t I«t t r ¡ -\ ¡t ars t I a]t
J t r¡I| t m a It ti ta m i s ar t r¡I| t m aIt a s j aj a |ar-tt si ta |ar ras| «| i t| i s
st |I-|i m i It 1
J j a sIa |ar m t |ar t si s i s 1 t Ii r t 1 | ¡ | rt «r m ata |ar | ast «i I| 1 r¡ tt si t|t s
m t rt tt m m t r i r K t ]rt i 1 i r Iar Is
DIAPER DERMATITIS
J 1 i IIt rt r Ii a| 1 i a]r t si s
• ¡ . i rri Iar I tt r IatI 1 t rm aIi Ii s
• I. st | t rr| t i t 1 t rm aIi Ii s
• 1. tar 1 i 1 i asi s
• \. j st ri asi s
Primary Irritant De rmatitis
J i r It rIri ]i r t a s art as r t I i r tt |tt 1 1 i IIt rt r Ii aIt s Irt m tar 1 i 1 a
J t| t m i ta| i rri IaIi t r a ri r t , It tt s – tt r¡ tt m m t r
J st t r i r i r Iar Is «i I| 1 i arr| t a t r | t m t 1 i aj t ri r ]
Tre atme nt
J a st 1 i sj t sa| |t 1 i aj t rs
J ¡ X | ¡1 rt tt rIi st r t trt am
J a st j rt It tIi tt t i r Im t r Is t .]. tast |i r t , ti r t t ti 1 t
SEBORRHEIC DERMATITIS
J a sa a||¡ aj j t ars i r I| t Ii rsI It « 1 a¡s t I |i It
J I| i t| ¡t ||t « ]rt as¡ sta|t
J si It s i r t|a 1 t sta|j tra1 |t taj , t ¡t | rt «s, r t st , 1 i aj t r art a
i r t|a 1 i r ] i r It rIri ]i r t a s art as
J r t r -j ra ri Ii t
J a sa a||¡ | aj j ¡ | a| ¡
Tre atme nt
J sta|t rt m t ta| «i I| t i |s ar 1 j | ¡si ta| m t ar s, Iar s| am j t t s, | ¡1 rt tt rIi st r t
CANDIDA
J rt 1 tt r I|a t r I |t si t r s «i I| “ saIt ||i It |t si t r s
J i r It rIri ]i r t a s art as i r tt |tt 1 1 i sIi r ]a i s| Irt m 1 i aj t r 1 t rm aIi Ii s
J m a¡ | att tt r tt m i Iar I t ra| I| ra s|
Tre atme nt
J It j i ta| ar Ii Ia r ]a|
ITCHY ERUPTIONS IN CHILDHOOD
¡ . kIt j i t 1 t rm aIi Ii s
I. | t r IatI 1 t rm aIi Ii s
1. ä ta| i t s
\. | rIi tari a
!. | i It s m t s| a i It , I|t a
t. | | i t|t r j t t
ATOPIC DERMATITIS (ECZEMA)
J Iam i |¡ | i sIt r¡ j t si Ii tt It r aIt j ¡ asI| m a, a||t r]¡, kä k st r si Ii ti I¡
J I| t st aIIt tIt 1 I| t a ]| I It | att a 1 t trt ast 1 I| rt s| t |1 It r j ra ri Ii s ar 1
It r rt atIi t r It i rri Iar Is
J st ra m | ]| |t tt |s art | i ]| t r i r î1-î!X t I I| t st aIIt tIt 1
| t 1 i aIri ts !I M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
DERMATOLOGY. . . CONT.
Clinical Stage s Location
i r Iar Ii |t 1 m t r I| s It 1 ¡t ars Iatt ar 1 t tIt r st rs t I |t «t r |t ]s
t| i |1 | t t 1 1 ¡t ars It j a | t rI¡ I|t ta ra| art as
a1 a |I j a | t rI¡ t r «ar1 s 1 i IIa st t r Iatt ar 1 t tIrt m i Ii t s
J 1 i a]r t sIi t tri It ri a i r t|a 1 t
• t| aratIt ri sIi ts t I |t si t r s ata It ar 1 t| rt r i t
• It ||t «s I¡j i ta| 1 i sIri | a Ii t r
• t| rt r i t rt |aj si r ] tt a rst
• Iam i |¡ | i sIt r¡ t I aIt j ¡
J ata It |¡. t r¡I| t m a, tt si t|t s, t ta 1 aIt ar 1 tra sIs, j ra ri Ii s
J t| rt r i t. sta|i r ], tt rt si s, |i t| t r i Ii taIi t r ar 1 j i ]m t r I t| ar ]t s
J j rt ]r t si s – aj j rt ti m aIt |¡ I!X | att rt m i ssi t r | ¡ a1 t |t stt r tt
Tre atme nt
J ]t r t ra|. sIrt ss t| rt r i ti I¡ t I i ||r t ss, j rt tt r I straIt| i r ] | ¡ j | ¡si ta| m t ar s
J sj t ti Ii t I| t raj ¡
• It j i ta| sIt rt i 1 s. | ¡1 rt tt rIi st r t ¡ X It Iatt ar 1 It |1 s,
m t 1 i a m sIrt r ]I| t r rt sI t I | t 1 ¡ r t s¡sIt m i t sIt rt i 1 s
• ar Ii | i sIam i r t s art t IIt tIi tt a]ai r sI j ra ri Ii s
• s|i r | ¡1 raIi t r | ¡ tast |i r t aj j |i taIi t r «| i |t «t I
• s|i r | ¡]i t r t It j rt tt r I i r It tIi t r
• att i 1 | ars| st aj s, t| t m i ta|s, j t rIa m t s, «t t |, t It.
J s¡sIt m i t m t 1 i taIi t r
• ar Ii | i sIam i r t s, ar Ii | i t Ii ts «| t r i r It tIt 1
• 1 t r t I a st s¡sIt m i t sIt rt i 1 s
Complications
J st tt r 1 ar¡ i r It tIi t r ä Iaj | , | t rj t s si m j |t t
IMPETIGO
J tt r Ia]i t a s i r It tIi t r | ¡ ä . aureusar 1 | rt a j k ä Irt j
J | t r t ¡-tt |t a rt 1 , tra sIi r ] t rt si t r s - Streptococcus
J m a¡ | att | a ||t a s |t si t r s | a ||t a s i m j t Ii ]t - Staphylococcus
J t tta rs t r t tj t st 1 art as Iatt
J saIt ||i It |t si t r s | ¡ aa It i r t ta |aIi t r
J r t r -j ra ri Ii t
Tre atme nt
J It j i ta| ar Ii | i t Ii ts Ia ti 1 i r I| atIrt | ar
J j t r i ti ||i r , t r¡I| rt m ¡ti r , tt j | a|t ti r
J |t ta| tra sI rt m t ta|
J tart Ia | | ¡]i t r t It j rt tt r I sj rt a1
Complications
J |t ta| tt ||a |i Ii s
J j t sI-sIrt j It tt tta| ]|t m t ra |t r t j | ri Ii s
SCABIES
J tt r¡ i It| ¡ j aj a |t s, | ar 1 ar 1 It t I tt m m t r |¡ i r tt |tt 1
J Irat| m ar|s ä -s| aj t 1 | a rrt «s
J i r Iar Is t r i m m a r t sa j j rt sst 1 j aIi t r Is tar ]t I tt r¡ st tt rt
sta| i t s sj ari r ] t I | t a1 ar 1 r t t| i r a1 a |Is
J m a¡ | att t ttt ri aIi t r s, | t r t ¡-tt |t a rt 1 tra sIs ar 1 j a sIa |t s Irt m st tt r 1 ar¡ i r It tIi t r
Tre atme nt
J j rt m t I| ri r K i t t r ]am m a | t r tt r t | t tat| |t ri 1 t I|i r 1 ar t
J j rt ti j i IaIt 1 sa |Ia r
J Irt aI Iam i |¡ ar 1 tt r IatIs
J ar Ii | i sIam i r t t .]. | ¡1 rt t¡ti r t kIarat t r 1 i j | t r | ¡1 ram i r t | t r a1 r¡|
ERYTHEMA MULTIFORME MINOR (80%)
J ¡ -I tm t r¡I| t m aIt a s j aj a |t s, tt r It r t|t ars It a j a rj a ri t t r t¡ar t Ii t
|t si t r i .t . Iar]t I |t si t r s
J s¡m m t Iri ta|, tt m m t r It 1 t rsa m t I | ar 1 sIIt t I, t || t «s, |r t t s ar 1 Iatt
J m a¡ | att m i |1 m a tt a s m t m | rar t i r tt |tt m t r I
J r t s¡sIt m i t si ]r s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts !1
K t It s
DERMATOLOGY. . . CONT.
Etiology
J i 1 i t j aI| i t m t sI tt m m t r
J i r It tIi t a s – 1 ä V i m j |i taIt 1
J 1 ra ]s
Tre atme nt
J aIIt m j I It i 1 t r Ii I¡ a]t r I, s¡m j It m aIi t
J r t ar Ii | i sIam i r t s, K ä k| | s t r sa|i t¡|aIt s r t tt ssar¡
Prognos is
J st |I-|i m i It 1
ERYTHEMA MULTIFORME MAJOR
(STEVENS-JOHNSON SYNDROME) (20%)
J |t si t r s t I | M m i r t r j |a s | a ||t a s |t si t r «i I| m a tt a s
m t m | rar t i r tt |tt m t r I t ra|, r asa|, tt r }a r tIi ta| ar 1 ]t r i Ia|
J t Ii t |t ]¡. 1 ra ]s sa |Ia, j | t r ¡It i r , j t r i ti ||i r , j | t r t | ar| i Ia|
J m a¡ | att r t r -sj t ti Ii t ti ra| j rt 1 rt m t
J Irt aIm t r I. sa j j t rIi tt -| V I|a i 1 s, ar a|]t si a, t j | I| a|m t |t ]¡ tt r sa |I,
j rt j | ¡|atIi t ar Ii | i t Ii ts, s¡sIt m i t sIt rt i 1 s tt r Irt tt rsi a|
PEDIATRIC EXANTHEMS
Table 20. Pe diatric Exanthe ms
Dis e as e Incubation Infe ctivity Spre ad Clinical S/SX Complications
rt st t |a !-¡ ! 1 a¡s a r |r t «r a r |r t «r | i ]| It tt r It | ri |t st i ta rt s
1 1 V-t, t I| t rs t II | t a rs m i |1 ras| t r
Ira r | aIIt r 1 t It rtt stt r tt ,
sj rt a1 s It r t t|
ra | t ||a ¡ \-I¡ 1 a¡s I 1 a¡s 1 rt j |t I It tt r ar 1 1 1 a¡ arI| ri Ii s,
ra | i ti ra s j rt -ras| ar 1 j i r | 1 t stt r 1 i r ] I| rt m | t t¡It j t r i a
! 1 a¡s j t sI m ata |t j aj a |ar rart , t r tt j | a|i Ii s
ras| , i r i Ii a||¡ rart
1 i strt It .
ä a | -t tti j i Ia|-
|¡m j | a1 t r t j aI| ¡
m t as|t s ¡ 1-¡ \ 1 a¡s \ 1 a¡s 1 rt j |t I It tt r, tt a ]| , st tt r 1 ar¡ | atIt ri a|
m t r| i ||i ti ra s j rt -ras| tt r¡ta, i r It tIi t r , ata It t Ii Ii s
tt r }a tIi ti Ii s m t 1 i a,
t II | t a rs as | rt r t| t j r t a m t r i a,
j rt 1 rt m t , t r tt j | a|i Ii s, ä ä | |
| t j |i |’ s sj t Is, I| t r rt 1
m ata |t j aj a |ar tt r I|a t r I
ras| Iatt It It t I
tari tt ||a ¡ 1-I¡ 1 a¡s ¡ -I 1 a¡s 1 rt j |t I ar 1 j rt 1 rt m t j r t a m t r i a, t r tt j | a|i Ii s,
j rt -ras| a r Ii | 1 i rt tI tt r IatI tari a| |t tt rt | t ||ar aIati a, | ¡ |,
a|| tt si t|t s Irt m r t r t 1 i sst m i r aIi t r ar 1 1 t aI|
| att tra sIt 1 It |t « ]ra1 t i r i m m a r t sa j j rt sst 1 ,
It tt r ar 1 | t rj t s tt sIt r, | t ¡t
m a|ai st , m ata |t j aj a |ar s¡r 1 rt m t
ras| t r Ira r | j rt ]rt sst s
It tt si t|t s, I| t r It tra sIs
m a m j s ¡ I-I! 1 a¡s I 1 a¡s 1 rt j |t I a r i - t r | i |aIt ra| m t r i r ]t t r tt j | a|i Ii s,
j aram ¡tt ti ra s j rt -j art Ii Ii s, j art Ii Ii s j ar trt aIi Ii s, t rt| i Ii s,
I 1 a¡s I– m i |1 rt sj sIt ri |i I¡, |a| ¡ri r I| i Ii s,
j t sI-j art Ii Ii s s¡m j It m s 1 t aIr t ss
t ttasi t r a||¡
a| 1 t m i r a| j ai r
1 a t It j ar trt aIi Ii s
t r¡I| t m a \-¡ \ 1 a¡s a r |r t «r !1 rt j |t I a sa a||¡ r t i r trt ast 1 It Ia| «asIa]t
i r It tIi t sa m j rt 1 rt m a| in utero, aj |asIi t tri si s i r
j artt ti ra s s¡m j It m s, j aIi t r Is «i I| t| rt r i t
sa 1 1 t r | t m t |¡Ii t ar t m i a
aj j t arar tt t I t ]. si t||t tt ||, arI| ri Ii s,
|i ti 1 t r¡I| t m a t r tasta |i Ii s
t| t t |s, j rt ]rt ssi r ]
It m ata t j aj a |ar ras| t r
Ira r | ar 1 t tIrt m i Ii t s, |aIt r
|at¡ aj j t arar tt , 1 a raIi t r
1-! «t t |s
| t 1 i aIri ts !\ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
CARDIOLOGY
HEART MURMURS
J !1-î1X t I t| i |1 rt r | att aa 1 i | |t | t arI m a rm a rs aI st m t j t i r I i r I| t i r |i tt s
J m t sI m a rm a rs art Ia r tIi t r a| i .t . i r r t tt r I «i I| t a I asst ti aIt 1
sIra tIa ra| a| r t rm a|i Ii t s
J m a rm a rs tar | t tt m t aa 1 i | |t t r attt r Ia aIt 1 i r | i ]| t a Ij a I sIaIt s,
t .]. It tt r
Table 21. Diffe re ntiating Innoce nt and Pathological He art Murmurs
Innoce nt Pathological
| i sIt r¡ ar 1 j | ¡si ta| as¡m j It m aIi t s¡m j It m s ar 1 si ]r s
t I tar1 i at 1 i st ast
Ii m i r ] s¡sIt |i t t }t tIi t r m a rm a r a|| 1 i asIt |i t, j ar s¡sIt |i t
t ttt j I tt r t a s | a m t r tt r Ii r a t a s
]ra1 t ≤ IIt - IIt
sj |i IIi r ] j | ¡si t |t ]i t ä I Ii tt 1 sj |i IIi r ] t r
si r ]|t ä I
t tIra st a r 1 sIt|i t|s r t r t j rt st r I
t| ar ]t t I j t si Ii t r m a rm a r tari t s a r t| ar ]t 1
Table 22. Five Innoce nt He art Murmurs
Type De s cription Diffe re ntial Diagnos is
ä Ii ||s m a rm a r ti | raIt r¡, | | ä | t r aj t t sa | at rIi t sIt r t si s, sm a|| Vä |
j a |m t r ar¡ t }t tIi t r st II, | |t «i r ], | | ä | kä | , | ä
tt r t a s | a m i r Irat|ati ta |ar | a m , | | k
tt r Ii r a t a s, | - |
sa j rat|ati ta |ar |t « i r It r si I¡, a| t tt t|ati t|t s kä , | i ta sj i 1 at rIi t ta|tt
arIt ri a| | ra i I
j t ri j | t ra| r t t r aIt s, |t «-j i It| t 1 | | k, | ä
j a |m t r i t sIt r t si s ra1 i aIt s It ati ||a ar 1 | at|
CONGENITAL HEART DISEASE
J îI¡ 111 |i tt | i rI| s, tar j rt st r I «i I| | t arI m a rm a r, | t arI Iai |a rt , t r t¡ar t si s
J i r trt ast 1 ri s|
• m aIt rr a| IatIt rs
• 1 i a| t It s, j | t r ¡||t It r a ri a
• m t 1 i taIi t r , a|tt | t | t r 1 ra ] a st
• i r It tIi t r t .]. ra | t ||a, | M V
• i r Iar I IatIt rs
• j rt m aIa ri I¡ t .]. | | k
• t| rt m t st m a| a| r t rm a|i Ii t s t .]. | t «r s¡r 1 rt m t
• j t si Ii tt Iam i |¡ | i sIt r¡ I-\X ri s| i I si | |i r ] aIIt tIt 1
J m t sI tt m m t r |t si t r . Vä |
J tt r ]t r i Ia| | t arI 1 i st ast tar | t taIt ]t ri tt 1 as.
• | It | s| a r Is. t .]. Vä | , kä | , | | k, t r 1 t tar1 i a| ta s| i t r 1 t It tI
• t¡ar t Ii t t .]. ¡t Ira|t ]¡ t I | a||t I, ¡rar sj t si Ii t r t I | rt aI krIt ri t s ¡ | k
• t | sIra tIi tt |t si t r s. t .]. at rIi t sIt r t si s, j a |m t r i t sIt r t si s,
tt artIaIi t r t I at rIa, | ¡j t j |asIi t |t II | t arI s¡r 1 rt m t
J sa | ata It | atIt ri a| t r 1 t tar1 i Ii s ä | | j rt j | ¡|ati s s| t a |1 | t ]i tt r It
a|| j aIi t r Is «i I| tt r ]t r i Ia| | t arI 1 i st ast t ttt j I I| t st «i I| ar i st |aIt 1
st ta r 1 a m kä | , tt rrt tIt 1 Vä | t r | | k «i I| t a I rt si 1 a a aI ]rt aIt r I| ar
t m t r I| s aIIt r rt j ai r, t r m i Ira| ta|tt j rt |aj st «i I| t a I m i Ira| rt ]a r]i IaIi t r
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts !!
K t It s
CARDIOLOGY. . . CONT.
