Pediatric A1 (2024)

اكو موضوع مهم ويعتبر emergency condition

و بيه high mortality rate ، كيس أخذته الخميس وجان كلش تعبان واعتقد دخل kidney و respiratory failure بسبب شي موروث اسمه السكَوه وهو شي خطير كلش ونسبه الوفيات بيه 2 كل 3 حالات او 7 كل 10 حالات 👇

السكَوه هو موروث قديم ولحد الان موجود نشوفه وتقريبا هذه وقته ، يعني موسمه اكثر شي بسبب انو هذه موسم الgastroenterities

يستخدمون هاي المصطلحات شام ريحه مجاري
شام النفاس من يروح يم أمراه حديثه الولادة ومتقرب من طفلهه ومشتم

يستخدموله السكَوه أو كَطوع الريح

يتكون من 3 مواد الأولى طينه بيهه حبه بركه ، كمون و ورد الدفله اللي هي ورده سامه ويتكون من جلد القنفذ أو اظافر الحيوانات أو اظافر الإنسان ومكون ايضا من مادة الرصاص ومادة علاجيه الليموتيل او loperamide عمود يوقف الإسهال ومرات طين وفضلات الحيوانات واجزاء من حيوانات ميته كالقنفذ وبيه مواد مخدره او narcotic مرات يخلون وياه او هم antispasmotic أو مورفين هم وكذلك بالبحث لكوا جراثيم نفس جرثومة الPseudomonas وكذلك ممكن herbal اللي بعض منهه مخدرات تكون وهنا خطورته لان كل واحد يسويه ب تركيبه شكل ف صعب واحد يعالج شي محدد بيه

طريقة الاستخدام اما يسوون جرح اعلى الرأس ويخلون الطينه عليهه أو يشممونه منهه أو يشربوهه اله من يحلوهه بمي يعني هي ممكن تكون باودر وممكن سائل اصلا


يسبب فشل كلوي لان هي مواد حتروح تترسب بالكليات ويدخل بفشل acidosis وكذلك electrolytes abnormalities
وممكن يصير seizure وغيرها

من يجي للطوارئ بعد ما ناخذ هستري سريع ونسوي الABC لازم نخليه ع الاوكسجين وننطيهfluids لان العلاج مالته support و systematically

نجيّك الvital مالته واهم شي ال O2 saturation هم assessment of dehydration

تحاليل اهم شي الrenal function نشوف ال urea وال creatinine وكذلك electrolytes وABG وغيرها

اما الtoxicology screening مو ذيج الفائدة لان اولا ممتوفر بس بمدينه الطب يمكن واذا توفر ف كم شغله معينه والسكَوه كل شي ممكن يخلطون بيهه مو شي ثابت


اللي يبيعوهه يستخدمون عبارات مثل اذا فادته معناهه الله كاتبله يعيش واذا مات ف ما كتبله يعيش عمود يغطون ع هذه الفعل الخطأ

وهدفهم ربحي لا اكثر لذلك وجب التنبيه

Serum bicarbonate not CO2 اللي بالجدول هاي

من افضل المصادر الشفتهه بتوضيح المواضيع

Toddler's diarrhoea is a benign condition that causes the child no problems.

It is due to the fast transit through their digestive system and often contains undigested food. It requires no treatment. It is prudent to plot their height and weight to ensure no severe underlying diagnosis is present such as coeliac, which would present with the child falling centiles on the growth chart.

Gastroenteritis wouldn't last for months and it is likely that others in the household would be suffering from it too.

Lactose intolerance would also have abdominal pain and bloating as symptoms and the diarrhoea would be linked to eating dairy.

Giardiasis is a parasitic infection, and the child typically has watery stools, nausea and fever.


 

Diarrhoea in children

Gastroenteritis :-
main risk is severe dehydration
most common cause is rotavirus - typically accompanied by fever and vomiting for the first 2 days. The diarrhoea may last up to a week
treatment is rehydration

Chronic diarrhoea

Infants most common cause in the developed world is cows' milk intolerance

toddler diarrhoea: stools vary in consistency, often contain undigested food

coeliac disease

post-gastroenteritis lactose intolerance

The diagnostic investigation for necrotising enterocolitis is an abdominal x-ray

The correct answer is an abdominal x-ray. This child is presenting with the signs and symptoms of necrotising enterocolitis. This condition has an unknown cause and is one of the leading causes of death among premature infants. It presents with abdominal distension, feeding intolerance and bloody stool. Additionally, the child can suffer from vomit bouts that are usually bilious. The x-ray will show dilated bowel loops, pneumatosis intestinalis (intramural gas) and occasionally portal venous gas. The treatment is with total gut rest and total parenteral nutrition, babies with perforations will require laparotomy.

Abdominal ultrasound is the investigation of choice for intussusception. This condition is characterised by paroxysmal abdominal colic pain and red currant jelly stool. The absence of these cardinal features makes this diagnosis unlikely.

Laparotomy is the investigation of choice in evident cases of perforation. In this case, the patient has no fever, making the diagnosis unlikely. Necrotising enterocolitis can eventually lead to perforation, so the child should be treated immediately to avoid so.

Test feed is used to diagnose pyloric stenosis. This condition is characterised by projectile vomiting, typically 30 minutes after a feed. Given that the child is presenting with generalised malaise and multiple gastrointestinal symptoms this diagnosis is unlikely.

An upper gastrointestinal tract contrast study is used to diagnose malrotation. This condition features exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia. This child was born healthy making this diagnosis unlikely.

A 25-days-old newborn presents to the emergency department with his parents. He has a distended abdomen and looks lethargic. The parents report that he has been feeding less during the last three days and vomited repeatedly. They describe the vomit as bilious. This morning he produced stools with blood in them but he has no fever. He was born at 35 weeks following premature rupture of membranes. Now he is otherwise healthy.

Given the most likely diagnosis, which one of the following investigations should be performed?

Abdominal U/S?

Abdominal x-ray?✅️

Laparotomy?

Test feed?

Upper gastrointestinal tract contrast study?