{"id":643,"date":"2009-03-08T15:14:04","date_gmt":"2009-03-08T14:14:04","guid":{"rendered":"http:\/\/www.zdravstvena.info\/vsznj\/?p=643"},"modified":"2010-06-15T14:15:31","modified_gmt":"2010-06-15T13:15:31","slug":"pediatrija-vaja-za-izpit-pediatrija-visoka-sola-za-zdravstvo","status":"publish","type":"post","link":"https:\/\/www.zdravstvena.info\/vsznj\/pediatrija-vaja-za-izpit-pediatrija-visoka-sola-za-zdravstvo\/","title":{"rendered":"Pediatrija vaja za izpit 2.del"},"content":{"rendered":"

\"pediatrija-vsznj\"Th\/zdravljenje respiratornih obolenj(simptomatska,vzro\u010dna,podporna…) !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

simptomatska<\/em><\/strong> :<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 antipiretiki oz. zni\u017eevanje telesne temperature<\/p>\n

\u00de\u00a0\u00a0\u00a0 hidracija<\/p>\n

\u00de\u00a0\u00a0\u00a0 respiratorna fizioterapija<\/p>\n

\u00de\u00a0\u00a0\u00a0 kisik<\/p>\n

\u00de\u00a0\u00a0\u00a0 antitusiki ??!<\/p>\n

<\/p>\n

<\/strong>vzro\u010dna:<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 antibiotiki<\/p>\n

\u00de\u00a0\u00a0\u00a0 redko antivirusna zdravila(V.herpesa)<\/p>\n

podporna:<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 inhalacije<\/p>\n

\u00de\u00a0\u00a0\u00a0 bronhodilatatorji(ventolin..)<\/p>\n

\u00de\u00a0\u00a0\u00a0 kortikosteroidi(ihalacije,per os,parenteralno)<\/p>\n

\u00de\u00a0\u00a0\u00a0 ev.kardiotoniki in\u00a0 diuretiki<\/p>\n

\"*\" klimatska-srednjegorska in obmorska zdravili\u0161\u010da<\/em><\/strong><\/p>\n

28.Mukoviscidoza !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" ali fibrosis cystica<\/em><\/strong><\/p>\n

\"*\" <\/strong>je recisivno dedna bolezen. Gen 1:60 prbivalcev,na sedmem kromosomu<\/p>\n

\"*\" etiologija <\/em><\/strong>:sluz v endokrinih \u017elezah je nenormalno gosta,lepljiva in zastaja;<\/p>\n

\"*\" posledice<\/em><\/strong> :<\/p>\n

\u00de\u00a0\u00a0\u00a0 pankreas<\/em> – sokovi se ne izlo\u010dajo v duodenum,zato slaba prebava \u2192driske \u2192distrofija<\/p>\n

\u00de\u00a0\u00a0\u00a0 bronhialno vejevje<\/em>: sluz zastaja \u2192plju\u010dnice<\/p>\n

\u00de\u00a0\u00a0\u00a0 jetra: <\/em>zastoj \u017eol\u010da\u2192ciroza jeter<\/em><\/p>\n

\u00de\u00a0\u00a0\u00a0 kasneje zastoj sperme<\/em>\u2192neplodnost in okvara \u0161e endokrinega pankreasa \u2192 diabetes<\/em><\/p>\n

\"*\" diagnoza:<\/em><\/strong>pilokarpinska jontoforeza,Cl v znoju v dveh izvidih nad 60 mmol\/l<\/p>\n

\"*\" terapija:<\/em><\/strong> stalna respiratorna fth.,inhalacije,pogosto antibiotiki,nadomestki pankr.sokov<\/p>\n

\"*\" prognoza:<\/em><\/strong> slaba,sedaj do\u017eivijo odraslo dobo<\/p>\n

29.Prirojene anomalije prebavnega sistema !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" atrezija ezofagusa,ev.s fistulo v trahejo<\/p>\n

\"*\" prirojene stenoze ali atrezije \u010drevesa<\/p>\n

\"*\" malrotacija \u010drevesa,volvulus<\/p>\n

\"*\" anomalije anusa in rektuma (okostje,se\u010dila,genit.!)<\/p>\n

\"*\" recidivno plivanje in bruhanje:<\/p>\n

a.\u00a0\u00a0\u00a0\u00a0\u00a0 gastroezofagialni refluks<\/p>\n

b.\u00a0\u00a0\u00a0\u00a0 hipertrofi\u010dna stenoza pilorusa – kon-genitalna =pilorostenoza<\/p>\n