Figure 7. Common Conge nital He art Dis e as e s
Drawingby Kevin Millar andJacquelyn Shaw
LEFT TO RIGHT SHUNT LESIONS
J t tIra | |t t 1 i s 1 i sj |att 1 I| rt a ]| a tt m m a r i taIi t r Irt m I| t |t II It I| t ri ]| I
si 1 t t I I| t | t arI, rt sa |Ii r ] i r i r trt ast 1 j a |m t r ar¡ | |t t 1 I|t «
J s| a r I tt |a m t 1 t j t r 1 t r I a j t r I| rt t IatIt rs. si tt t I 1 t It tI, j rt ssa rt
]ra1 i t r I | t I«t t r t| am | t rs t r tt sst |s, j t ri j | t ra| t a II|t « rt si sIar tt
J a r Irt aIt 1 s| a r Is tar rt sa |I i r j a |m t r ar¡ tasta |ar 1 i st ast , | V1 , ar 1 | It | s| a r Is
Atrial Se ptal De fe ct (ASD)
J I| rt t I¡j t s
• t sIi a m j ri m a m - tt m m t r i r | t «r s¡r 1 rt m t
• t sIi a m st ta r 1 a m - m t sI tt m m t r I¡j t !1-I1X
• si r a s tt r t sa s - 1 t It tI |t taIt 1 aI t r Ir¡ t I ä V| i r It ri ]| I aIri a m
J t IIt r as¡m j It m aIi t i r t| i |1 | t t 1
J m a rm a r. t IIt r ]ra1 t | | -| | | IV| j a |m t r i t t a II|t « m a rm a r «i I| «i 1 t |¡ sj |i I
ar 1 Ii tt 1 ä I
J | | | . | k| , m i |1 | V1 , | | | |
J | X| . i r trt ast 1 j a |m t r ar¡ tasta |aIa rt
J r aIa ra| | i sIt r¡. î1-¡ 11X sj t r Iar t t a s t|t sa rt raIt i I kä | 1 i am t It r - î m m
J i I rt m ai r s j aIt r I, | 1 | ar 1 j a |m t r ar¡ 1 ¡ K tar 1 t tt |t j i r a1 a |I |i It
J m ar a]t m t r I. t |t tIi tt sa r]i ta| t r taI| t It r t|t sa rt
|t « ri s| j rt tt 1 a rt s | t I«t t r I-! ¡t ars t I a]t
Ve ntricular Se ptal De fe ct (VSD)
J m t sI tt m m t r tt r ]t r i Ia| | t arI 1 t It tI 11-!1X
J sm a|| Vä | m a}t ri I¡
• as¡m j It m aIi t, r t rm a| ]rt «I| ar 1 1 t tt |t j m t r I
• m a rm a r. t ar|¡ s¡sIt |i t It | t |t s¡sIt |i t, | t sI | t ar1 aI | | ä |
• | | | ar 1 | X| art r t rm a|
• m t sI t|t st sj t r Iar t t a s|¡, 1 t t s r t I r t t 1 sa r]i ta| t|t sa rt t tt r
i I rt m ai r s j aIt r I
J m t 1 t raIt It |ar]t Vä |
• 1 t |a¡t 1 ]rt «I| ar 1 1 t tt |t j m t r I, 1 t trt ast 1 t tt rti st
It |t rar tt , rt ta rrt r I | | ¡ | s t r asI| m a t j i st 1 t s, | 1 |
• m a rm a r. | t |t s¡sIt |i t aI | | ä | «i I| I| ri ||, m i 1 -1 i asIt |i t ra m | |t aI aj t t
• | | | . |V1 , | k1 , | V1
• | X| . i r trt ast 1 j a |m t r ar¡ tasta |aIa rt , tar1 i t m t ]a|¡, | 1 |
k | |
|
| |
k. kIri a| ä t j Ia| | t It tI
| . | aIt r I | a tIa s
krIt ri t rsa s
| . ¡rar sj t si Ii t r t I
| rt aI kIt ri t s
| . Vt r Iri ta |ar ä t j Ia|
| t It tI
| . | t artIaIi t r t I I| t
kt rIa
|. ¡t Ira|t ]¡ t I | a||t I
| t 1 i aIri ts !t M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
CARDIOLOGY. . . CONT.
• r aIa ra| | i sIt r¡. st tt r 1 ar¡ j a |m t r ar¡ 1 ¡ K , | 1 | | ¡ I m t r I| s t I a]t
• m ar a]t m t r I. Irt aIm t r I t I | 1 | , sa r]i ta| t|t sa rt
Pate nt Ductus Arte rios us (PDA)
J j aIt r I tt sst | | t I«t t r 1 t stt r 1 i r ] at rIa ar 1 j a |m t r ar¡ arIt r¡
J !-¡ 1X t I a|| tt r ]t r i Ia| | t arI 1 t It tIs
J tt m m t r i r j rt m aIa rt i r Iar Is ¡ I1 t I i r Iar Is - ¡ I!1 ]ram s
J m a¡ | t as¡m j It m aIi t t r | att aj r t i t t r | ra1 ¡tar1 i t sj t ||s, t tt rIi t r a| 1 ¡sj r t a
J asst ti aIt 1 Iat| ¡tar1 i a, | t a r 1 i r ] j a |st s, | ¡j t ratIi tt j rt tt r1 i a m ,
«i 1 t j a |st j rt ssa rt
J m a rm a r. tt r Ii r a t a s m at| i r t r¡ m a rm a r, | t sI | t ar1 aI |t II i r Irat|ati ta |ar art a
J | | | . m a¡ s| t « |V1 , | V1
J | X| . r t rm a| It m i |1 |¡ t r |ar]t 1 | t arI, i r trt ast 1 j a |m t r ar¡ tasta |aIa rt
J 1 i a]r t si s | ¡ t t| t tar1 i t ]raj | ¡
J r aIa ra| | i sIt r¡. sj t r Iar t t a s t|t sa rt tt m m t r i r j rt m aIa rt i r Iar Is,
|t ss tt m m t r i r It rm i r Iar Is
J m ar a]t m t r I. i r 1 t m t I| ati r , sa r]i ta| |i ]aIi t r , t r taI| t It r t|t sa rt
J | i ]| ri s| t I ä | | , ar Ii | i t Ii t j rt j | ¡|ati s rt | a i rt 1 a r Ii | t m t r I| s aIIt r t|t sa rt
Endocardial Cus hion De fe ct
J sj t tIra m Irt m t r 1 t tar1 i a| ta s| i t r Vä | ar 1 t sIi a m j ri m a m kä | It
tt m j |t It kV tar a| «i I| tt m m t r kV ta|tt
J tt m m t r |¡ asst ti aIt 1 «i I| | t «r s¡r 1 rt m t
J r aIa ra| | i sIt r¡ 1 t j t r 1 s t r si tt t I 1 t It tI ar 1 ta|ta |ar i r tt |tt m t r I
J tt m j |t It kV tar a| rt | a i rt t ar|¡ tt m j |t It sa r]i ta| rt j ai r, j rt It ra| |¡
| t It rt 1 m t r I| s t I a]t
CYANOTIC CONGENITAL HEART DISEASE
J s¡sIt m i t tt r t a s rt Ia rr rt -t r It rs s¡sIt m i t ti rta |aIi t r 1 i rt tI|¡
J m t sI j rt m i r t r I It aIa rt i s t¡ar t si s 1 I saI - I!X
J 1 i IIt rt r Ii aIt | t I«t t r tar1 i at ar 1 t I| t r taa st s t I t¡ar t si s «i I| | ¡j t ti a It sI
J sa rti ta| 1 t j t r 1 s t r m i ti r ] ti a s| a r Is t .]. kä | , Vä | , | | k
Trans pos ition of the Gre at Arte rie s
J m t sI tt m m t r tar1 i at |t si t r i r I| t t¡ar t Ii t r t «| t rr
J at rIi t rt t I ari st s ar It ri t r|¡ Irt m I| t ri ]| I tt r Iri t|t ar 1 I| t m ai r
j a |m t r ar¡ arIt r¡ ari st s j t sIt ri t r|¡ Irt m |t II tt r Iri t|t , rt sa |Ii r ] i r
j ara||t | j a |m t r ar¡ ar 1 s¡sIt m i t ti rta |aIi t r s | i ]a rt î
J r t «| t rr j rt st r Is «i I| j rt ]rt ssi tt t¡ar t si s a r rt sj t r si tt It t t¡]t r
I| t raj ¡ as I| t 1 a tIa s arIt ri t sa s t|t st s ar 1 m i ti r ] | t I«t t r I| t I«t
ti rta |aIi t r s 1 i m i r i s| s, st tt rt | ¡j t tt m i a, ati 1 t si s, ar 1 1 t aI| tar
t tta r raj i 1 |¡
J i I Vä | j rt st r I, t¡ar t si s i s r t I j rt m i r t r I, i r Iar I j rt st r Is «i I| | 1 |
aIIt r a It « «t t |s t I |i It
J m a rm a r. r t r t t r ]ra1 t | | IV| ä | M
J | | | . | k| , | V1
J | X| . t ]]-s| aj t 1 | t arI «i I| r arrt « m t 1 i asIi r a m t ]] t r a sIri r ]
J m ar a]t m t r I.
• j rt sIa]|ar 1 i r | ¡ i r Ia si t r It |t t j 1 a tIa s t j t r
• | a||t t r aIri a| st j It sIt m ¡ «i I| taI| t It r
• sa r]i ta| tt rrt tIi t r . arIt ri a| s«i It| j rt tt 1 a rt
| k | k
ä ¡sIt m i t | i rta |aIi t r | V |V | a |m t r ar¡ | i rta |aIi t r
kt rIa | a |m t r ar¡
krIt r¡
Figure 8. Paralle l Circulations of TGA
Te tralogy of Fallot
J ¡ 1X t I a|| tt r ]t r i Ia| | t arI 1 t It tIs, m t sI tt m m t r t¡ar t Ii t | t arI 1 t It tI
| t ¡t r 1 i r Iar t¡
J t m | r¡t |t ]i ta||¡ a si r ]|t 1 t It tI «i I| | ¡j t j |asi a t I I| t tt r a s taa si r ].
• Vä |
• | V t a II|t « IratI t | sIra tIi t r | V1 ¡ 1
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts !I
K t It s
CARDIOLOGY. . . CONT.
• t tt rri 1 i r ] at rIa
• | V1
J 1 i rt tIi t r ar 1 1 t ]rt t t I s| a r I art Ia r tIi t r s t I I| t rt |aIi tt t a II|t « rt si sIar tt
J i r Iar Is m a¡ i r i Ii a||¡ | att a |t II It ri ]| I s| a r I ar 1 I| t rt It rt art r t I
t¡ar t Ii t | a I I| t | V1 ¡ 1 i s j rt ]rt ssi tt , rt sa |Ii r ] i r i r trt asi r ] ri ]| I It
|t II s| a r Ii r ] «i I| | ¡j t tt m i a ar 1 t¡ar t si s
J “ It I” sj t ||s
• taa st 1 | ¡ i r trt ast 1 ri ]| I It |t II s| a r Ii r ] 1 a t It t tt rti st t r
tr¡i r ] «| i t| 1 t trt ast s s¡sIt m i t rt si sIar tt
• j art t¡sm t I raj i 1 ar 1 1 t t j | rt aI| i r ], i rri Ia| i |i I¡ ar 1 tr¡i r ]
• i r trt ast 1 t¡ar t si s ar 1 1 t trt ast 1 i r It r si I¡ t I m a rm a r
• j t a| i r ti 1 t r tt aI I-\ m t r I| s t I a]t
• i I st tt rt m a¡ |t a1 It st i ta rt s, |t ss t I tt r sti t a sr t ss, 1 t aI| rart
• m ar a]t m t r I. t t¡]t r , |r t t -t| t sI j t si Ii t r , m t rj | i r t sa |IaIt , j rt j ar t |t |
J m a rm a r. si r ]|t |t a 1 ä I 1 a t It st tt rt j a |m t r i t sIt r t si s
J | | | . ri ]| I ati s 1 t ti aIi t r , | V1
J | X| . | t t I s| aj t 1 | t arI, 1 t trt ast 1 j a |m t r ar¡ tasta |aIa rt , ri ]| I at rIi t art|
J m ar a]t m t r I. sa r]i ta| rt j ai r i r t|a 1 i r ] t|t sa rt t I Vä | ar 1 «i 1 t r i r ] t I | V1 ¡ 1
Clinical Pe arl
J Characte ris tic Che s t X-Ray Findings in Conge nital He art Dis e as e
Boot-Shape d He art - Te tralogy of Fallot, tricus pid atre s ia
Egg-Shape d He art - Trans pos ition of Gre at Arte rie s
“Snowman” He art - Total Anamolous Pulmonary Ve nous Re turn
OBSTRUCTIVE LESIONS
J j rt st r I «i I| j a||t r, 1 t trt ast 1 a ri r t t a Ij a I, tt t | t tIrt m i Ii t s ar 1 j t t r j a |st s
Coarctation of the Aorta
J r arrt «i r ] t I at rIa a|m t sI a|«a¡s aI I| t |t tt | t I I| t 1 a tIa s arIt ri t sa s
J tt m m t r |¡ asst ti aIt 1 «i I| | i ta sj i 1 at rIi t ta|tt !1X
J i I st tt rt , j rt st r Is «i I| s| t t| i r I| t r t t r aIa| j t ri t 1 «| t r I| t 1 a tIa s t|t st s
J t IIt r as¡m j It m aIi t «i I| a j j t r t tIrt m i I¡ s¡sIt |i t j rt ssa rt s t I ¡ \1-¡ \! m m 1 ]
J «t a| j a |st s, 1 t trt ast 1 | |t t 1 j rt ssa rt i r |t «t r t tIrt m i Ii t s,
ra1 i a|-It m t ra| 1 t |a¡
J i I asst ti aIt 1 «i I| t I| t r |t si t r s t .]. | | k, Vä | , tar taa st | 1 |
J m a rm a r. a| st r I t r s¡sIt |i t «i I| |aIt j t a| aI aj t t, |t II ati ||a, |t II | at|
J m ar a]t m t r I. | a||t t r arIt ri t j |asI¡ t r sa r]i ta| tt rrt tIi t r
J tt m j |i taIi t r s. t sst r Ii a| | ¡j t rIt r si t r
Aortic Ste nos is
J ta|ta |ar I!X , sa | ta|ta |ar I1X , sa j rata|ta |ar ar 1 i 1 i t j aI| i t
| ¡j t rIrt j | i t sa | at rIi t sIt r t si s | 1 ä ä !X
J t IIt r as¡m j It m aIi t | a I m a¡ | t asst ti aIt 1 «i I| | 1 |, t tt rIi t r a| t| t sI
j ai r , s¡r tt j t t r sa 1 1 t r 1 t aI|
J m a rm a r. ä | M aI | | ä | «i I| at rIi t t }t tIi t r t|i t| aI I| t aj t t
J m ar a]t m t r I. sa r]i ta| t r | a||t t r ta|ta |t j |asI¡, rt j t aIt 1 i r It rtt r Ii t r s
ar 1 ta|tt rt j |att m t r I m a¡ | t r t tt ssar¡
J ä | | j rt j | ¡|ati s ar 1 t tt rti st rt sIri tIi t r rt | a i rt 1
Pulmonary Ste nos is
J ta|ta |ar 11X , sa | ta|ta |ar t r sa j rata|ta |ar
J a sa a||¡ j arI t I t I| t r tt r ]t r i Ia| | t arI |t si t r s t .]. ¡t Ira|t ]¡ t I | a||t I
t r i r asst ti aIi t r «i I| t I| t r s¡r 1 rt m t s t .]. tt r ]t r i Ia| ra | t ||a, K t t r ar s¡r 1 rt m t
J tri Ii ta| j a |m t r i t sIt r t si s. i r a1 t | a aIt j a |m t r ar¡ | |t t 1 I|t «,
1 t j t r 1 t r I t r 1 a tIa s It r t t¡]t r aIi t r , j rt ]rt ssi tt | ¡j t ti a ar 1
t¡ar t si s
J j rt st r IaIi t r tari t s Irt m as¡m j It m aIi t It | 1 |
J m a rm a r. «i 1 t sj |i I ä I m ati m a| t r t tj i raIi t r , ä | M aI | | ä | ,
j a |m t r ar¡ t }t tIi t r t|i t|
J | | | . | V1
J | X| . 1 i |aIt 1 j t sIsIt r t Ii t j a |m t r ar¡ arIt r¡
J m ar a]t m t r I. | a||t t r ta|ta |t j |asI¡
Hypoplas tic Le ft He art Syndrome
J a sj t tIra m t I | ¡j t j |asi a t I |t II tt r Iri t|t , aIrt Ii t m i Ira| ar 1 It r at rIi t ta|tt s, sm a||
astt r 1 i r ] at rIa, tt artIaIi t r t I I| t at rIa «i I| rt sa |Iar I s¡sIt m i t | ¡j t j t rIa si t r
J m t sI tt m m t r taa st t I 1 t aI| Irt m tt r ]t r i Ia| | t arI 1 i st ast i r Ii rsI m t r I| t I |i It
J j rt st r Is «i I| ti rta |aIt r¡ s| t t| ar 1 m t Ia| t |i t ati 1 t si s t r t|t sa rt t I I| t 1 a tIa s
| t 1 i aIri ts !î M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
CARDIOLOGY. . . CONT.
