clinical notes of pediatrics

الLP نسحب تقريبآ 1 - 1.5 cc . 🚫 . تقريبآ 15 الى 20 قطرة

الblood pressure والpulse rate ليش مهمات ؟ 🚫 لان اذا المريض صار عنده raised I.C.P There will be hypertention and bradycardia 🚫

شلون نسوي follow up to patient with meningitis 🌷 1.vital signs 2. OFC daily اذا الOFC ازدادت ممكن يكون Hydrocephalus or subdural effusion

In meningitis why we give 2/3 of maintenance ( fluid )...?🤔 🚫 There is risk of Inappropriate ADH release ➡️ brain edema

✔Eye examination is important in Meningitis ➡️ to look for papilledema by fundoscope of course تفيدنا بالأطفال الي عمرهم اكثر من سنة والfontanelle closed معناتها اكو raised intracranial pressure

Mumps decrease glucose and it is viral . ") where it cause meningioencephalitis

🌷 Why glucose decrease in bacterial infection ? It is an inflammatory condition and destructive process so protein will increase and glucose transportation will decrease .

✔ Causes of prolonged fever in meningitis 🤔 مهم 1.drug fever 2.throbmophlebitis 3.coincedental inection 4.subdural effusion 5.empyema

شلون نميز بين الviral and bacterial type of Gastroenteritis 🤔 🚫 toxic , ill , feverish patient ➡️ bacterial If it is invasive type of bacteria on CBC ➡️ leukocytosis and neutrophilia If non Invasive like cholera ➡️ normal investigations . اذا كانت الinvestigations normal رح يكون لو viral لو non invasive bacteria Most of viral type of G.E preceded by Upper respiratory tract infection .... 🚫 Presence of tensmus ➡️ bacterial or Amebiasis . Tensmus ➡️ painful defecation where it invlove the large bowel Viral usually involve the small bowel الtensmus يعني رغم عنده diarrhea بس يعصر الا تطلع بطنه لان الstool تمر خلال الinflammed bowel . د قحطان .

والAntibiotic حسب الindication ... Causes of diarrhrea Bacterial , viral , parastic or parentral (مهمة اسبابها) ✔ parentral type due to infection outside the GIT like otitis media

الDiet مهم كذلك 🚫Avoid sugar and fatty meals ✔continue breast feeding 🚫 don't give diluted formula اكثر اسباب الchronic diarrhea هي الpost gastroenteritis syndrome Where there will be atrophy of villi due to poor nutritional rehabilitation (بسبب الdiluted formula او قطعوا الأكل عنه نگدر نتجنبها عن طريق الgood nutritional rehabilitation

ننطي Probiotic Also decrease the duration and severity of illness , it act like normal flora where it competes with microorganism

ننطي Zinc مرة واحدة باليوم وحسب العمر Less than 6 months ➡️ 10mg/day More than 6 mo.➡️ 20mg/day لمدة 10-14 يوم شنو فائدته ؟ Decrease the duration and severity of illness And enhance local and systemic immunity in GIT also act as antimicrobial where it prevent certain enzymes inside the microorganism ( prevent the replication of microorganism )

Sever type :- 20ml/kg/20 minute نگدر نعيدها ٣ مرات Type of fluid ➡️ normal saline Maintenance مثل ما نعرفها Defecit ➡️ wt in gram × degree of dehydration تعتبرdegree of dehydration 10% Where there is risk of fluid overload and cerebral edema ✔Type of fluid ➡️ half strength glucose saline ( 5% dextrose or 0.45 % NS ) Glucose important cuz there is risk of hypoglycemia ... Total ➡️ ( maintenance + defecit )-shoot ننطي نصف الكمية خلال 8 ساعات والنصف الثاني خلال ال١٦ ساعة المتبقية

Rx of moderate degree of dehydration :- نعالجه بالORS واذا ما فاد ننطي IV مثلا عنده vomiting or abdominal distention وكلما ننطيه الORS يتقيأ So / give ORS ➡️ 100ml/kg/6 hour Then 10ml/kg for each bowel motion مثلا وزنه 10kg فراح تكون 1000ml 4 گلاصات ماء تعادل 1000ml يعني راح ننطي اللتر خلال 6 ساعات شلون ننطيه ؟ ننطيه by sips or spoon every 2-3 minute واذا ما ياخذ الطريقة الأولى By bottle feeding نصف رقم كل 10 دقائق ..... بعدين نحل كيس ثاني وننطي 10cc/kg ثلث الگلاص يعادل 100 cc وكذلك ال3 ارقام بالbottle feeding And continue eating and feeding

Treatment of gastroenteritis :- 1- assess the degree of dehydration اذا كان Mild ➡️ appear normal just thirst Moderate ➡️ signs present in moderate degree ( moderately depressed fontanelle , moderately sunken eye , moderately delayed capillary refilling (3-5)sec . Sever dehydration ➡️ hypotention and tachycardia العلامتين مهمات وما موجودات بالmild and moderate ....... Rx of mild dehydration ➡️ Oral rehydration solution ( 50ml/kg/4 hour ) نحل الباكيت بلتر ماء وننطي نصف اللتر خلال اربع ساعات بعدين ورا ال4 ساعات ننطي 10ml/kg/bowel motion مثلا لو كان وزنه 10kg (10ml×10kg =100 ml ) فراح نگول لأمه كلما تطلع بطنه انطيه 100 ml This 10ml/kg to prevent the recurrance of dehydration بينما ال50ml/kg to treat the dehydration

دكتور رحمن What is ineffective erythropoiesis ? Active erythropoiesis BUT - premature cell death - decreased RBC output from bone marrow Where do we see it ? Megaloblastic anemias Thalassemia IDA What is its marker ? Elevated LDH #hematology

Rx for vesicouretric reflux :- Medical ➡️ 1.prophylactic antibiotic (TM-SMX or nitrofurantoin or amoxicillin ) prevent pyelonephritis and renal scaring for mild to moderate grade surgical Indication :- 1.Failure of medical treatment 🤔 مايلتزم بالعلاج او صار deterioration in renal function Persistant reflux 2.High grade 3. Parents wish