\"*\" obstipacija (zaprtost)<\/p>\n

<\/em><\/strong><\/p>\n

30.Hipertrofi\u010dna stenoza pilorusa !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" 1: 400-800 otrok, 8x pogosteje fantki, pozit. fam. an. v 15%;<\/p>\n

\"*\" hipertrofija mi\u0161ice pilorusa, ki napreduje;<\/p>\n

\"*\" bruhanje praviloma za\u010dne v 2-4. tednu, vse mo\u010dnej\u0161e, na koncu eksplozivno, vidna peristaltika \u017eelodca, lahko “tumor”<\/p>\n

\"*\" zguba vodika, klora in kalija vodi v hipokloremi\u010dno alkalozo in hipokaliemijo; v distrofijo radi bruhanja;<\/p>\n

\"*\" diagnostika: UZ abdomna, rtg pasa\u017ee z barijevo ka\u0161o<\/p>\n

\"*\" terapija: prekinitev hranjenja, infuzija, ev. korekcija ionov; OPERACIJA!<\/span><\/p>\n

31.Obstipacija<\/em><\/strong> (zaprtost) !<\/p>\n

\"*\" idiopatski megakolon<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 predvsem drugo in tretje leto starosti<\/p>\n

\u00de\u00a0\u00a0\u00a0 pogoste abdominalne bole\u010dine,trebuh ni velik,pogosta enkopreza,redko distrofija<\/p>\n

\u00de\u00a0\u00a0\u00a0 telesni\u00a0 in motori.razvoj normalna<\/p>\n

\u00de\u00a0\u00a0\u00a0 potek ugoden,rektum pri pregledu poln<\/p>\n

\u00de\u00a0\u00a0\u00a0 predvsem psihogeno dogajanje !<\/p>\n

\"*\" megakolon congenitum aganglionare-Mb.Hirschprung:<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 dojen\u010dki in pred\u0161olski otroci<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 agang.segm.je ozek(peristaltika ne prehaja),nad njim \u010drevo mo\u010dno raz\u0161irjeno,blato zastaja<\/p>\n

\u00de\u00a0\u00a0\u00a0 nekaj dni zaprt,mato kak dan driske..<\/p>\n

\u00de\u00a0\u00a0\u00a0 ev.bruhanje,bole\u010dine,velik trebuh,rektum prazen – vodi v distrofijo<\/p>\n

\u00de\u00a0\u00a0\u00a0 diagnostika:<\/em><\/strong> biopsija sluznice,UZ irigografija<\/p>\n

\u00de\u00a0\u00a0\u00a0 komplikacije:<\/em><\/strong>ob te\u017eki driski \u0161okovno stanje<\/p>\n

\u00de\u00a0\u00a0\u00a0 terapija:<\/em><\/strong> operacija !!<\/p>\n

32.Diarea !<\/em><\/strong><\/p>\n

\"*\" klasifikacija:<\/p>\n

a.\u00a0\u00a0\u00a0\u00a0\u00a0 po \u0161tev.stolic dnevno<\/em><\/strong> :<\/p>\n

\u00de\u00a0\u00a0\u00a0 blaga 5 – 6 x<\/p>\n

\u00de\u00a0\u00a0\u00a0 zmerna 6 – 10 x<\/p>\n

\u00de\u00a0\u00a0\u00a0 te\u017eka 10 – 15<\/p>\n

b.\u00a0\u00a0\u00a0\u00a0 po izgubi te\u017ee<\/em><\/strong>(= dehidracija)<\/p>\n

\u00de\u00a0\u00a0\u00a0 lahka do 5%<\/p>\n

\u00de\u00a0\u00a0\u00a0 zmerna 5 – 10%<\/p>\n

\u00de\u00a0\u00a0\u00a0 te\u017eka nad 10%<\/p>\n

c. <\/em><\/strong>vrsta dehidracije glede na koli\u010dino Na+<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 izotoni\u010dna – Na+ neizpremenjen<\/p>\n