J m ar a]t m t r I
• i r Ia | aIt ar 1 tt rrt tI m t Ia| t |i t ati 1 t si s
• | V i r Ia si t r t I | | | ¡ It |t t j 1 a tIa s t j t r
• Irt aIm t r I t j Ii t r s
• sa r]i ta| tt rrt tIi t r t tt ra|| sa rti ta| !1X It |aIt t| i |1 | t t 1
• Irar sj |ar IaIi t r
• r t Irt aIm t r I
CONGESTIVE HEART FAILURE
Etiology
J tt r ]t r i Ia| | t arI 1 t It tIs
J aIt ri t tt r t a s m a|It rm aIi t r s
J tar1 i t m ¡t j aI| ¡
J arr| ¡I| m i as
J ata It | ¡j t rIt r si t r
J ar t m i a
J tt r j a |m t r a|t
Pathophys iology
J st t | ar1 i t |t ]¡ K t It s
Symptoms
J i r Iar I. It t 1 i r ] 1 i IIi ta |Ii t s, t as¡ IaIi ]a| i |i I¡, t tt rIi t r a| 1 ¡sj r t a,
1 i aj | t rt si s «| t r s|t t j i r ] t r t aIi r ], rt sj i raIt r¡ 1 i sIrt ss, tt m i Ii r ],
|t I| ar]¡, t¡ar t si s
J t| i |1 . 1 t trt ast 1 t tt rti st It |t rar tt , IaIi ]a t , 1 t trt ast 1 aj j t Ii It , Iai |a rt It I| ri tt ,
rt sj i raIt r¡ 1 i sIrt ss, s¡r tt j t , Irt | a t r I | | ¡ | s t r asI| m a t j i st 1 t s
J t rI| t j r t a, j art t¡sm a| r t tIa rr a| 1 ¡sj r t a, t 1 t m a art a r tt m m t r i r t| i |1 rt r
Phys ical Findings
J It a r |t ¡ It aIa rt s. tachytar1 i a, tachyj r t a, tar1 i t me galy,
| t j aIt me galy I Iat| ¡’ s, I m t ]a|¡’ s
J Iai |a rt It I| ri tt
J rt sj i raIt r¡ 1 i sIrt ss, «| t t tt , trat||t s, t¡ar t si s ar 1 t|a | | i r ]
J a|It raIi t r s i r j t ri j | t ra| j a |st s, It a r |i m | | |t t 1 j rt ssa rt s
J 1 ¡sm t rj | i t It aIa rt s asst ti aIt 1 «i I| tt r ]t r i Ia| s¡r 1 rt m t s
Manage me nt
J ]t r t ra|. si IIi r ] a j , t t¡]t r , st 1 i a m ar 1 «aIt r rt sIri tIi t r , i r trt ast 1
ta|t ri t i r Ia|t
J j | arm att |t ]i t. 1 i a rt Ii ts, i r t Irt j i t a]t r Is, aIIt r|t a1 rt 1 a tIi t r
J tt rrt tIi t r t I a r 1 t r|¡i r ] taa st
INFECTIVE ENDOCARDITIS
J st t a|st | ar1 i t |t ]¡ K t It s
J ¡ 1-¡ !X t I tast s art ta |Ia rt r t ]aIi tt
J 1 s|t rs r t 1 t s, !ar t «a¡s |t si t r s, sj |i r It r | t m t rr| a]t s art |aIt Ii r 1 i r ]s i r t| i |1 rt r
J ar Ii | i t Ii t j rt j | ¡|ati s It r j rt tt r Ii t r i s r t tt ssar¡ It r a|| j aIi t r Is «i I| .
• tt r ]t r i Ia| | t arI 1 i st ast t ttt j I It r i st |aIt 1 st ta r 1 a m kä |
• r| t a m aIi t ta|tt |t si t r s
• j rt sI| t Ii t | t arI ta|tt s
• sa r]i ta| s| a r Is
• j rt ti t a s t r 1 t tar1 i Ii s
• j att m a|t r |t a1 s
DYSRHYTHMIAS
J st t a|st | ar1 i t |t ]¡ K t It s
J tar | t Irar si t r I t r j t rm ar t r I, tt r ]t r i Ia| sIra tIa ra||¡ r t rm a| t r
a| r t rm a| t r at| a i rt 1 It ti r , i r It tIi t r
Sinus Arrhythmia
J j | asi t tari aIi t r s «i I| rt sj i raIi t r
J | t ar1 i r a|m t sI a|| r t rm a| t| i |1 rt r
Pre mature Atrial Contractions
J m a¡ | t r t rm a| tari ar I t r tar | t taa st 1 | ¡ t |t tIrt |¡It 1 i sIa r| ar tt ,
| ¡j t rI| ¡rt i 1 i sm , tar1 i at sa r]t r¡, 1 i ]i Ia|i s It ti ti I¡
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts !1
K t It s
CARDIOLOGY. . . CONT.
Pre mature Ve ntricular Contractions (PVCs )
J tt m m t r i r a1 t |t stt r Is
J | t r i ]r i I si r ]|t , a r i It rm , 1 i saj j t ar «i I| t tt rti st , r t asst ti aIt 1 sIra tIa ra| |t si t r s
J i I r t I | t r i ]r , m a¡ 1 t ]t r t raIt i r It m t rt st tt rt 1 ¡sr| ¡I| m i as
Suprave ntricular Tachycardia (SVT)
J m t sI Irt | a t r I sa sIai r t 1 1 ¡sarr| ¡I| m i a i r t| i |1 rt r
J r t I |i It I| rt aIt r i r ] | a I tar |t a1 It s¡m j It m s
J taa st 1 | ¡ rt -t r Ir¡ ti a attt sst r¡ tt r r t tIi t r , kV r t 1 t m t sI tt m m t r si It
J t| aratIt ri tt 1 | ¡ a raIt t I ]rt aIt r I| ar I¡ 1 | j m
J Irt aIm t r I. ta]a| m ar t a tt r, a1 t r t si r t , 1 i ]t ti r t ttt j I i r w| w
HEMATOLOGY
APPROACH TO ANEMIA
His tory
J ata It ar t m i a. j t t r t tt rti st It |t rar tt , | t a1 at| t , IaIi ]a t , s¡r tt j t
J t| rt r i t ar t m i a. a sa a||¡ «t || It |t raIt 1
J 1 i t I | i sIt r¡, m i || t ttt ss ––- i rt r 1 t Ii ti t r t¡ ar t m i a
J m t |t r aI| t m aIt t| t ti a ––- | |t t 1 |t ss ––- i rt r 1 t Ii ti t r t¡ ar t m i a
J Iam i |¡ | i sIt r¡ t I t| t |t t¡sIt tIt m ¡ t r sj |t r t tIt m ¡ ––- | t rt 1 i Iar¡
| t m t |¡Ii t 1 i st r1 t r
J t I| r i t t ri ]i r ––- I| a|asst m i a, si t||t tt || ar t m i a
J t tj t sa rt It t ti 1 ar I 1 ra ]s sa |j | a 1 ra ]s ––- | t| | 1 t Ii ti t r t¡
J a r 1 t r|¡i r ] t| rt r i t i ||r t ss rt r a|, | t j aIi t, i r I|am m aIt r¡
J st ti a| | i sIt r¡ ––- |t a1 i r It ti taIi t r i r trt ast 1 i r t |1 t r | t a si r ]
Phys ical Exam
J | t arI raIt , | |t t 1 j rt ssa rt , t rI| t sIaIi t t| ar ]t s
J I|t « m a rm a r, j a||t r, |t tt | t I atIi ti I¡
J }aa r 1 i tt ––- | t m t |¡si s
J j t It t| i at , j a rj a ra ––- | |t t 1 i r ] It r 1 t r t¡
J | t j aIt m t ]a|¡, sj |t r t m t ]a|¡ ––- i r Ii |IraIi tt 1 i st r1 t r
J Iai |a rt It I| ri tt ––- t| rt r i t 1 i st ast , t r]ar Iai |a rt
J sIt t | ––- t tta |I | |t t 1
Table 23. Diffe re ntial Diagnos is of Ane mia
microcytic normocytic
• i rt r 1 t Ii ti t r t¡
- | |t t 1 |t ss t r 1 i t Iar¡ |at|
• I| a|asst m i a Irai I
• t| rt r i t i r I|am m aIi t r
• si 1 t rt | |asIi t ar t m i a
• |t a1 j t i st r i r ]
PHYSIOLOGIC ANEMIA
J t |t taIt 1 | t m t ]|t | i r - ¡ I1 ]I| ar 1 rt Ii ta |t t¡It tt a r I aI | i rI|
rt sa |I t I rt |aIi tt |¡ | ¡j t ti t t r ti rt r m t r I i r a It rt
J aIIt r | i rI| , |t tt |s sIarI It Ia|| 1 a t It s| t rIt r | | | |i It sj ar ,
1 t trt ast 1 | | | j rt 1 a tIi t r , ar 1 i r trt asi r ] | |t t 1 tt |a m t
st tt r 1 ar¡ It ]rt «I|
J |t «t sI |t tt |s aI t-¡ I «t t |s a]t t ar|i t r i r j rt m aIa rt i r Iar Is ,
a| t a I ¡ 11 ]I| , |t tt |s ri st a]ai r aIIt r 1 m t r I| s
J r t Irt aIm t r I rt | a i rt 1 i I as¡m j It m aIi t
IRON DEFICIENCY ANEMIA
J m t sI tt m m t r taa st t I t| i |1 | t t 1 ar t m i a (s e e Colour Atlas E1)
J j rt m aIa rt i r Iar Is aI i r trt ast 1 ri s| - |t « i rt r sIt rt s aI | i rI|
low re ticulocyte count
• | t r t m arrt « i r Ii |IraIi t r
• Irar si t r I t r¡I| rt | |asIt j t r i a
t I t| i |1 | t t 1
• t| rt r i t 1 i st ast
• aj |asIi t tri si s
macrocytic
• It |i t ati 1 1 t Ii ti t r t¡
• ti Iam i r | ¡ I 1 t Ii ti t r t¡
• | ¡j t I| ¡rt i 1 i sm
• |i tt r 1 i st ast
high re ticulocyte count
• | |t t 1 |t ss
• | t m t |¡si s
• t tIri r si t
- ar Ii| t 1 ¡-m t 1 iaIt 1
- Ira]m t r IaIit r . | || , 1 | ä , | t arI ta|tt
• ir Irir sit
- m t m | rar t 1 ist r1 t rs. sj | t rt t¡It sis
- t r t¡m t 1 t Iitit r tit s. | t| |
- | t m t ]|t | ir 1 ist r1 t rs. I| a|asst m ia
| t 1 i aIri ts t1 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
HEMATOLOGY. . . CONT.
Etiology
J 1 i t Iar¡, I¡j i ta||¡ | t I«t t r t-I\ m t r I| s a]t , j arIi ta |ar|¡ i r | t II|t It 1
i r Iar Is rt tt i ti r ] |ar]t tt |a m t s t I tt «s m i ||
J | |t t 1 |t ss t r m a|a| st rj Ii t r
J | t «art i aIrt ]t r i t | |t t 1 |t ss I| rt a ]| rt j t aIt 1 | |t t 1 sam j |i r ]
t sj t ti a||¡ i r r t t r aIt s
J tt «s m i ||Itt «’ s m i ||-| ast 1 It rm a |a m a¡ rt sa |I i r | |t t 1 |t ss ar 1
j rt It i r -|t si r ] t r It rt j aI| ¡ st tt r 1 ar¡ It | | i r I|am m aIi t r
Pre ve ntion
J It r | rt asI-It 1 i r Iar Is aIIt r t m t r I| s, ]i tt i rt r -It rIi Ii t 1 tt rt a|s ar 1
i rt r -ri t| It t 1 s
J i I r t I | rt asI It 1 , ]i tt i rt r -It rIi Ii t 1 It rm a |a Irt m | i rI|
J j rt m aIa rt i r Iar Is s| t a |1 sIarI i rt r sa j j |t m t r Is aI t-î «t t |s t I a]t
ar 1 tt r Ii r a t a r Ii | ¡ ¡t ar t |1
Manage me nt
J 1 t It rm i r t taa st
J t ra| i rt r I| t raj ¡ - | |at| sIt t |s sa ]]t sI tt m j |i ar tt
• sa | }t tIi tt i m j rt tt m t r I i r I\-\î | t a rs
• i r trt ast 1 rt Ii ta |t t¡It tt a r I i r \î-II | t a rs
• i r trt ast 1 | t m t ]|t | i r i r \-11 1 a¡s
• rt j |t Ii t r t I i rt r sIt rt s i r ¡ -1 m t r I| s
SICKLE CELL DISEASE
J 1 t stri | t s s¡r 1 rt m t t I | t m t ]|t | i r ä ä , ä -| ar 1 rart tari ar Is
J i 1 t r Ii Ii taIi t r t I sj t ti Ii t ]t r t I¡j t s i m j t rIar I 1 a t It 1 i IIt rt r tt s i r
Irt | a t r t¡, I¡j t , ar 1 st tt ri I¡ t I t|i r i ta| tt m j |i taIi t r s
Pathophys iology
J rt 1 | |t t 1 tt ||s si t||t «i I| |t « j 1 I, 1 t | ¡1 raIi t r , It tt r, ati 1 t si s
J ata It i r Iratasta |ar si t||i r ] rt sa |Is i r i r IartIi t r t I Ii ssa t
J | t m t |¡si s taa st s t| rt r i t, «t ||-tt m j t r saIt 1 , st tt rt ar t m i a, r t I
rt a Ii r t |¡ Irar sIa si t r 1 t j t r 1 t r I (s e e Colour Atlas E5)
J i r trt ast 1 i r ti 1 t r tt i r | |at|s ar 1 M t 1 i It rrar t ar s
Pre s e ntation
J Irai I —- as¡m j It m aIi t m i trt stt j i t | t m aIa ri a
J 1 i st ast —- aIIt r t-1 m t r I| s a]t «i I| Ia|| i r It Ia| 1 ]| , ar t m i a, }aa r 1 i tt , sj |t r t m t ]a|¡
Type s of Cris e s (us ually have more than 1 cris is by age 1)
J tast -t tt|a si tt tri st s - i r ar ¡ t r]ar , m t sI tt m m t r |¡ i r |t r ] | t r t s t I
arm s ar 1 |t ]s, t| t sI, a| 1 t m t r , | K ä , 1 atI¡|i Ii s s«t ||t r | ar 1 s ar 1
It t I i r ¡t a r ] t| i |1 rt r
J aj |asIi t tri si s - Irar si t r I | | | aj |asi a aIIt r j artt ti ra s | ¡ 1 i r It tIi t r t I
rt 1 tt || j rt ta rst rs i r | t r t m arrt «
J sj |t r i t st | a t sIraIi t r - si t||i r ] i r sj |t t r , |ar]t j t t |i r ] t I | |t t 1 «i I|
ata It Ia|| i r | t m t ]|t | i r , s| t t|
Functional As ple nia
J sj |t r i t 1 ¡sIa r tIi t r as t ar|¡ as \ m t r I| s, a sa a||¡ | ¡ ! ¡t ars
J sa stt j Ii | |t It i r It tIi t r | ¡ t r taj sa |aIt 1 t r]ar i sm s, t sj t ti a||¡
Streptococcus pneumoniae
J rt | a i rt s j rt j | ¡|atIi t t ra| j t r i ti ||i r 1 ai |¡, j r t a m t tt tta| tatti r t , ar 1
i m m t 1 i aIt t ta|a aIi t r t I It tt r
Manage me nt
J ata It
• sa j j t rIi tt ar 1 s¡m j It m aIi t
• I|a i 1 s, ar a|]t si a, t tt| ar ]t Irar sIa si t r s
• t t¡]t r i I rt sj i raIt r¡ 1 i sIrt ss t r t| t sI tri si s
• i r tt r Ii tt sj i rt m t Ir¡
J t| rt r i t
• t ar|¡ a]]rt ssi tt Irt aIm t r I t I i r It tIi t r s, j rt j | ¡|atIi t ar Ii | i t Ii ts
• j r t a m t tt tta|, m t r i r ]t tt tta|, 1 . influenzae, 1 t j aIi Ii s | , ar 1 i r I|a t r ta tatti r t s
• It |aIt sa j j |t m t r IaIi t r
• | ¡1 rt t¡a rt a
• t| rt r i t Irar sIa si t r j rt ]ram i I | i sIt r¡ t I sIrt |t
• ]t r t Ii t tt a r st ||i r ] ar 1 t 1 a taIi t r
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts t¡
K t It s
HEMATOLOGY. . . CONT.
SPHEROCYTOSIS
J rt 1 tt || m t m | rar t 1 i st r1 t r, taa st s a sj | t ri r ] t I rt 1 | |t t 1 tt ||s
«| i t| art rt m t tt 1 | ¡ I| t sj |t t r (s e e Colour Atlas E16)
J ]t r t Ii ts
• aa It st m a| 1 t m i r ar I
• m a¡ | att j t si Ii tt Iam i |¡ | i sIt r¡ | a I | i ]| sj t r Iar t t a s m a IaIi t r raIt
J t|i r i ta| st tt ri I¡ tar rar ]t Irt m «t ||-tt m j t r saIt 1 , m i |1 | t m t |¡Ii t
ar t m i a It st tt rt | t m t |¡Ii t ar t m i a «i I| ]rt «I| Iai |a rt , sj |t r t m t ]a|¡,
ar 1 t| rt r i t Irar sIa si t r rt | a i rt m t r Is i r i r Iar t¡
J m ar a]t m t r I
• sj |t r t tIt m ¡ as r t t 1 t 1
• ]t r t Ii t tt a r st ||i r ]
GLUCOSE-6-PHOSPHATE DEHYDROGENASE
(G6PD) DEFICIENCY
J X-|i r |t 1 rt tt ssi tt , 1 i IIt rt r I tari ar Is t I I| t 1 i st ast
J | i ]| t r j rt ta|t r tt i r M t 1 i It rrar t ar s, | |at|s, 1 ri t r Ia|s
J t r t¡m t 1 t Ii ti t r I rt 1 | |t t 1 tt ||s art a r a| |t It 1 t It r 1 a]ai r sI t ti 1 ar I
sIrt ss i r It tIi t r , 1 ra ]s ar 1 It rm s 1 t i r t | t 1 i t s 1 t r aIa rt 1
| t m t ]|t | i r «| i t| art j | a]t t¡It st 1 | ¡ sj |t r i t m atrt j | a]t s,
trt aIi r ] | i It s t r tt ||s
J j rt st r Is «i I| ata It | t m t |¡Ii t ar t m i a «i I| }aa r 1 i tt ar 1 1 ar| a ri r t
J m ar a]t m t r I. sa j j t rIi tt , | ¡1 raIi t r , Irar sIa si t r , j | t It I| t raj ¡
J j rt tt r Ii t r . att i 1 |r t «r t ti 1 ar Is t .]. Iata | t ar s, kä k, ar Ii m a|ari a|s,
sa |It r am i 1 t s, i r It tIi t r s
BLEEDING DISORDERS st t 1 t m aIt |t ]¡ K t It s
Coagulation De fe cts
J t| aratIt ri tt 1 | ¡ 1 t t j | |t t 1 i r ] i r It }t i r Is ar 1 m a st|t s
J |ar]t sj rt a1 i r ] t tt| ¡m t Ii t |t si t r s ar 1 | t m aIt m a
Plate le t Abnormalitie s
J t| aratIt ri tt 1 | ¡ j t It t| i at , j a rj a ra, | ra i st s, m a tt ta Iar t t a s
| |t t 1 i r ], | |t t 1 i r ] Irt m sa j t rIi ti a| ta Is i .t . t j i Iati s, ]a m | |t t 1 i r ]
m t r t rr| a]i a
Table 23. Clas s ification of Ble e ding Dis orde rs
Me chanis m Example s
| |t t 1 Vt sst |s tasta |i Ii s 1 ä |
| |aIt |t Is |t « j rt 1 a tIi t r 1 ra ]s, m arrt « i r Ii |IraIi t r , |t a |t m i a
| i ]| 1 t sIra tIi t r | ¡ |, i r It tIi t r , 1 ra ]s
| i ]| tt r sa m j Ii t r | | | , ]i ar I | t m ar ]i t m a, | ¡j t rsj |t r i sm
1 ¡sIa r tIi t r a| tw 1 i st ast , 1 ra ]s kä k , a rt m i a
| t a]a |aIi t r | aI| «a¡ Vi Iam i r | 1 t Ii ti t r t¡ | t m t rr| a]i t 1 i st ast t I r t «| t rr
| atIt r V| | | 1 t Ii ti t r t¡ 1 t m t j | i |i a k
| atIt r | X 1 t Ii ti t r t¡ 1 t m t j | i |i a |
a| r t rm a| tw| tt r wi ||t | rar 1 s 1 i st ast
Immune Thrombocytope nia Purpura of Childhood (childhood ITP)
J j t a| a]t . I-t ¡t ars, M = |
J a sa a||¡ It ||t «s ar ata It ti ra| i r It tIi t r , rart |¡ a j rt st r Ii r ] s¡m j It m t I
aa It i m m a r t 1 i st ast t .]. ä | |
J taa st 1 | ¡ ar Ii | t 1 i t s I| aI | i r 1 It j |aIt |t I m t m | rar t s
J sj |t r i t 1 t sIra tIi t r t I ar Ii | t 1 ¡-tt aIt 1 j |aIt |t Is
J I¡j i ta||¡ j rt st r Is ¡ -\ «t t |s aIIt r ti ra| i ||r t ss «i I| sa 1 1 t r t r st I t I
j t It t| i at , j a rj a ra, t j i Iati s i r ar t I| t r«i st «t || t| i |1
J st |I-|i m i It 1 i r t| i |1 rt r , sj t r Iar t t a s rt tt tt r¡ i r î1X t I tast s
J 1 i IIt rt r Ii a| 1 i a]r t si s. 1 ra ]-i r 1 a tt 1 I| rt m | t t¡It j t r i a, 1 | V, |t a |t m i a,
i r It tIi t r ti ra| , ä | |
| t 1 i aIri ts tI M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
HEMATOLOGY. . . CONT.
J t|i r i ta||¡. r t |¡m j | a1 t r t j aI| ¡, r t | t j aIt sj |t r t m t ]a|¡
J |a| s. I| rt m | t t¡It j t r i a «i I| r t rm a| | | | , w| |
J i I aI¡j i ta| j rt st r IaIi t r , 1 t | t r t m arrt « It ra |t t a I |t a |t m i a
J m ar a]t m t r I. tt r si 1 t r j rt 1 r i st r t t r | V| | i I t|i r i ta||¡ | |t t 1 i r ] t r
st tt rt I| rt m | t t¡It j t r i a, sj |t r t tIt m ¡ t r |¡ It r |i It -I| rt aIt r i r ] | |t t 1 i r ]
Ne onatal Thrombocytope nia
J Irar sj |att r Ia| j assa]t t I m aIt rr a| ar Ii j |aIt |t I ar Ii | t 1 i t s
J I«t I¡j t s
• r t t r aIa| a||t i m m a r t I| rt m | t t¡It j t r i a K k| ¡
• m t I| t r m t a r Is i m m a r t rt sj t r st a]ai r sI ar Ii ]t r s
t r It Ia| j |aIt |t Is
• sa sj t tI i r I| rt m | t t¡It j t r i t r t «| t rr «| t i s t I| t r«i st
«t ||, r t rm a| m aIt rr a| j |aIt |t Is, r t | i sIt r¡ t I m aIt rr a|
aa It i m m a r t 1 i st ast t r | ¡ |
• 1 i a]r t si s. m aIt rr a| st ra m «i I| i m m a r t ]|t | a |i r s
rt atIs «i I| IaI| t r t r t| i |1 ’ s j |aIt |t Is
• Irt aIm t r I. Irar sIa si t r t I i r Iar I «i I| «as| t 1 m aIt rr a|
j |aIt |t Is
• r t t r aIa| | ¡ |
• taa st 1 | ¡ ar Ii j |aIt |t I ar Ii | t 1 i t s Irt m m aIt rr a| | ¡ |
• si m i |ar j rt st r IaIi t r It K k| ¡ | a I m a sI 1 i sIi r ]a i s| , i I
i r Iar I i s Irar sIa st 1 «i I| m aIt rr a| j |aIt |t Is, I| t
Irar sIa st 1 j |aIt |t Is «i || a|st | t 1 t sIrt ¡t 1
• Irt aIm t r I. sIt rt i 1 s It m t I| t r t ¡ 1-¡ \ 1 a¡s j ri t r It
1 t |i tt r¡ t r | V| | It m t I| t r 1 t It rt 1 t |i tt r¡ t r It i r Iar I
aIIt r 1 t |i tt r¡
He morrhagic Dis e as e of the Ne wborn
J taa st 1 | ¡ ti Iam i r | 1 t Ii ti t r t¡
J IatIt rs | | , V| | , | X, X art ti Iam i r | -1 t j t r 1 t r I, I| t rt It rt | t I| | ¡ ar 1
| ¡ ¡ art a| r t rm a|
J j rt st r Is aI I-I 1 a¡s t I |i It «i I| ]t r t ra|i tt 1 t tt| ¡m t st s, | |
| t m t rr| a]t , | |t t 1 i r ] Irt m a ti rta m ti si t r t r a m | i |i ta| sIa m j
J j rt tt r Ii t r . ti Iam i r | a1 m i r i sIraIi t r aI | i rI| It a|| r t «| t rr s
He mophilia A: Factor VIII De ficie ncy
J X-|i r |t 1 rt tt ssi tt , ! Ii m t s m t rt tt m m t r I| ar 1 t m t j | i |i a |
J |at| t I IatIt r V| | | 1 t |a¡s It rm aIi t r t I I| rt m | i r «| i t| i s tra ti a| It
It rm i r ] a r t rm a|, Ia r tIi t r a| Ii | ri r t|t I ar 1 st |i 1 i I¡i r ] I| t j |aIt |t I j |a ]
aI art as t I tasta |ar i r }a r¡
J st tt ri I¡ 1 t It rm i r t 1 | ¡ |t tt | t I IatIt r V| | | , st tt ri I¡ t I | |t t 1 s, ar 1
j rt st r tt t I ar Ii | t 1 i t s It IatIt r V| | |
• st tt rt | t m t j | i |i ts - ¡ X IatIt r V| | | | att sj t r Iar t t a s | |t t 1 i r ]
t r | |t t 1 i r ] Irt m m i r t r Iraa m a ar 1 m ar i It sIs i r i r Iar t¡, | a||m ar|.
| t m arI| rt si s
• m i |1 | t m t j | i |i ts - !X IatIt r V| | | | att | |t t 1 i r ] «i I| si ]r i Ii tar I
Iraa m a t .]. sa r]t r¡ ar 1 m a¡ ]t a r 1 i a]r t st 1 It r m ar ¡ ¡t ars
J | | kV| It r m i |1 1 i st ast , IatIt r V| | | rt j |att m t r I
He mophilia B (Chris tmas Dis e as e ): Factor IX De ficie ncy
J X-|i r |t 1 rt tt ssi tt , Irt aIt 1 «i I| IatIt r | X rt j |att m t r I t r j |asm a
J j rt st r IaIi t r sam t as 1 t m t j | i |i a k
von Wille brand's Dis e as e
J 1 t It tI. tari a| |t a| r t rm a|i I¡ i r tt r wi ||t | rar 1 IatIt r tw|
J tw| i s ar a1 | t si tt j rt It i r I| aI | ri 1 ]t s sa | t r 1 t I| t |i a| tt ||a]t r ar 1
j |aIt |t Is, ar 1 j rt It tIs IatIt r V| | | Irt m raj i 1 t|t arar tt
J aa It st m a| 1 t m i r ar I m t rt tt m m t r , m i |1 t r aa It st m a| rt tt ssi tt
rart r, m t rt st tt rt
J j rt st r Is «i I| m a tt ta Iar t t a s | |t t 1 i r ], t j i sIati s, ]i r ]i ta| | |t t 1 i r ],
t tt| ¡m t si s, m t r t rr| a]i a
J a| r t rm a| | ¡ ¡ ar 1 | |t t 1 i r ] Ii m t
J | | kV| It r m i |1 1 i st ast i r trt ast s rt |t ast t I tw| , tr¡t j rt ti j i IaIt
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts t1
K t It s
HEMATOLOGY. . . CONT.
Table 24. Evaluation of the Child with Abnormal Bruis ing/Ble e ding
BT PT PTT VIII:C vWF Plate le ts Fibrinoge n
| t m t j | i |i a k K K 8 9 K K K
| t m t j | i |i a k K K 8 K K K K
tt r wi ||t | rar 1 ’ s 8 K K t r 8 9 9 K K
| | | K t r 8 8 8 9 K 9 9
ti I | 1 t Ii ti t r t¡ K 8 8 K K K K
I| rt m | t t¡It j t r i a 8 K K K K 9 K
| ¡ = | |t t 1 i r ] Ii m t , V| | | .| = IatIt r V| | | tt a]a |ar I atIi ti I¡
J t tIt r si tt | ra i si r ] i r I| t a| st r tt t I |a| a| r t rm a|i It s. tt r si 1 t r t| i |1 a| a st
ONCOLOGY
J tar tt r i s st tt r 1 m t sI tt m m t r taa st t I 1 t aI| i r t| i |1 rt r aIIt r ¡ ¡t ar
t I a]t   ¡ = i r }a ri t s
J a sa a||¡ t tta r sj t ra1 i ta||¡, | a I i r trt ast 1 ri s| «i I|
• r t a rt ta Iar t t a s s¡r 1 rt m t s • t| rt m t st m a| s¡r 1 rt m t s
• i m m a r t 1 t Ii ti t r t¡ s¡r 1 rt m t s • j ri t r m a|i ]r ar t¡
• Iam i |¡ | i sIt r¡
• t tj t sa rt It ra1 i aIi t r , t| t m i ta|s, | i t |t ]i t a]t r Is
J |t a |t m i a I!-1!X ar 1 | rai r Ia m t a rs I1X m t sI tt m m t r
J st m t m a|i ]r ar ti t s m a¡ | t m t rt j rt ta|t r I i r tt rIai r a]t ]rt a j s
• r t «| t rr s. r t a rt | |asIt m a, tt r ]t r i Ia| |t a |t m i a
• i r Iar t¡ ar 1 t| i |1 | t t 1 . |t a |t m i a, r t a rt | |asIt m a, wi |m s’ ,
rt Ii r t | |asIt m a
• a1 t |t stt r tt . |¡m j | t m a, ]t r a1 a| Ia m t a rs, | t r t
LEUKEMIA
J m t sI tt m m t r t| i |1 | t t 1 m a|i ]r ar t¡
J | t It rt ]t r t a s ]rt a j t I 1 i st ast s, I¡j t s. k| | î1X , kM | ¡ !X ar 1 | M | !X
J t Ii t |t ]¡ a r |r t «r , | | V asst ti aIt 1 «i I| kIri tar | a r|i II |¡m j | t m a,
rt Irt ti ra s «i I| ¡ tt || |t a |t m i a
J si ]r s ar 1 s¡m j It m s 1 a t It i r Ii |IraIi t r t I |t a |t m i t tt ||s i r It | t r t m arrt «
| t r t j ai r , ar t m i a, r t a Irt j t r i a, I| rt m | t t¡It j t r i a ar 1 i r It Ii ssa t s
|¡m j | a1 t r t j aI| ¡, | t j aIt sj |t r t m t ]a|¡, | K ä , It sIt s
J j rt ]r t si s. |t «-ri s| - 11X |t r ]-It rm rt m i ssi t r , | i ]| -ri s| - I1X |t r ]-It rm rt m i ssi t r
J st t a|st 1 t m aIt |t ]¡ K t It s
Table 25. Prognos tic Indicators in Childhood Acute
Lymphocytic Le uke mia
Good Poor
a]t I-¡ 1 ¡t ars - I t r - ¡ 1 ¡t ars
t I| r i ti I¡ «| i It | |at|
st t It m a|t m a|t
|¡m j | a1 t r t j aI| ¡ r t ¡t s
| t j aIt sj |t r t m t ]a|¡ r t ¡t s
m t 1 i asIi r a| m ass r t ¡t s
i r i Ii a| w| | - I1 t ¡ 1
1
I| - I1 t ¡ 11I|
| t m t ]|t | i r - ¡ 11 ]I| - ¡ 11 t ]I|
| | 1 |t « | i ]|
|¡m j | t | |asIs I¡j i ta| a r 1 i IIt rt r Ii aIt 1
| ¡j t rj |t i 1 ¡ ¡t s r t
Irar s|t taIi t r r t ¡t s
| t 1 i aIri ts t\ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
ONCOLOGY. . . CONT.
LYMPHOMA
J I| i r1 m t sI tt m m t r t| i |1 | t t 1 Ia m t a r
J 1 t 1 ]|i r ’ s |¡m j | t m a
• t |1 t r t| i |1 rt r a]t - ¡ ! , si m i |ar It a1 a |I 1 t 1 ]|i r ’ s
• j rt st r Is «i I| j ai r |t ss, Ii rm |¡m j | a1 t r t j aI| ¡
• | s¡m j It m s t r |¡ i r 11X t I t| i |1 rt r
J K t r -1 t 1 ]|i r ’ s |¡m j | t m a
• ¡t a r ]t r t| i |1 rt r I-¡ ¡ ¡t ars
• raj i 1 |¡ ]rt «i r ] Ia m t a r «i I| 1 i sIar I m t IasIast s
• si ]r s ar 1 s¡m j It m s rt |aIt 1 It 1 i st ast si It , m t sI tt m m t r |¡
a| 1 t m t r , t| t sI m t 1 i asIi r a| m ass , | t a1 ar 1 r t t| rt ]i t r
J st t a|st 1 t m aIt |t ]¡ K t It s
BRAIN TUMOURS
J j rt 1 t m i r ar I|¡ i r IraIt r It ri a| i r tt |ti r ] tt rt | t ||a m , m i 1 | rai r , | rai r sIt m
J ]|i a| asIrt t¡It m as m t sI tt m m t r t r j ri m i Ii tt r t a rt t tIt 1 t rm a|
m t 1 a ||t | |asIt m a, ]t rm tt || Ia m t a rs, t j t r 1 ¡m t I| t ra
J si ]r s ar 1 s¡m j It m s
• i r IraIt r It ri a|. tt m i Ii r ], m t rr i r ] | t a1 at| t , i r trt ast 1 | t a1 ti rta m It rt r tt ,
aIati a, 1 i j |t j i a, r ¡sIa]m a s, j aj i ||t 1 t m a
• sa j raIt r It ri a|. It ta| 1 t Ii ti Is, st i ta rt , |t r ] IratI si ]r s
J t ta|a aIi t r
• | i sIt r¡, j | ¡si ta| t tam i r t|a 1 i r ] tt m j |t It r t a rt |t ]i ta| t tam
• | ¡ ar 1 It r M | | t I | t a1 as i r 1 i taIt 1
J st t a|st K t a rt sa r]t r¡ K t It s
WILMS’ TUMOUR (NEPHROBLASTOMA)
J m t ar a]t aI 1 i a]r t si s 1-1 ¡ II ¡t ars, M = |
J !X t I a|| t| i |1 | t t 1 tar tt rs
J ¡ I1 | t rt 1 i Iar¡ ar 1 II1 sj t ra1 i t
J asst ti aIt 1 «i I| a r a m | t r t I tt r ]t r i Ia| a| r t rm a|i Ii t s. sj t ra1 i t
ar ri 1 i a t IIt r «i I| ¡ ¡ j ¡ 1 1 t |t Ii t r , | t m i | ¡j t rIrt j | ¡, ]t r i It a ri r ar¡
a| r t rm a|i Ii t s
J j rt st r IaIi t r
• î1X «i I| as¡m j It m aIi t a| 1 t m i r a| m ass
• | ¡j t rIt r si t r , | t m aIa ri a
J 1 i IIt rt r Ii a| 1 i a]r t si s. | ¡1 rt r t j | rt si s, j t |¡t¡sIi t |i 1 r t ¡, rt r a| tt ||
tarti r t m a, r t a rt | |asIt m a, |¡m j | t m a
J m ar a]t m t r I
• r t j | rt tIt m ¡
• sIa]i r ]
• t| t m t I| t raj ¡ j rt - t r j t sI-t j
• ra1 i aIi t r
J ]t r t ra||¡ ]t t 1 j rt ]r t si s
NEUROBLASTOMA
J r t a ra| trt sI tt || Ia m t a r ari si r ] Irt m s¡m j aI| t Ii t Ii ssa t s t I I| t
a1 rt r a| m t 1 a ||a \!X t r I| t s¡m j aI| t Ii t t| ai r I!X rt Irt j t ri It r t a|,
I1X j t sIt ri t r m t 1 i asIi r a|, \X j t |ti s, \X r t t|
J m t sI tt m m t r m a|i ]r ar t¡ i r i r Iar t¡, m t 1 i ar a]t t I t r st I I1 m t r I| s
Pre s e ntation
J a| 1 t m i r a| m ass m t sI tt m m t r , r t t| m ass, t| t sI m ass m a¡ | t
i r ti 1 t r Ia| Ii r 1 i r ] t r t| t sI t-ra¡
J 1 i rt tI t tIt r si t r . sj i r a| tt r1 tt m j rt ssi t r , 1 t rr t r s¡r 1 rt m t
J m t IasIast s.j t ri t r| i Ia| t tt| ¡m t si s, | t r t j ai r , | t j aIt m t ]a|¡,
“ | |a t | t rr¡ m a IIi r ” s|i r r t 1 a |t s
J j arar t t j |asIi t. | ¡j t rIt r si t r , 1 i arr| t a V| | st trt Ii t r , t j st t|t r a s, m ¡t t|t r a s
Diagnos is and Staging
J | | ¡s, rt r a| Ia r tIi t r It sIs, st ra m It rri Ii r
J VM k, 1 Vk a ri r t
J | ¡ star t| t sI, a| 1 t m t r
J | t r t star
J | t r t m arrt « t tam - It r r t a rt | |asIt m a tt ||s i r rt st IIt s
J Ii ssa t | i t j s¡
Manage me nt
J sa r]t r¡, ra1 i aIi t r , t| t m t I| t raj ¡
J I– | t r t m arrt « Irar sj |ar IaIi t r
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts t!
K t It s
ONCOLOGY. . . CONT.
Good Prognos tic Factors
J - ¡ ¡t ar t |1
J It m a|t
J j ri m ar¡ si It - j t sIt ri t r m t 1 i asIi r a m ar 1 r t t|
J sIa]t | , | | , | Vä 1 i st ast
J |t « st ra m It rri Ii r
J VM kI1 Vk raIi t - ¡
J ar t a j |t i 1 ¡
J r t K -m ¡t t r tt ]t r t am j |i Ii taIi t r
RHEUMATOLOGY
EVALUATION OF LIMB PAIN
His tory
J j ai r . t r st I, 1 a raIi t r , |t taIi t r , t| aratIt r, i r It r si I¡, Irt | a t r t¡,
a]]rataIi r ]Ia||t ti aIi r ] IatIt rs, |i m i IaIi t r s i r 1 ai |¡ atIi ti I¡
J Iraa m a, i r }a r¡
J m t rr i r ] sIi IIr t ss, |i m j , s«t ||i r ]Irt 1 r t ss t I }t i r Is
J ]t r t ra|. It tt r, ras| , IaIi ]a t , «t i ]| I |t ss, tt a ]| , t| t sI j ai r , | ai r |t ss
J Iam i |¡ | i sIt r¡. arI| ri Ii s, j st ri asi s, | | | , | |t t 1 i r ] 1 i st r1 t rs
Phys ical Exam
J tt m j |t It j | ¡si ta| t tam
J a|| }t i r Is. i r sj t tIi t r , j a|j aIi t r , rar ]t t I m t Ii t r
J ]ai I, |t ] |t r ]I| 1 i strt j t r t¡
J It r 1 t rr t ss t r It r 1 t r s t r It r 1 t r i r st rIi t r si It s
J m a st|t «t a|r t ss t r aIrt j | ¡
Inve s tigations
J | | | , 1 i IIt rt r Ii a|, sm t ar, | ä |
J X-ra¡s t I j ai r Ia | }t i r IsI|i m | s
J as i r 1 i taIt 1 . kK k, | |, | ¡ ¡, si t||t tt || j rt j , ti ra| st rt |t ]¡,
i m m a r t ]|t | a |i r s, tt m j |t m t r I, a ri r a|¡si s, s¡r t ti a| ar a|¡si s ar 1 ta |Ia rt
Table 26. Diffe re ntial Diagnos is of Limb Pain
Caus e < 3 ye ars 3-10 ye ars > l0 ye ars
Iraa m a t t t
i r It tIi t r
st j Ii t arI| ri Ii s t t t
t sIt t m ¡t |i Ii s t t t
i r I|am m aIt r¡
Irar si t r I s¡r t ti Ii s t
!| k t t t
st rt r t ]aIi tt sj t r 1 ¡|t arI| rt j aI| ¡ t
ä | | t
1 t rm aIt m ¡t si Ii s t
1 t r t t| -ä t| t r |t i r | a rj a ra t
ar aIt m i tIt rI| t j t 1 i t
| t ]]-| a|tt -| t rI| t s 1 i st ast t t
s|i j j t 1 taj i Ia| It m t ra| t j i j | ¡si s t
r t t j |asIi t
|t a |t m i a t t t
r t a rt | |asIt m a t t t
| t r t Ia m t a rs t t
| t m aIt |t ]i t
| t m t j | i |i a t t t
si t||t tt || ar t m i a t t t
j ai r s¡r 1 rt m t s
]rt «i r ] j ai r s t
Ii | rt m ¡a|]i a t
rt I|t t s¡m j aI| t Ii t 1 ¡sIrt j | ¡ t
K t It s
| t 1 i aIri ts tt M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
RHEUMATOLOGY. . . CONT.
GROWING PAINS
J a]t I-¡ I ¡t ars, M = |
J j ai r
• j t t r|¡ |t ta|i tt 1 aIIt tIi r ] s| i r s, rart |¡ ta|tt s
• a sa a||¡ | i |aIt ra|
• t tta rs i r t tt r i r ] t r a«a|t r s t| i |1 aI r i ]| I
• rt sj t r 1 s It rt assa rar tt , m assa]t t r ar a|]t si ts
• rt st |tt s tt m j |t It |¡ i r I| t m t rr i r ]
J r t asst ti aIt 1 s¡sIt m i t s¡m j It m s t .]. It tt r
J r t rm a| j | ¡si ta| t tam i r aIi t r
J |a| i r tt sIi ]aIi t r s r t I r t tt ssar¡ i I I¡j i ta| j rt st r IaIi t r
JUVENILE RHEUMATOID ARTHRITIS (JRA)
J a | t It rt ]t r t a s ]rt a j t I tt r 1 i Ii t r s t| aratIt ri tt 1 | ¡ a j t rsi sIt r I
arI| ri Ii s i r t| i |1 | t t 1
J 1 i a]r t si s
• arI| ri Ii s i r aI |t asI t r t }t i r I
• |asIs It r aI |t asI t «t t |s
• t r st I | t It rt I| t a]t t I ¡ t
• t I| t r taa st s t I arI| ri Ii s t tt|a 1 t 1
J t|assi Ii taIi t r
• 1 t Ii r t 1 | ¡ It aIa rt sIr a m | t r t I }t i r Is aIIt tIt 1 i r I| t Ii rsI
t m t r I| s t I t r st I
• s¡sIt m i t t r st I - It tt r aI t r st I «i I| arI| ri Ii s aj j t ari r ] aIIt r
• j aa ti arIi ta |ar - \ t r |t ss }t i r Is i r tt |tt 1
• j t |¡arIi ta |ar - ! t r m t rt }t i r Is i r tt |tt 1
J j rt ]r t si s. a |Ii m aIt |¡ ]t t 1 , î1X | att ]t t 1 t a Itt m t , «t rsI j rt ]r t si s
«i I| s¡sIt m i t t r st I ar 1 j t |¡arIi ta |ar tt a rst
Table 26. Juve nile Arthritis Clas s ification
Sys te mic Pauciarticular Polyarticular
¡¡j t | ¡¡j t | | | | r t ] | | j t s
st t j rt 1 t m i r ar tt M = | î1X | 11X M 11X | î1X |
a]t t I t r st I ar ¡ - ! - î - ! - î
| | t a m aIt i 1 IatIt r r t ] r t ] r t ] r t ] ¡ 11X
kK k r t ] t1X r t ] I!X I!X
1 | k-| II r t ] r t ] I!X r t ] r t ]
t ¡t i r tt |tt m t r I r t ] I1X r t ] ¡ 1-I1X r t ]
X t I j aIi t r Is I1 11 ¡ ! I! ¡ 1
Sys te mic (Still's Dis e as e )
J | i ]| sj i |i r ] It tt r ≥ 1î.!˚| It r aI |t asI I «t t |s
J t tIra-arIi ta |ar It aIa rt s. t r¡I| t m aIt a s “ sa|m t r -tt |t a rt 1 ”
m ata |t j aj a |ar ras| , |¡m j | a1 t r t j aI| ¡, | t j aIt sj |t r t m t ]a|¡,
|t a |t t¡It si s, I| rt m | t t¡It si s, ar t m i a, st rt si Ii s j t ri tar1 i Ii s, j |t a ri Ii s
J arI| ri Ii s m a¡ t tta r «t t |s It m t r I| s |aIt r
Pauciarticular Type I
J m t sI tt m m t r sa | I¡j t , j t a| a]t I ¡t ars
J a sa a||¡ i r tt |tt s |ar]t }t i r Is. |r t t , ar ||t t r t || t «, rart |¡ s| t a |1 t r t r | i j
J t IIt r rt st |tt s «i I| t a I j t rm ar t r I st | a t |at
J j rt r t It t| rt r i t i ri 1 t t¡t|i Ii s ar 1 a tt i Ii s, «| i t| , i I a r Irt aIt 1 ,
m a¡ |t a1 It j t rm ar t r I ti sa a| 1 am a]t
J s|i I |am j t tam s| t a |1 | t 1 t r t t ar|¡ i r t| i |1 j rt st r Ii r ]
«i I| }t i r I s«t ||i r ] ar 1 I| t r t tt r¡ 1 m t r I| s i I kK k j t si Ii tt
Pauciarticular Type II
J aI t r st I, I| t rt i s ar as¡m m t Iri ta| j t ri j | t ra| arI| ri Ii s a sa a||¡
tt r Ii r t 1 It }t i r Is | t |t « I| t «ai sI | i j , |r t t s, ar ||t s, It t I
J t r I| t si Ii s i r I|am m aIi t r aI It r 1 t r i r st rIi t r si It s t I kt| i ||t s It r 1 t r ,
j aIt ||ar It r 1 t r , j |ar Iar Iasti a
J st rt r t ]aIi tt sj t r 1 ¡|t arI| rt j aI| ¡ m a¡ 1 t tt |t j |aIt r i r |i It
J Iam i |¡ | i sIt r¡ t I sj t r 1 ¡|t arI| rt j aI| ¡, | | | t r j st ri asi s
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts tI
RHEUMATOLOGY. . . CONT.
Polyarticular RF Ne gative
J t IIt r i r tt |tt s sm a|| }t i r Is t I | ar 1 s ar 1 It t I, It m j t rt m ar 1 i | a |ar
}t i r I, sIt rr t t|ati ta |ar }t i r I, 1 i sIa| i r It rj | a|ar ]t a| }t i r Is, tt rti ta| sj i r t
J j aIi t r Is «| t art kK k j t si Ii tt art j rt r t It t| rt r i t a tt i Ii s
Polyarticular RF Pos itive
J si m i |ar It I| t a]]rt ssi tt It rm t I a1 a |I r| t a m aIt i 1 arI| ri Ii s
J st tt rt , raj i 1 |¡ 1 t sIra tIi tt , s¡m m t Iri ta| arI| ri Ii s t I |ar]t ar 1 sm a|| }t i r Is
J asst ti aIt 1 «i I| r| t a m aIt i 1 r t 1 a |t s aI j rt ssa rt j t i r Is t || t «s, |r t t s
J a r rt m i IIi r ] 1 i st ast , j t rsi sIs i r It a1 a |I| t t 1
Manage me nt
J t| i |1 rt r m a¡ tt m j |ai r tt r¡ |i II|t a| t a I I| t i r j ai r ar 1 1 i sa| i |i I¡
J tar 1 t tt |t j tt r IratIa rt s Irt m ]a ar1 i r ] ar 1 1 i sa st rt | a i ri r ] r i ]| I
sj |i r Is ar 1 ai 1 s
J t tt rti st It m ai r Iai r | 1 M ar 1 m a st|t sIrt r ]I|
J m a |Ii 1 i sti j |i r ar¡ aj j rt at| «i I| 1 ¡ I| ¡, st ti a| «t r|, t rI| t j t 1 i ts,
t j | I| a|m t |t ]¡, r| t a m aIt |t ]¡
J | sI |i r t 1 ra ] I| t raj ¡. K ä k| | s r aj rt tt r , i r 1 t m t I| ati r atai |a| |t as
sa sj t r si t r s
J t I| t r t j Ii t r s
• m t I| t Irt taIt
• tt rIi tt sIt rt i 1 s - i r Ira-arIi ta |ar, s¡sIt m i t, t r It j i ta| t ¡t 1 rt j s
• | ¡1 rt t| |t rt | a i r t
• | V ]am m a]|t | a |i r
HENOCH-SCHÖNLEIN PURPURA
J m t sI tt m m t r tasta |i Ii s t I t| i |1 | t t 1
J j t a| i r ti 1 t r tt \-¡ 1 ¡t ars, M - |
J t IIt r | att | i sIt r¡ t I | | ¡ | ¡ -1 «t t |s | t It rt t r st I t I s¡m j It m s
J It aIa rt s
• s|i r . j a|j a| |t , r t r -I| rt m | t t¡It j t r i t j a rj a ra i r |t «t r t tIrt m i Ii t s
ar 1 | a IIt t|s, t 1 t m a, strt Ia| s«t ||i r ]
• }t i r Is. arI| ri Ii sIarI| ra|]i a i r tt |ti r ] |ar]t }t i r Is
• | | . a| 1 t m i r a| j ai r , | | | |t t 1 i r ], i r Ia ssa stt j Ii t r
• rt r a|. | ]k r t j | rt j aI| ¡, | t m aIa ri a, j rt It i r a ri a, | ¡j t rIt r si t r ,
ata It rt r a| Iai |a rt i r - !X , j rt ]rt ssi tt rt r a| Iai |a rt i r ar t I| t r !X
J m ar a]t m t r I
• s¡m j It m aIi t, tt rIi tt sIt rt i 1 s m a¡ rt |i t tt a| 1 t m i r a| j ai r ar 1 t 1 t m a
• m t r i It r It r rt r a| 1 i st ast , m a¡ |asI a It « ¡t ars
J j rt ]r t si s. st |I-|i m i It 1 1 i st ast i r 11X
KAWASAKI DISEASE
J ata It tasta |i Ii s t I a r |r t «r t Ii t |t ]¡
J m t sI tt m m t r taa st t I at| a i rt 1 | t arI 1 i st ast i r t| i |1 rt r
J j t a| a]t - ! ¡t ars, 1 ri t r Ia|s - | |at|s - | aa sasi ar s, M - |
Diagnos tic Crite ria
J It tt r j t rsi sIi r ] ! 1 a¡s t r m t rt ar 1
J \ t I I| t It ||t «i r ] ! It aIa rt s
• | i |aIt ra| r t r j a ra |t r I tt r }a r tIi ti Ii s
• rt 1 Ii ssa rt 1 |i j s, sIra«| t rr¡ It r ]a t , t r¡I| t m a t I t rt j | ar¡r t
• t| ar ]t s t I I| t j t ri j | t ra| t tIrt m i Ii t s
• ata It j | ast . t r¡I| t m a, t 1 t m a t I | ar 1 s ar 1 It t I, ]rt i r j t t |i r ]
• sa | ata It j | ast . j t t |i r ] Irt m Ii j s t I Ii r ]t rs ar 1 It t s
• j t |¡m t rj | t a s ras|
• tt rti ta| |¡m j | a1 t r t j aI| ¡ - ¡ .! tm i r 1 i am t It r
J t tt|a si t r t I t I| t r 1 i st ast s t .]. star|t I It tt r, m t as|t s
J aI¡j i ta| | a«asa|i 1 i st ast . |t ss I| ar ! t I t 1 i a]r t sIi t It aIa rt s | a I
tt rt r ar¡ arIt r¡ i r tt |tt m t r I
As s ociate d Fe ature s
J ar It ri t r a tt i Ii s
J i rri Ia| i |i I¡, ast j Ii t m t r i r ]i Ii s
J 1 i arr| t a, a| 1 t m i r a| j ai r , m i |1 | t j aIi Ii s, ]a|| | |a1 1 t r | ¡1 rt j s
J sIt ri |t j ¡a ri a
J arI| ri Ii s, st rt a s t Ii Ii s m t 1 i a, j r t a m t r i a
J j t ri tar1 i Ii s, m ¡t tar1 i Ii s, arr| ¡I| m i as
| t 1 i aIri ts tî M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
RHEUMATOLOGY. . . CONT.
Complications
J tt rt r ar¡ arIt r¡ tasta |i Ii s «i I| ar t a r¡sm It rm aIi t r 1 a ri r ] sa | ata It j | ast
J t tta rs i r I1-I!X t I a r Irt aIt 1 t| i |1 rt r , \-îX i I rt tt i tt | V| | «i I| i r ¡ 1
1 a¡s t I It tt r t r st I
J ri s| IatIt rs It r tt rt r ar¡ 1 i st ast . m a|t , a]t - ¡ t r - 1 ¡t ars, It tt r - ¡ 1 1 a¡s
J t I I| t st «i I| ar t a r¡m s. !1X t I ar t a r¡sm s rt ]rt ss «i I| i r I ¡t ars, I1X
1 t tt |t j sIt r t si s «i I| ri s| t I M |
J t| i |1 rt r m a¡ | att t r 1 t I| t |i a| 1 ¡sIa r tIi t r «i I| ri s| t I t ar|¡ | k|
Manage me nt
J | V ]am m a]|t | a |i r I ]I|]
J | i ]| ar Ii i r I|am m aIt r¡ 1 t st t I kä k «| i |t It | ri |t
J |t « ar Ii j |aIt |t I 1 t st t I kä k i r sa | ata It j | ast
J It ||t « a j «i I| j t ri t 1 i t I| -t t| t tar1 i t ]ram s
ENDOCRINOLOGY
DIABETES MELLITUS st t | r 1 t tri r t |t ]¡ K t It s
Type I Diabe te s
J i r sa |i r 1 t j t r 1 t r I, m t sI tt m m t r I¡j t i r t| i |1 | t t 1
J j rt ta|t r tt . ¡ i r !11 t| i |1 rt r a r 1 t r ¡ î ¡t ars t I a]t
J t Ii t |t ]¡. ]t r t Ii t j rt 1 i sj t si Ii t r ar 1 t r ti rt r m t r Ia| Iri ]]t r |t a1 i r ] It
aa It i m m a r t 1 t sIra tIi t r t I I| t j ar trt as
J t|assi t j rt st r IaIi t r . j t |¡a ri a, j t |¡1 i j si a, j t |¡j | a]i a, «t i ]| I |t ss,
I!X j rt st r I i r 1 i a| t Ii t |t It ati 1 t si s
J m ar a]t m t r I
• i r sa |i r , | |t t 1 ]|a tt st m t r i It ri r ]
• ¡t a r ] t| i |1 rt r m t rt sa stt j Ii | |t It | K ä 1 am a]t «i I|
| ¡j t ]|¡tt m i a «i I| It «t r | t r t Ii Is Irt m Ii ]| I tt r Irt |,
| t r tt Iar]t I ]|a tt st rar ]t | i ]| t r aI t-¡ I m m t |I|
• i r trt asi r ]|¡ Ii ]| It r tt r Irt | i r t |1 t r t| i |1 rt r , \-î m m t |I|
• 1 i t I, t tt rti st
• t 1 a taIi t r , j s¡t| t st ti a| sa j j t rI
J tt m j |i taIi t r s
• | ¡j t ]|¡tt m i a
• taa st . m i sst 1 I1 t |a¡t 1 m t a|s, t ttt ss i r sa |i r , i r trt ast 1 t tt rti st
• tt m j |i taIi t r s. tt m a, st i ta rt s
• | ¡j t r]|¡tt m i a
• taa st . i r It tIi t r , sIrt ss, 1 i t I-It -i r sa |i r m i sm aIt|
• tt m j |i taIi t r s. ri s| t I 1 i a| t Ii t |t It ati 1 t si s, |t r ]-It rm tt m j |i taIi t r s
• 1 i a| t Ii t |t It ati 1 t si s
• taa st . r t «-t r st I 1 i a| t It s, m i sst 1 i r sa |i r 1 t st s, i r It tIi t r
• tt m j |i taIi t r s. 1 t | ¡1 raIi t r , tt rt | ra| t 1 t m a, 1 t trt ast 1
|t tt | t I tt r sti t a sr t ss
• |t r ]-It rm tt m j |i taIi t r s a sa a||¡ r t I st t r i r t| i |1 | t t 1
• j rt st r I ¡ 1-I1 ¡t ars aIIt r t r st I, rt |aIt 1 It m t Ia| t |i t
tt r Irt | 1 | k¡ t
• rt Ii r t j aI| ¡, r t j | rt j aI| ¡, r t a rt j aI| ¡
HYPOTHYROIDISM
J st t a|st | r 1 t tri r t |t ]¡ K t It s
Conge nital Hypothyroidis m
J i r ti 1 t r tt . ¡ i r \111 | i rI| s
J a sa a||¡ taa st 1 | ¡ 1 ¡s]t r t Ii t a]t r t si s t r t tIt j i t m a|It rm aIi t r t I I| t
I| ¡rt i 1 ]|ar 1
J 1 i a]r t si s I| rt a ]| rt a Ii r t r t t r aIa| strt t r i r ]
J a sa a||¡ as¡m j It m aIi t i r r t t r aIa| j t ri t 1 | a I m a¡ | att .
• j rt |t r ]t 1 }aa r 1 i tt
• tt r sIi j aIi t r
• s|a ]]i s| , tt arst tr¡, |t I| ar]¡, j t t r It t 1 i r ]
• | i ] It r ]a t , tt arst Iati a| It aIa rt s, |ar]t It r It r t ||t , a m | i |i ta| | t rr i a
K t It s
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts t1
ENDOCRINOLOGY. . . CONT.
J j rt ]r t si s
• t ttt ||t r I i I Irt aIm t r I sIarIt 1 «i I| i r ¡ -I m t r I| s t I | i rI|
• i I Irt aIm t r I sIarIt 1 aIIt r 1-t m t r I| s t I a]t m a¡ rt sa |I i r
1 t tt |t j m t r Ia| 1 t |a¡
J m ar a]t m t r I. I| ¡rt ti r t rt j |att m t r I
Acquire d Hypothyroidis m
J m t sI tt m m t r . 1 as| i m t It s I| ¡rt i 1 i Ii s aa It i m m a r t 1 t sIra tIi t r t I I| t I| ¡rt i 1
J si ]r s ar 1 s¡m j It m s si m i |ar It | ¡j t I| ¡rt i 1 i sm i r a1 a |Is, | a I a|st .
• 1 t |a¡t 1 | t r t a]t , 1 t t|i r t i r ]rt «I| tt |t ti I¡, s| t rI sIaIa rt
• j rt tt ti t a s j a | t rI¡
• 1 t t s r t I taa st j t rm ar t r I 1 t tt |t j m t r Ia| 1 t |a¡
HYPERTHYROIDISM st t | r 1 t tri r t |t ]¡ K t It s
Conge nital Hype rthyroidis m
J rt sa |Is Irt m Irar sj |att r Ia| j assa]t t I m aIt rr a| I| ¡rt i 1 sIi m a |aIi r ]
ar Ii | t 1 i t s m t I| t r «i I| | ratt ’ s
J t|i r i ta| m ar i It sIaIi t r s i r I| t r t t r aIt m a¡ | t m as|t 1 | ¡
Irar sj |att r Ia| m aIt rr a| ar Ii I| ¡rt i 1 m t 1 i taIi t r
J j rt st r Is «i I| Iat| ¡tar1 i a «i I| | 1 |, i rri Ia| i |i I¡, trar i t s¡r t sIt si s, j t t r
It t 1 i r ], | ¡ ¡
J sj t r Iar t t a s rt st |a Ii t r | ¡ I-1 m t r I| s t I |i It as ar Ii | t 1 i t s t|t art 1
J m ar a]t m t r I. j rt j ¡|I| i t a rati | a r Ii | ar Ii | t 1 i t s t|t art 1
Grave ’s Dis e as e
J | .M = !.¡ , j t a| i r ti 1 t r tt i r a1 t |t stt r tt
J rt sa |Is Irt m I| ¡rt i 1 sIi m a |aIi r ] ar Ii | t 1 i t s as «i I| a1 a |I | ratt ’ s
J m a¡ t t| i | i I t|assi t si ]r s ar 1 s¡m j It m s t I | ¡j t rI| ¡rt i 1 i sm , | a I a|st .
• j t rst r a|i I¡ t| ar ]t s
• st| t t | 1 i IIi ta |I¡
• m t t 1 i r sIa| i |i I¡
J m ar a]t m t r I si m i |ar It a1 a |Is. ar Ii -I| ¡rt i 1 1 ra ]s j rt j ¡|I| i t a rati | ,
ra1 i t i t 1 i r t rt st rtt 1 It r t |1 t r It t r s, sa r]i ta| I| ¡rt i 1 t tIt m ¡
Clinical Pe arl
J Childre n with a s olitary thyroid nodule re quire prompt
e valuation as 30-40%have carcinoma. Re s t have
ade noma, abs ce s s , cys t or multinodular goite r
NORMAL SEXUAL DEVELOPMENT
J «i 1 t rar ]t t I a]t t I t r st I ar 1 1 t tt |t j m t r I t I j a | t rI¡
J It m a|t s
• a]t 1 - ¡ 1
• st | a t r tt | t ]i r s «i I| | rt asI | a 1 , m t ar a]t aI m t r at| t = ¡ I.î ¡t ars
J m a|t s
• a]t ¡ 1 - ¡ \
• st | a t r tt | t ]i r s «i I| It sIi ta |ar t r |ar]t m t r I
Table 27. Tanne r Staging
fe male male
s tage bre as t pubic hair ge nitalia pubic hair
¡ – – – –
I | a 1 sj arst strt Ia|IIt sIt s sj arst | ai r aI
|a| i a| | ai r t r |ar]t m t r I | ast t I j t r i s
1 si r ]|t tt r It a r | ai r t tt r i r trt ast i r | ai r t tt r
j a | i s |t r ]I| t I j t r i s j a | i s
\ r i j j |t It rm s tt arst Ia rI| t r i r trt ast tt arst
st tt r 1 ar¡ a1 a |I | ai r i r |t r ]I| ar 1 a1 a |I | ai r
m t a r 1 | rt a1 I| t I j t r i s
! a1 a |I si tt t tIt r 1 s It a1 a |I si tt t tIt r 1 s It
ar 1 s| aj t m t 1 i a| I| i ]| ar 1 s| aj t m t 1 i a| I| i ]|
| t 1 i aIri ts I1 M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
ENDOCRINOLOGY. . . CONT.
PRECOCIOUS PUBERTY st t | ¡r t tt |t ]¡ K t It s
J st tt r 1 ar¡ st ta a| 1 t tt |t j m t r I | t It rt î ¡t ars i r ]i r|s, 1 ¡t ars i r | t ¡s
True (Ce ntral) Pre cocious Pube rty
J j rt m aIa rt atIi taIi t r | ¡j t I| a|am i t-j i Ia i Iar¡-]t r a1 a| ati s
J | ¡j t r]t r a1 t Irt j i t | ¡j t r]t r a1 i sm , | t rm t r t |t tt |s as i r r t rm a| j a | t rI¡
J r i r t Ii m t s m t rt tt m m t r i r It m a|t s I| ar m a|t s
J 1 i IIt rt r Ii a| 1 i a]r t si s
• i 1 i t j aI| i t t r tt r sIi Ia Ii t r a| m t sI tt m m t r , t sj t ti a||¡ It m a|t s
• | K ä Ia m t a rs, | am arIt m as, j t sIm t r i r ]i Ii s, i r trt ast 1 | | |, ra1 i t I| t raj ¡
• r t a rt Ii | rt m aIt si s, | ¡j t I| ¡rt i 1 i sm
Pe riphe ral Pre cocious Pube rty
J | ¡j t ]t r a1 t Irt j i t | ¡j t r]t r a1 i sm
J 1 i IIt rt r Ii a| 1 i a]r t si s
• tt r ]t r i Ia| a1 rt r a| | ¡j t rj |asi a, a1 rt r a| r t t j |asm
• It sIi ta |arIt tari ar Ia m t a r
• ]t r a1 t Irt j i r st trt Ii r ] Ia m t a r. | t j aIt | |asIt m a, i r Iratrar i a| It raIt m a
• t tt ]t r t a s sIt rt i 1 a1 m i r i sIraIi t r
Evaluation
J | i sIt r¡. s¡m j It m s t I j a | t rI¡, Iam i |¡ | i sIt r¡ t I j a | t rI¡ t r st I, m t 1 i ta| i ||r t ss
J j | ¡si ta| t tam . ]rt «I| tt |t ti I¡, ¡ar r t r sIa]i r ], r t a rt |t ]i ta| t tam
J | t rm t r t |t tt |s. t sIra1 i t |, It sIt sIt rt r t , | 1 , | ä 1 , ¡ ä 1 , | r | 1 It sI
J | t r t a]t
J tt r si 1 t r | ¡ t r M | | t I | t a1 , a |Irast a r 1 t I a1 rt r a|s, j t |ti s
Manage me nt
J | r | 1 ar a|t ]s, m t 1 rt t¡j rt ]t sIt rt r t
J Irt aI a r 1 t r|¡i r ] taa st
Be nign Pre mature The larche
J i st |aIt 1 | rt asI Ii ssa t 1 t tt |t j m t r I i r ]i r|s a]t t m t r I| s It 1 ¡t ars
J r t t I| t r si ]r s t I j a | t rI¡ t r t ttt ssi tt t sIrt ]t r t IIt tI
J m a¡ | t 1 a t It i r trt ast 1 st r si Ii ti I¡ It t sIrt ]t r t r It m j t rar¡ i r trt ast
i r t sIrt ]t r |t tt |s
J r t rm a| | t r t a]t ar 1 a1 rt r a| ar 1 rt ]t r s
J t ta|a aIt t tt r¡ t-¡ I m t r I| s It t r sa rt r t Ia rI| t r si ]r s t I j a | t rI¡
Is olate d Pre mature Adre narche
J aj j t arar tt t I st tt r 1 ar¡ | ai r | t It rt a]t î i r It m a|t s, a]t 1 i r m a|t s
J rt |aIi tt |¡ tt m m t r , taa st 1 | ¡ j rt m aIa rt i r trt ast i r a1 rt r a| ar 1 rt ]t r s
J j rt st r tt t I t I| t r It aIa rt s t I ti ri |i taIi t r t|i It ra| t r |ar]t m t r I,
a1 tar tt 1 | t r t a]t t r t I| t r si ]r s atr t , raj i 1 ]rt «I| , tt i tt t| ar ]t
rt | a i rt s 1 t Iai |t 1 i r tt sIi ]aIi t r It r j aI| t |t ]i t taa st
J rt assa rar tt , r t Irt aIm t r I rt | a i rt 1
DELAYED PUBERTY
J st t | ¡r t tt |t ]¡ st tIi t r
J a| st r tt t I j a | t rIa| 1 t tt |t j m t r I | ¡ a]t ¡ 1 i r ]i r|s ar 1 a]t ¡ \ i r | t ¡s
J m t rt tt m m t r i r m a|t s
Ce ntral Caus e s
J 1 t |a¡ i r atIi taIi t r t I | ¡j t I| a|am i t-j i Ia i Iar¡-]t r a1 a| ati s
J | ¡j t ]t r a1 t Irt j i t | ¡j t ]t r a1 i sm
J 1 i IIt rt r Ii a| 1 i a]r t si s
• tt r sIi Ia Ii t r a| | t r t a]t 1 t |a¡t 1 – m t sI tt m m t r - 11X
• t| rt r i t 1 i st ast , ar t rt ti a r t rtt sa, m a|r a Iri Ii t r
• j i Ia i Iar¡I| ¡j t I| a|am i t Iai |a rt i 1 i t j aI| i t t r at| a i rt 1
• ]t r t Ii t t .]. | a||m ar ’ s s¡m 1 rt m t
• | ¡j t I| ¡rt 1 i sm
Pe riphe ral Caus e s
J | ¡j t r]t r a1 t Irt j i t | ¡j t ]t r a1 i sm
J 1 i IIt rt r Ii a| 1 i a]r t si s
• ]t r t Ii t t .]. ¡a rr t rs, | |t i r It |It rs
• ]t r a1 a| 1 am a]t – i r It tIi t r , ra1 i aIi t r , Iraa m a
• ]t r a1 a| 1 ¡s]t r t si s
• | t rm t r a| 1 t It tI – ar 1 rt ]t r i r st r si Ii ti I¡, !-rt 1 a tIast 1 t Ii ti t r t¡
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I¡
K t It s
ENDOCRINOLOGY. . . CONT.
Evaluation
J | i sIt r¡. «t i ]| I |t ss, s| t rI sIaIa rt , Iam i |¡ | i sIt r¡ t I j a | t rI¡ t r st I, m t 1 i ta| i ||r t ss
J j | ¡si ta| t tam . ]rt «I| tt |t ti I¡, ¡ar r t r sIa]i r ], r t a rt |t ]i ta| t tam ,
tt m j |t It j | ¡si ta| t tam
J | t rm t r t |t tt |s. t sIra1 i t |, It sIt sIt rt r t , | 1 , | ä 1 , ¡ ä 1 , | r | 1 It sI
J | t r t a]t
J tt r si 1 t r | ¡ t r M | | t I | t a1 , a |Irast a r 1 t I a1 rt r a|s, j t |ti s
J |ar¡t I¡j t i r ]i r|s - 1r1 j t rtt r Ii |t i r | t i ]| I ra |t t a I ¡a rr t rs
Manage me nt
J i 1 t r Ii I¡ ar 1 Irt aI a r 1 t r|¡i r ] taa st
J | t rm t r a| rt j |att m t r I. t¡t|i t t sIra1 i t | ar 1 j rt ]t sIt rt r t It r It m a|t s,
It sIt sIt rt r t It r m a|t s
GENITOURINARY
HEMATURIA
As ymptomatic Micros copic He maturia
J !X t I st| t t | a]t 1 t| i |1 rt r t r si r ]|t It sI | a I - ¡ X t r rt j t aIt 1 It sIi r ]
J a sa a||¡ It a r 1 t r rt a Ii r t strt t r i r ]
J !-¡ 1 | | | s j t r | j I t I tt r Iri Ia ]t 1 a ri r t , 1 i j sIi t|s art tt r¡
st r si Ii tt | a I | att a | i ]| Ia|st j t si Ii tt raIt
J | t r i ]r rt ta rrt r I | t m aIa ri a i r II1 t I tast s
• sj t ra1 i t t r Iam i |i a|
• r t asst ti aIt 1 j rt It i r a ri a
Gros s He maturia
J a j j t r a ri r ar¡ IratI st a rtt
• tt |aIIt a-tt |t a rt 1 a ri r t , tasIs, j rt It i r a ri a, 1 ¡sm t rj | i t | | | s,
asst ti aIt 1 s¡m j It m s i .t . t 1 t m a, att It m i a, 1 ¡ K
J |t «t r a ri r ar¡ IratI st a rtt
• | ri ]| I rt 1 a ri r t , i r i Ii a| ar 1 It rm i r a| sIrt am | t m aIa ri a, t|t Is,
r t rm a| | | | m t rj | t |t ]¡, - Ij rt It i r a ri a, r t tasIs
J tt r¡ |ar]t rt r a| | |t t 1 i r ] tar |t t | |i |t a |t «t r a ri r ar¡ IratI | |t t 1
1 i j sIi t|, m i trt stt j ¡
K t ]aIi tt , r t | | | s | t si Ii tt , | a I r t | | | s | t si Ii tt , | | | s st t r
tt |t a rt 1 a rir t
t .]. | t t Is, |t a1 ,
riIam j ir , a raIt s, 1 t m t ]|t | ir a ria K t | asIs st t r
r iIrt Ia rar It ir , i| a j rt It r ... • ir Iratasta |ar | t m t |¡sis
• ir Iratasta |ar tt a]a |aIit r J | |t t 1 ir ] st a rtt 1 isIa| It
]|t m t ra |a s ar 1 Ia | a |t s
t .]. | ¡ |, r t j | rt |iI| iasis, 1 ä |,
M ¡t ]|t | ir a ria J sit||t tt || 1 ist ast
• r| a| 1 t m ¡t |¡sis J t tt rtist , Iraa m a
J tt a]a |t j aI| ¡
| asIs st t r
|t t | It t 1 ]t t I s|i1 t
J | |t m t ra |ar
• ¡ ¸ ]|t m t ra |t j aI| ¡
|]k r t j | rt j aI| ¡, j t sI-ir It tIit a s r t j | riIis, M | | K
ar Ii-]|t m t ra |ar | M 1 ist ast , | t r i]r Iam i|ia| | t m aIa ria
• I¸ ]|t m t ra |t j aI| ¡ t ]. 1 ä |, ä | |
J ¡a | a |t ir It rsIiIia|
• t .]. k¡ K , ir It rsIiIia| r t j | riIiIis,
j ¡t |t r t j | riIis, | ¡j t rta|tia ria
Figure 13. Caus e s of Gros s He maturia in Childre n
| t 1 i aIri ts II M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GENITOURINARY. . . CONT.
PROTEINURIA
J 1 t Ii r i Ii t r . | a a|i IaIi tt . ¡ t r 1 i |a It , It r tt r tt r IraIt 1 a ri r t sj t ti Ii t
]rati I¡- ¡ .1¡ ! , | a ar Ii IaIi tt . \m ]I|]I| t r Ii m t 1 a ri r t - \1 m ]I|]I| r i s
r t j | rt Ii t rar ]t
J Irar si t r I. 1 a t It It tt r, 1 t | ¡1 raIi t r , t tt rti st , st i ta rt s, sIrt ss
J j t rsi sIt r I
• t rI| t sIaIi t m t rt tt m m t r i r a1 t |t stt r Is
• i r trt ast 1 j |asm a j rt It i r tt r tt r IraIi t r
• ]|t m t ra |ar t .]. r t j | rt Ii t s¡r 1 rt m t , ]|t m t ra |t r t j | ri Ii s
• Ia | a |t i r It rsIi Ii a| t .]. | ar tt r i s s¡r 1 rt m t , k¡ K
• sIra tIa ra| a| r t rm a|i Ii t s t I a ri r ar¡ IratI
t .]. | ¡1 rt r t j | rt si s
HEMOLYTIC UREMIC SYNDROME
J at| a i rt 1 rt r a| i r sa IIi ti t r t¡
J Iri a1 . r t j | rt j aI| ¡, I| rt m | t t¡It j t r i a, m i trt ar ]i t j aI| i t
| t m t |¡Ii t ar t m i a
J m t rt tt m m t r Irt m t m t r I| s It \ ¡t ars t |1
J t Ii t |t ]¡. | . coli It ti r 1 ¡ !I.1 I tt rt It ti r t r ä | i ]t ||a It ti r “ | am | a r]t r
1 i st ast ” taa st s t r 1 t I| t |i a| 1 am a]t
J j rt 1 rt m t t I | |t t 1 ¡ 1 i arr| t a !-I 1 a¡s | t It rt t r st I t I rt r a| i r sa IIi ti t r t¡
J | i sIt r¡ – «t a|r t ss, |t I| ar¡, t |i ]a ri a
J j | ¡si ta| t tam – j a||t r, }aa r 1 i tt | t m t |¡si s , t 1 t m a, j t It t| i at ,
| t j aIt sj |t r t m t ]a|¡, | ¡j t rIt r si t r
J i r tt sIi ]aIi t r s – | | | , j |aIt |t Is, rt Ii ta |t t¡It s, | |t t 1 sm t ar, | t t m | s,
a ri r a|¡si s, rt r a| Ia r tIi t r
J j rt ]r t si s. !-¡ 1X m t rIa|i I¡, ¡ 1-11X |i 1 r t ¡ 1 am a]t
J sa j j t rIi tt Irt aIm t r I, 1 i a|¡si s i I st tt rt , sIt rt i 1 s r t I | t |j Ia |
NEPHRITIC SYNDROME
J ata It , sa | ata It t r t| rt r i t
• | t m aIa ri a «i I| | | | tasIs, j rt It i r a ri a - !1 m ]I|]I1 a¡, r t I
r t j | rt Ii t-rar ]t , | ¡j t rIt r si t r ,
• rt r a| Iai |a rt t |i ]a ri a
J j t sI-sIrt j It tt tta| ]|t m t ra |t r t j | ri Ii s
• m t sI tt m m t r i r t| i |1 rt r , t sj t ti a||¡ i r \-î ¡t ar t |1 s, M - |
• t tta rs ¡ -1 «t t |s It ||t «i r ] | rt a j k | t m t |¡Ii t ä Irt j i r It tIi t r
I| rt aIIi m j t Ii ]t
• 1 i IIa st , j rt |i It raIi tt ]|t m t ra |t r t j | ri Ii s
• 1 i a]r t st 1 | ¡ t |t taIt 1 st ra m ar Ii | t 1 ¡ Ii Irt s a]ai r sI ä Irt j ar Ii ]t r s
• 1!X t I t| i |1 rt r rt tt tt r tt m j |t It |¡ «i I| i r ¡ -I «t t |s
• !-¡ 1X | att j t rsi sIt r I | t m aIa ri a
Table 28. Major Caus e s of Acute Glome rulone phritis
C3 Normal C3
Re nal | t sI-i r It tIi t a s | M K | ]k K t j | rt j aI| ¡
M t m | rar t j rt |i It raIi tt | 1 i t j aI| i t raj i 1 |¡ j rt ]rt ssi tt | M K
¡¡j t ¡ !1-î1X kr Ii | | M 1 i st ast
¡¡j t I - î1X
Sys te mic ä | | | t |¡arIt ri Ii s
ä | | wt ]t r t rs
ä | a r I r t j | ri Ii s | t t 1 j asIa rt s
| r¡t ]|t | a |i r t m i a 1 t r t t| -ä t| t r |t i r
NEPHROTIC SYNDROME
J st tt rt j rt It i r a ri a - !1 m ]I|]I1 a¡, t r - \1 m ]Im
I
I| r
| ¡j t a|| a m i r t m i a - I! ]I| , t 1 t m a, | ¡j t r|i j i 1 t m i a
J | i sIt j aI| t |t ]¡
• m i r i m a| t| ar ]t 1 i st ast ItX
• It ta| st ]m t r Ia| ]|t m t ra |ar st|t rt si s IX
• m t m | rar t a s ]|t m t ra |t r t j | ri Ii s îX
• m t m | rar t j rt |i It raIi tt ]|t m t ra |t r t j | ri Ii s !X
J m i r i m a| t| ar ]t 1 i st ast
• j t a| t tta rrt r tt | t I«t t r I-t ¡t ars t |1
• 11X art sIt rt i 1 -rt sj t r si tt
¨
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I1
K t It s
GENITOURINARY. . . CONT.
J Irt aIm t r I
• sa|I ar 1 «aIt r rt sIri tIi t r
• 1 i a rt Ii ts m a¡ | t rt | a i rt 1
• j rt 1 r i st r t It r î «t t |s, i I r t rt sj t r st , rt r a| | i t j s¡ m a¡ | t rt | a i rt 1
• Irt | a t r I rt |aj st s t r sIt rt i 1 rt si sIar tt m a¡ rt | a i rt
i m m a r t sa j j rt ssar I t¡It It ti t a]t r Is
J t| i |1 rt r «i I| r t j | rt Ii t s¡r 1 rt m t art aI ri s| t I
• i r It tIi t r s j t ri It r i Ii s, tt ||a |i Ii s
• | ¡j t rtt a]a |a| i |i I¡ | | , rt r a| tt i r I| rt m | t si s
• si 1 t t IIt tIs t I 1 ra ]s 1 i a rt Ii ts, sIt rt i 1 s,
i m m a r t sa j j rt ssar Is
• | ¡j t It r si t r , s| t t|, rt r a| Iai |a rt
URINARY TRACT OBSTRUCTION
Pos te rior Ure thral Valve s
J ¡ I!1 111 m t sI tt m m t r t | sIra tIi tt a rt I| ra| |t si t r i r m a|t i r Iar Is
J m a tt sa| It |1 s aI I| t 1 i sIa| j rt sIaIi t a rt I| ra
J j rt st r Is «i I| t | sIra tIi tt s¡m j It m s, | ¡ | , I|ar | m asst s, a ri r ar¡
asti It s i I rt r a| j t |ti s ra j Ia rt s
J r t « 1 t It tIt 1 ar It r aIa||¡. | ¡1 rt r t j | rt si s, j a |m t r ar¡ | ¡j t j |asi a
J 1 i a]r t si s. | Iä , V| | |
J Irt aIm t r I. 1 t sIra tIi t r t I ta|tt s
UPJ Obs truction
J m t sI tt m m t r a rt It ri t a| r t rm a|i I¡ i r t| i |1 rt r
J a sa a||¡ i r | t ¡s, t r I| t |t II ¡ 1-¡ !X | i |aIt ra|
J t Ii t |t ]¡. st ]m t r I t I a rt It r |at|i r ] j t ri sIa|Ii t atIi ti I¡,
tt r ]t r i Ia| r arrt «i r ], m a sta |ar | ar 1 s, t tIt rr a| tt m j rt ssi t r
J 1 i a]r t si s. | Iä , rt r a| star I– Ia rt st m i 1 t
J sa r]i ta| tt rrt tIi t r «i I| ]t t 1 j rt ]r t si s
VESICOURETERAL REFLUX (VR)
J a ri r t I|t «s | at| Irt m I| t | |a1 1 t r i r It I| t a rt It r, |i 1 r t ¡, tt m m t r
J j aI| t j | ¡si t |t ]¡
• m t sI tt m m t r |¡ 1 a t It s| t rI Ia r r t | t I a rt It r i r «a|| t I | |a1 1 t r
• 11-!1X t I I| t st «i I| m ¡t |t m t r i r ]t tt |t s, | ¡ asst ti aIi t r «i I|
r t a rt ]t r i t | |a1 1 t r
• st tt r 1 ar¡ It | |a1 1 t r t | sIra tIi t r
J s¡m j It m s t I
• a ri r ar¡ IratI i r It tIi t r , j ¡t |t r t j | ri Ii s
• rt r a| Iai |a rt | ¡ ¡, a rt m i a, | ¡j t rIt r si t r rart
J 1 i a]r t si s «i I| | Iä , V| | | , It-| M ä k It asst ss rt r a| starri r ]
J ä Ia]i r ] | ¡ V| | |
• | - a rt It rs t r |¡ Ii ||
• | | - a rt It rs ar 1 j t |ti s Ii ||
• | | | - a rt It rs ar 1 j t |ti s Ii ||, st m t 1 i |aIaIi t r
• | V - a rt It rs, j t |ti s ar 1 ta|i tt s Ii ||, si ]r i Ii tar I 1 i |aIaIi t r
• V - a rt It rs, j t |ti s, ar 1 ta|i tt s Ii ||, m a}t r 1 i |aIaIi t r ar 1
It rIa t si I¡
J tt m j |i taIi t r s. j ¡t |t r t j | ri Ii s, rt ta rrt r I | ¡ | , rt I|a t r t j | rt j aI| ¡,
| ¡j t rIt r si t r , t r 1 sIa]t rt r a| 1 i st ast
J m ar a]t m t r I. |t t j a ri r t sIt ri |t It j rt tt r I rt r a| 1 am a]t
• ä Ia]t | -| | | . m t rt I| ar î1X rt st |tt «i I| Ii m t
• t | st rtt «i I| rt j t aI V| | | , | Iä , a ri r t ta |Ia rt s
• m t r i It r rt r a| Ia r tIi t r
• j rt j | ¡|atIi t ar Ii | i t Ii ts ¡ M | Iä M l , r i Irt Ia rar It i r
• ä Ia]t | V ar 1 ]rt aIt r —- sa r]i ta| i r It rtt r Ii t r
GENITAL ABNORMALITIES
Hypos padias
J ¡ .!11 r t «| t rr s
J a rt I| ra| m t aIa s t j t r s t r I| t tt r Ira| si 1 t t I I| t j t r i s,
j rt ti m a| It I| t ]|ar s
J m a¡ | t asst ti aIt 1 «i I| t| t r1 t t tt r Ira| ta rtaIa rt t I j t r i |t s| aII ,
a r 1 t stt r 1 t 1 It sIi t|t s, i r ]a i r a| | t rr i a
J i I st tt rt , 1 i sIi r ]a i s| Irt m am | i ]a t a s ]t r i Ia|i a, ar 1 ra |t
t a I t I| t r | | a| r t rm a|i Ii t s
J 1 t r t I ti rta m ti st , It rt s|i r a st 1 It r sa r]i ta| rt j ai r
| t 1 i aIri ts I\ M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
GENITOURINARY. . . CONT.
Epis padias
J a rt I| ra| m t aIa s t j t r s t r I| t 1 t rsa m t I I| t j t r i s,
aI j t i r Is a|t r ] I| t ]|ar s ar 1 s| aII
Phimos is
J i r a| i |i I¡ It rt IratI j rt j a tt j t rsi sIt r I - 1 ¡t ars t I a]t
J m a¡ | t tt r ]t r i Ia| t r a tt r st | a t r tt t I i r I|am m aIi t r
J i I i I i s st tt rt , rt | a i rt s ti rta m ti si t r t r sa r]i ta| t r |ar]t m t r I t I t j t r i r ]
Cryptorchidis m
J arrt sIt 1 1 t stt r I t I It sIi t|t s i r r aIa ra| j aI| It strt Ia m
j rt j a | i t - t tI i r ]a i r a| ri r ] - i r ]a i r a| tar a| - a| 1 t m i r a|
J tt m m t r 11X i r j rt m i t s, 1-\X t I Ia || It rm | a| i t s
J m t sI 1 t stt r 1 | ¡ 1 m t r I| s, r t sj t r Iar t t a s 1 t stt r I aI - ¡ ¡t ar t |1
J st | a t |at . Iraa m a i r ]a i r a| It sIt s , It rsi t r , m a|i ]r ar t¡ \1t ri s| ,
i r It rIi |i I¡
J 1 i IIt rt r Ii a|. rt IratIi |t , t tIt j i t, aIrt j | i t It sIt s, i r It rst t sIaIt
J a r 1 t stt r 1 t 1 It sIt s. m a¡ j a|j aIt i r i r ]a i r a| tar a| | a I a r a| |t It m i ||
1 t «r i r It strt Ia m
J rt IratIi |t It sIt s. j art r Is m a¡ | att st t r I| t m i r strt Ia m , tar m i ||
I| t m 1 t «r «i I| «arm | ar 1 sI«arm rt t m
J i r tt sIi ]aIi t r s
• 1 | | sIi m a |aIi t r It sI It i r 1 a tt 1 t stt r I, st ra m It sIt sIt rt r t ,
| Iä , | ¡, sa r]i ta| t tj |t raIi t r , |ar¡t I¡j t
J Irt aIm t r I
• t rt| i 1 t j |t t¡ | ¡ a]t I ¡t ars, 1 | | st m t Ii m t s Iri t 1
RESPIROLOGY
UPPER RESPIRATORY TRACT DISEASES
STRIDOR
Common Caus e s of Stridor
J |a m t r . It rt i ]r | t 1 ¡, | ¡j t rIrt j | i t It r si |s t r a1 t r t i 1 s
J rt sj i raIt r¡ «a||. trt a j , t j i ]|t IIi Ii s, | atIt ri a| Irat| t i Ii s, j t sI-i r Ia | aIi t r
t 1 t m aIIraa m a, Irat| t t m a|ati a, sa | ]|t IIi t sIt r t si s
J sa rrt a r 1 i r ] sIra tIa rt s. rt Irt j | ar¡r ]t a| t r j t ri It r si ||ar a| stt ss,
r t t j |asm , tasta |ar ri r ]
CROUP AND EPIGLOTTITIS (s e e Colour Atlas J3 and J4)
st t 1 It |ar¡r ]t |t ]¡ K t It s
Table 29. Croup vs . Epiglottitis
Croup Epiglottitis
j rt ta|t r tt tt r¡ tt m m t r tt r¡ rart 1 t trt ast 1 si r tt a st t I 1 i | tatti r t
tt m m t r a]t r Is | arai r I|a t r ta | , | | , | | | H.influenzaI¡j t |
| ä V, t r It rt ti ra s
a]t 1 m t r I| s-1 ¡t ars 1-I ¡t ars
t r st I | | | j rt 1 rt m t raj i 1 t r st I
j | ¡si ta| t tam | ar|i r ] tt a ]| , sIri 1 t r, | a i t I sIri 1 t r, It ti t,
r t r -It ti t rt sj i raIt r¡ 1 i sIrt ss,
1| ’ s. 1 rt t |i r ], 1 ¡sj | a]i a, 1 ¡sj | t r i a
It tt r - 11˚| - 11˚|
w| | r t rm a| t |t taIt 1
t-ra¡ sIt t j |t si ]r I| a m | j ri r I si ]r
Irat| t a| r arrt «i r ] s«t ||t r t j i ]|t IIi s
Irt aIm t r I | a m i 1 i Ii t 1 ai r i r Ia | aIt Itt r Ii |aIt
t t¡]t r i I | ¡j t ti t ar Ii | i t Ii ts. tt Ia rt ti m t
ratt m i t t j i r t j | ri r t
1 t tam t I| ast r t
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I!
K t It s
RESPIROLOGY. . . CONT.
FOREIGN BODY ASPIRATION
J ata It . sa 1 1 t r t r st I t I t| t |i r ], sIri 1 t r, «| t t ti r ], tt a ]| , rt sj i raIt r¡ 1 i sIrt ss
J t| rt r i t. j t rsi sIt r I, |t ta|i tt 1 aIt |t tIasi s i r |a r ], rt ta rrt r I j r t a m t r i a
Diagnos is
J | i sIt r¡. t| t |i r ] sj t || rt tt r I t r rt m t It
J t| t sI t-ra¡. | i |aIt ra| 1 t ta | i Ia s Ii |m s m a¡ s| t « ai r Iraj j i r ], It rt i ]r
| t 1 ¡, t r st ]m t r Ia| tt ||aj st (s e e Colour Atlas J6)
J | rt r t| t stt j ¡. ti sa a|i tt t | sIra tIi t r
Manage me nt
J tt m j |t It t | sIra tIi t r . 1 t i m |i t| m ar t a tt r t r a|It rr aIi r ] | at| | |t «s
ar 1 t| t sI I| ra sIs It r i r Iar Is - ¡ ¡t ar t |1
J i I a r a| |t It t tj t | It rt i ]r | t 1 ¡. 1 i rt tI |ar¡r ]t stt j ¡ ar 1 rt m t ta|,
i r Ia | aIi t r t r t m t r]t r t¡ Irat| t t It m ¡
LOWER RESPIRATORY TRACT DISEASES
WHEEZING
Diffe re ntial Diagnos is of Whe e zing
J asI| m a. rt ta rrt r I «| t t ti r ] t j i st 1 t s
J j r t a m t r i a. It tt r, tt a ]| , m a|ai st
J | rt r t| i t |i Ii s. Ii rsI t j i st 1 t t I «| t t ti r ] st t | rt r t| i t |i Ii s ä t tIi t r
J | | . j rt |t r ]t 1 «| t t ti r ] a r rt sj t r si tt It I| t raj ¡
J It rt i ]r | t 1 ¡ asj i raIi t r . sa 1 1 t r t r st I «| t t ti r ] ar 1 tt a ]| i r ]
J ]asIrt t st j | a]t a| rt I|a t «i I| asj i raIi t r . It t 1 i r ] 1 i IIi ta |Ii t s
J tt r ]t sIi tt | t arI Iai |a rt . asst ti aIt 1 | ¡ ¡
BRONCHIOLITIS
J j rt st r Is as Ii rsI t j i st 1 t t I «| t t ti r ] asst ti aIt 1 «i I| | | | ar 1 si ]r s t I
rt sj i raIt r¡ 1 i sIrt ss
J tt m m t r , aIIt tIs ¡ !X t I t| i |1 rt r i r Ii rsI I ¡t ars t I |i It
J j t a| i r ti 1 t r tt aI t m t r I| s, t IIt r i r |aIt Ia|| ar 1 «i r It r
J t tta rs i r t| i |1 rt r j rt r t It ai r«a¡ rt atIi ti I¡, i .t . i r trt ast 1
i r ti 1 t r tt t I asI| m a
Etiology
J | ä V I!X
J | arai r I|a t r ta, | r I|a t r ta, k1 t r t ti ra s
Clinical Fe ature s
J j rt 1 rt m t t I | | | «i I| tt a ]| ar 1 It tt r
J It t 1 i r ] 1 i IIi ta |Ii t s, i rri Ia| i |i I¡
J «| t t ti r ], rt sj i raIt r¡ 1 i sIrt ss, Iat| ¡j r t a, Iat| ¡tar1 i a
J t| i |1 rt r «i I| t| rt r i t |a r ] 1 i st ast , st tt rt | 1 | ar 1
i m m a r t 1 t Ii ti t r t¡ | att a m t rt st tt rt tt a rst t I I| t i ||r t ss
Diagnos is
J t| t sI t-ra¡
• ai r Iraj j i r ], j t ri | rt r t| i a| I| i t|t r i r ], aIt |t tIasi s, i r trt ast 1
|i r t ar m ar|i r ]s
J r ast j | ar¡r ]t a| s«a|
• 1 i rt tI 1 t It tIi t r t I ti ra| ar Ii ]t r i m m a r t I|a t rt stt r tt
Manage me nt
J m i |1 1 i sIrt ss
• sa j j t rIi tt . t ra| t r | V | ¡1 raIi t r , ar Ii j ¡rt Ii ts It r It tt r
• | a m i 1 i Ii t 1 t t¡]t r ar 1 It r i r | a|t 1 | rt r t| t 1 i |aIt r Vt r It |i r
J m t 1 t raIt It st tt rt 1 i sIrt ss
• | a m i 1 i Ii t 1 t t¡]t r
• i r | a|t 1 | rt r t| t 1 i |aIt r Vt r It |i r t r ratt m i t t j i r t j | ri r t
• tt r Ii r a t t r |¡ i I t IIt tIi tt
• kIrt tt r I ar 1 sIt rt i 1 s art r t I t IIt tIi tt
• rart |¡ i r Ia | aIi t r ar 1 tt r Ii |aIi t r
• tt r si 1 t r ri | ati ri r i r | i ]| ri s| ]rt a j s. | | | , | 1 | , tt r ]t r i Ia| |a r ]
1 i st ast , i m m a r t 1 t Ii ti t r I
• tast IaIa|i I¡ raIt - ¡ X
| t 1 i aIri ts It M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
RESPIROLOGY. . . CONT.
J i r 1 i taIi t r s It r | t sj i Ia|i taIi t r
• | ¡j t ti a. t t¡]t r saIa raIi t r - 1IX
• j t rsi sIt r I rt sIi r ] Iat| ¡j r t a - t1Im i r a It ar 1 rt IratIi t r s aIIt r
st tt ra| Vt r It |i r m as|s
• j asI | i sIt r¡ t I t| rt r i t |a r ] 1 i st ast , | t m t 1 ¡r am i ta||¡
si ]r i Ii tar I tar1 i at 1 i st ast , r t a rt m a sta |ar j rt | |t m ,
i m m a r t tt m j rt m i st
• ¡t a r ] i r Iar Is - 1 m t r I| s t |1 a r |t ss t tIrt m t |¡ m i |1
• si ]r i Ii tar I It t 1 i r ] j rt | |t m s
• st ti a| j rt | |t m , i .t . i r a1 t | a aIt tart aI | t m t
PNEUMONIA
Clinical Fe ature s
J i r ti 1 t r tt i s ]rt aIt sI i r Ii rsI ¡t ar t I |i It
J It tt r, tt a ]| , trat||t s
J Iat| ¡j r t a, Iat| ¡tar1 i a, rt sj i raIt r¡ 1 i sIrt ss
J | atIt ri a| taa st | as m t rt ata It t r st I, | a I ti ra| taa st i s m t rt tt m m t r
J a| r t rm a| t| t sI t-ra¡
Etiology
Table 30. Common Caus e s of Pne umonia at Diffe re nt Age s
Age Bacte rial Viral Othe rs
r t t r aIt s | rt a j | sIrt j It tt tta s | M V Mycoplasma
| . Coli 1 t rj t s ti ra s Ureaplasma
¡ -1 m t r I| s ä . aureus | M V, | ä V Chlamydia trachomatis
1 . influenzae | r I|a t r ta ti ra s Ureaplasma
ä . pneumoniae | arai r I|a t r ta ti ra s
1 m t r I| s - ä . pneumoniae | ä V ¡ |
! ¡t ars ä . aureus k1 t r t ti ra s
1 . influenzae | r I|a t r ta ti ra s
- ! ¡t ars ä . pneumoniae | r I|a t r ta ti ra s Mycoplasma pneumonia m t sI tt m m t r
1 . influenzae Chamydia pneumonia
¡ |
Manage me nt
J sa j j t rIi tt Irt aIm t r I. | ¡1 raIi t r , ar Ii j ¡rt Ii ts, | a m i 1 i Ii t 1 t t¡]t r
J | V t r | 1 ar Ii | i t Ii ts
• r t «| t rr
• am j i ti ||i r ar 1 ]t r Iam i ti r I– t r¡I| rt m ¡ti r
• ¡ -1 m t r I| s
• am j i ti ||i r I– t r¡I| rt m ¡ti r
• 1 m t r I| s - ! ¡t ars
• si t|. | V am j i ti ||i r
• r t I si t|. | 1 am t ti ti ||i r
• - ! ¡t ars
• t r¡I| rt m ¡ti r
ASTHMA
J t| aratIt ri tt 1 | ¡ ai r«a¡ | ¡j t rrt atIi ti I¡, | rt r t| t sj asm ar 1
i r I|am m aIi t r , rt tt rsi | |t sm a|| ai r«a¡ t | sIra tIi t r
J tt r¡ tt m m t r i ||r t ss «| i t| j rt st r Is m t sI t IIt r i r t ar|¡ t| i |1 | t t 1
J asst ti aIt 1 «i I| t I| t r aIt j i t 1 i st ast s sa t| as a||t r]i t r| i r i Ii s t r t ttt m a
Clinical Fe ature s
J t j i st 1 i t | t a Is t I
• «| t t ti r ]
• tt a ]| . aI r i ]| I, t ar|¡ m t rr i r ], «i I| atIi ti I¡
• Iat| ¡j r t a
• 1 ¡sj r t a
• Iat| ¡tar1 i a
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts II
K t It s
RESPIROLOGY. . . CONT.
Trigge rs
J | | | ti ra| t r Mycoplasma
J «t aI| t r tt |1 t tj t sa rt , | a m i 1 i I¡ t| ar ]t s
J a||t r]t r s j t Is , i rri Iar Is sm t |t , tt |1 1 r¡ ai r
J t tt rti st , t m t Ii t r a| sIrt ss
J 1 ra ]s asj i ri r , â-| |t t|t rs
Clas s ification
J m i |1 asI| m a
• t ttasi t r a| aIIat|s t I «| t t ti r ] t r tt a ]| i r ] - I j t r «t t |
• s¡m j It m s rt sj t r 1 | a i t||¡ It i r | a|aIi t r I| t raj ¡
J m t 1 t raIt asI| m a
• m t rt Irt | a t r I t j i st 1 t s «i I| s¡m j It m s j t rsi sIi r ] ar 1
t| rt r i t tt a ]|
• 1 t trt ast 1 t tt rti st It |t rar tt
J st tt rt asI| m a
• 1 ai |¡ ar 1 r t tIa rr a| s¡m j It m s
• Irt | a t r I | | ti si Is ar 1 | t sj i Ia|i taIi t r s
Manage me nt
J ata It
• t t¡]t r . It |t t j t t¡]t r saIa raIi t r - 1IX
• I|a i 1 s. i I 1 t | ¡1 raIt 1
• âI-a]t r i sIs. sa|| a Iam t | Vt r It |i r 1.11ttI|] i r 1tt K ä | I1
m i r a It s | ¡ m as| a r Ii | i m j rt tt m t r I, I| t r m as|s | | t a r|¡
• i j aIrt j i a m | rt m i 1 t kIrt tt r I i I st tt rt . ¡ tt a1 1 t 1 It
Vt r It |i r m as|
• sIt rt i 1 s. | rt 1 r i st r t Im ]I|] i r | | , I| t r ¡ m ]I|] j t t 1 t \
1 a¡s
• i r st tt rt 1 i st ast , ]i tt sIt rt i 1 s i m m t 1 i aIt |¡
si r tt t r st I t I atIi t r i s s|t « \ | t a rs
J i r 1 i taIi t r s It r | t sj i Ia|i taIi t r
• i r i Ii a| t t¡]t r saIa raIi t r - 1IX
• j asI | i sIt r¡ t I |i It -I| rt aIt r i r ] asI| m a | | | a1 m i ssi t r
• j t t r rt sj t r st It !-t Irt | a t r I 1 t st s t I Vt r It |i r
• tt r tt rr t tt r t r ti rt r m t r Ia| i ssa t s t r Iam i |¡’ s a| i |i I¡ It tt j t
J t| rt r i t
• t 1 a taIi t r , t m t Ii t r a| sa j j t rI, m t 1 i Ii taIi t r t I
t r ti rt r m t r Ia| a||t r]i t s t r i rri Iar Is t .]. ti ]art IIt sm t |t
• t tt rti st j rt ]ram t .]. s«i m m i r ]
• m t r i It ri r ] i I aj j rt ti aIi t r t I s¡m j It m s i s j t t r t .]. j t a| I|t « m t It r
• | | ¡s - t ¡t ars t |1
• j aIi t r Is «i I| m t 1 t raIt t r st tt rt asI| m a «i || r t t 1 rt ]a |ar
j rt j | ¡|ati s i r a1 1 i Ii t r It | rt r t| t 1 i |aIt rs t .]. i r | a|t 1 sIt rt i 1 s,
st 1 i a m trt m t ]|¡taIt
CYSTIC FIBROSIS
J aa It st m a| rt tt ssi tt
J ¡ I1,111 |i tt | i rI| s, m t sI|¡ | aa tasi ar s
J m a IaIi t r i r Irar sm t m | rar t tt r 1 a tIar tt rt ]a |aIt r t I t| |t ri 1 t
J | | ¡ | ]t r t It a r 1 t r t| rt m t st m t I | !1î m a IaIi t r i r I1X
Clinical Fe ature s
J r t t r aIa|
• m t tt r i a m i |t a s
• j rt |t r ]t 1 }aa r 1 i tt
• ar It r aIa| | t «t | j t rIt raIi t r
J i r Iar t¡
• j ar trt aIi t i r sa IIi ti t r t¡ «i I| sIt aIt rr| t a ar 1 | ¡ ¡
| a I tt rati t a s aj j t Ii It
J t| i |1 | t t 1
• ar t m i a, | ¡j t j rt It i r t m i a, | ¡j t r aIrt m i a
• | t aI j rt sIraIi t r
• rt ta rrt r I t| t sI i r It tIi t r s t r «| t t ti r ] ä . aureus,
|. aeruginosa, H. influenzae
• | t m t j I¡si s
• r asa| j t |¡j s asst ti aIt 1 «i I| m i |1 t r 1 i st ast
• 1 i sIa| i r It sIi r a| t | sIra tIi t r s¡r 1 rt m t , rt tIa| j rt |aj st
• t|a | | i r ] t I Ii r ]t rs
| t 1 i aIri ts Iî M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s
K t It s
RESPIROLOGY. . . CONT.
J t |1 t r j aIi t r Is
• | 1 | |
• i r It rIi |i I¡
Complications
J rt sj i raIt r¡ Iai |a rt
J j r t a m t I| t rat j t t r j rt ]r t sIi t si ]r
J tt r j a |m t r a|t |aIt
J j ar trt aIi t Ii | rt si s «i I| 1 i a| t It s m t ||i Ia s
J ]a||sIt r t s
J ti rr| t si s «i I| j t rIa| | ¡j t rIt r si t r
J i r It rIi |i I¡
J t ar|¡ 1 t aI| ta rrt r I m t 1 i ar sa rti ta| i s 11 ¡t ars
Diagnos is
J s«t aI t| |t ri 1 t It sI t I - t1 m t | I|
• Ia|st j t si Ii tt It sIs. m a|r a Iri Ii t r , | t |i at 1 i st ast , a1 rt r a|
i r sa IIi ti t r t¡, ar t rt ti a r t rtt sa, | ¡j t I| ¡rt i 1 i sm , r t j | rt ]t r i t
1 i a| t It s i r si j i 1 a s, r t j | rt Ii t s¡r 1 rt m t
• Ia|st r t ]aIi tt It sIs. j t ri j | t ra| t 1 t m a, t|t tati ||i r , ]|¡tt ]t r
sIt ra]t 1 i st ast , | ¡j t j araI| ¡rt i 1 i sm , aIt j i t 1 t rm aIi Ii s,
| |i r t It |It r s¡r 1 rt m t , | ¡j t ]am m a]|t | a |i r t m i a
J j ar trt aIi t 1 ¡sIa r tIi t r - 1 t It rm i r t 1 | ¡ 1-1 a¡ It ta| IaI tt ||t tIi t r
J ]t r t Ii ts - a st Ia | «| t rt s«t aI t| |t ri 1 t It sI i s t | a i tt ta|
J j rt r aIa| 1 i a]r t si s It r | i ]| ri s| Iam i |i t s
Manage me nt
J r a Iri Ii t r a| tt a r st ||i r ]
• | i ]| ta|t ri t 1 i t I
• j ar trt aIi t t r t¡m t rt j |att m t r Is
• IaI st |a | |t ti Iam i r sa j j |t m t r Is
J m ar a]t m t r I t I t| t sI 1 i st ast
• j | ¡si t I| t raj ¡, j t sIa ra| 1 rai r a]t
• t tt rti st
• | rt r t| t 1 i |aIt rs
• ar Ii | i t Ii ts 1 t j t r 1 s t r sj a Ia m | & ä , t .]. tt j | a|t sj t ri r ,
t|t tati ||i r , ti j rt I|t tati r , i r | a|t 1 It | ram ¡ti r
• |a r ] Irar sj |ar IaIi t r
J ]t r t Ii t tt a r st ||i r ]
ADOLESCENTS
HEALTH ISSUES
J ]rt «I| ar 1 1 t tt |t j m t r I
• j | ¡si ta| ]rt «I|
• st ta a| m aIa raIi t r ar 1 j s¡t| t st ta a| i ssa t s
• s|i r j rt | |t m s
J r a Iri Ii t r a| tt r tt rr s
• j t t r r a Iri Ii t r
• t aIi r ] 1 i st r1 t rs
• t | t si I¡
J st ta a|i I¡ i ssa t s
• It t r j rt ]r ar t¡
• st ta a| a| a st
• ä ¡ | s ar 1 1 | V i r ti 1 t r tt ri si r ] i r a1 t |t stt r Is
• tt r Iratt j Ii t r
• st ta a| t ri t r IaIi t r
J sa | sIar tt a| a st
• It | attt
• a|tt | t | ar 1 1 ra ]s
J 1 t j rt ssi t r ar 1 m t r Ia| | t a|I| 1 i st r1 t rs
• sa i ti 1 t , | t m i ti 1 t ar 1 atti 1 t r Is I1X t I It t r m t rIa|i I¡
• aIIt tIi tt , | t | ati t r, a1 }a sIm t r I, ar ti t I¡ 1 i st r1 t rs
• st |I-t sIt t m i ssa t s
• t| rt r i t i ||r t ss I-¡ 1X
M | | â | I111 | t ti t « K t It s ar 1 | t tIa rt ä t ri t s | t 1 i aIri ts I1
K t It s
ADOLESCENTS . . . CONT.
Clinical Pe arl
J Injurie s are the le ading caus e of de ath in adole s ce nts , accounting for 80%
of de aths in 15 to 19 ye ar olds . Ris k factors include : alcohol us e , failure to
us e s afe ty de vice s , acce s s to fire arms and athle tic participation
Re me mbe r the HEEADSS Inte rvie w - as s ure confide ntiality
J 1 1 M | . «| t rt , «i I| «| t m ! rt |aIi t r s «i I| Iam i |¡, rt tt r I m t tt s,
t tt r ra r a«a¡!
J | | | | k¡ | 1 K . aIIt r 1 i r ] st| t t |! ]ra1 t s, 1 t i r ] 1 | !, Iai |a rt s,
sa sj t r si t r s, Ia Ia rt j |ar s, ]t a|s
J | k¡ | K | . | a| i Is, ar t rt ti a, ar t m i a, t | t si I¡
J k| ¡ | V| ¡ | | ä . t tIrata rri ta |ar, «t r|, sj t rIs, m a si t, tar, st ti a| t|a | s, ]ar ]s,
| t sI Iri t r 1
J | | | | ä . I¡j t s a st 1 IIri t 1 , a|tt | t |, sm t |i r ], «i I| Iri t r 1 s t r a|t r t !
J ä | X| k| | ¡ Y. 1 aIi r ], atIi tt , j rt It rt r tt , I¡j t s t I t tj t ri t r tt s, saIt
st tItt r Iratt j Ii t r , j rt ]r ar ti t s, ä ¡ | s, st ta a| a| a st
J ä | | | | | | . st |I | arm I| t a ]| Is, j ri t r aIIt m j Is, 1 t j rt ssi t r
NORMAL VARIATION IN PUBERTY
J | rt asI as¡m m t Ir¡ m a¡ t tta r as t r t | rt asI m a¡ ]rt « IasIt r I| ar I| t
t I| t r, | t tt m t s |t ss r t Ii tt a| |t as m aIa raIi t r tt r Ii r a t s
J j | ¡si t |t ]i t |t a |t rr| t a t tta rs j ri t r It m t r art| t , star I m a tt i 1 , t|t ar It
m i ||¡ 1 i st| ar]t r t I asst ti aIt 1 «i I| j ra ri Ii s t r It a | t 1 t a r, t tta rs
| t taa st t I sIi m a |aIi t r t I t r 1 t m t Iri a| ]|ar 1 s | ¡ t sIrt ]t r
J m t r st s m a¡ | t i rrt ]a |ar i r 1 a raIi t r t I j t ri t 1 ar 1 It r Ii m t | t I«t t r
j t ri t 1 s, t r att ra]t i I Ia|t s ¡ î m t r I| s It ]t I| rt a ]| I| t Ii rsI
¡ I j t ri t 1 s, | i rI| tt r Irt | j i ||s s| t a |1 | t att i 1 t 1 as Irt aIm t r I
J ]¡r t tt m asIi a i s a tt m m t r st |I-|i m i It 1 tt r 1 i Ii t r st t r i r !1-t1X t I
t ar|¡ m a|t a1 t |t stt r Is,¡ -1 tm rt a r 1 , m t | i |t , st m t Ii m t s It r 1 t r, Ii rm
m ass a r 1 t rr t aI| art t |a, i I 1 i st| ar]t t r Ii tt 1 m ass, s| t a |1 | t i r tt sIi ]aIt 1
ACKNOWLEDGEMENTS
| r. | t a ]|as | . M tM i ||ar , | rt It sst r, | t j arIm t r I t I | t 1 i aIri ts,
| i ti si t r t I K t t r aIt |t ]¡, | r i tt rsi I¡ t I | a|]ar¡
| r. M a| a 1 a1 i , | t st art| ksst ti aIt , | t j arIm t r I t I | m t r]t r t¡ | t 1 i aIri ts,
1 t sj i Ia| It r ä i t| | | i |1 rt r , ¡t rt r It
Drawing by Roula Drossis

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