\u00de\u00a0\u00a0\u00a0 hiponatremi\u010dna – Na+ zni\u017ean<\/p>\n

\u00de\u00a0\u00a0\u00a0 hipernatremi\u010dna – Na+ zvi\u0161an<\/p>\n

33.Klini\u010dni znaki dehidracije !<\/em><\/strong><\/p>\n

\"*\" padec te\u017ee<\/strong><\/p>\n

\"*\" slab,zni\u017ean turgor ko\u017ee<\/strong><\/p>\n

\"*\" suhe sluznice<\/strong><\/p>\n

\"*\" pri dojen\u010dku vdrta velika fontanela<\/em><\/strong><\/p>\n

\"*\" vdrte o\u010di- \u00bbsredi glave\u00ab<\/em><\/strong><\/p>\n

\"*\" redko utripanje z vekami<\/em><\/strong><\/p>\n

\"*\" \u017eeja<\/em><\/strong><\/p>\n

\"*\" napet trebuh,meteorizem,kr\u010di v trebuhu<\/em><\/strong><\/p>\n

\"*\" oligurija<\/em><\/strong><\/p>\n

\"*\" motnje zavesti<\/em><\/strong><\/p>\n

\"*\" hipotermija – hladne okon\u010dine,bledica<\/em><\/strong><\/p>\n

\"*\" pospe\u0161en pulz,padec RR,tihi sr\u010dni toni,globlje in hitrej\u0161e dihanje(<\/strong>acidoza, hiperventil)<\/p>\n

<\/em><\/strong><\/p>\n

34.Preiskave pri otroku z drisko in dehidr.!<\/em><\/strong><\/p>\n

\"*\" te\u017ea – padec te\u017ee !!<\/p>\n

\"*\" koprokultura -i\u0161\u010demo bakterijo ali virus kot povzro\u010ditelj<\/p>\n

\"*\" preiskave krvi –<\/p>\n

\u00de\u00a0\u00a0\u00a0 hemogram, hematokrit !<\/p>\n

\u00de\u00a0\u00a0\u00a0 elektroliti\u00a0 (jonogram) – K+, Na+ !!<\/p>\n

\"*\" plinska analiza krvi – pH,BE- bazni eksces<\/p>\n

\"*\" urin: koli\u010dina in specifi\u010dna te\u017ea<\/p>\n

Gornje preiskave so nujne za oceno stanja in stopnje dehidracije!!<\/p>\n

***********************************************<\/p>\n

\"*\" event.ostale preiskave:<\/p>\n

\u00de\u00a0\u00a0\u00a0 alergolo\u0161ke preiskave, biopsija sluznice<\/p>\n

\u00de\u00a0\u00a0\u00a0 D-xylozni test(otrok popije umeten sladkor in uro kasneje se dolo\u010di koli\u010dina v krvi) specif IgE na mleko, gliadin, obremenilni testi<\/p>\n

\u00de\u00a0\u00a0\u00a0 biopsija sluznice<\/p>\n

35.Th driske in dehidracije !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" rehidracija – per os,p.p. z infuzijami<\/strong><\/p>\n

\"*\" korekcija elektrolit.motenj – Na+,K+ in motenj v pH – acidoze z Na bikaronatom<\/p>\n

\"*\" dieta – omejitev ma\u0161\u010dob, saharin ali kako drugo umetno sladilo, nastrgana, postana jabolka, pretla\u010dene banane, pre\u017eganka – sedaj nekateri vso dieto opu\u0161\u010dajo;<\/p>\n

\"*\" zelo izjemoma antibiotik – pri posebnem soju E. coli in \u0161e redkeje pri Campylobacter jejuni<\/p>\n

<\/em><\/strong><\/p>\n

36.Malabsorbcija !<\/em><\/strong>
\n
\n <\/em><\/strong><\/p>\n

\"*\" okvara tankega \u010drevesja<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 anatomske anomalije – sindrom kratkega \u010drevesja<\/p>\n

\u00de\u00a0\u00a0\u00a0 vnetja tankega \u010drevesja – npr.po driski<\/p>\n

\u00de\u00a0\u00a0\u00a0 paraziti<\/p>\n

\u00de\u00a0\u00a0\u00a0 metabolne motnje<\/p>\n

37.Hepatobiliarni trakt !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" ciroza jeter<\/p>\n

\"*\" kroni\u010dni hepatitis<\/p>\n

\"*\" biliarna obstrukcija<\/p>\n

38.Metabolne motnje !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" intoleranca – monosaharidov<\/p>\n

– disaharidov<\/p>\n

– beljakovin kravjega mleka<\/p>\n

\"*\" infiltrativni procesi v steni tankega \u010drev. Hodgkin-ov in non-Hodgkin-ov limfon<\/p>\n

\"*\" endokrine motnje – AGS(adrenogenitalni sindrom, hipertireoza, nepravilno delovanje nadledvi\u010dne \u017eleze<\/p>\n

\"*\" kardiovaskularne motnje – cianoti\u010dne sr\u010dne napake z zastojem teko\u010dine v telesu<\/p>\n

39.Kroni\u010dno vnetje sluznice debelega \u010drevesa !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" ali Colitis ulcerosa<\/em><\/strong>(<\/strong>ev. tudi terminalnega dela ileuma)<\/p>\n

\u00de\u00a0\u00a0\u00a0 etiologija – ni znana<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 znaki : abdominalne bole\u010dine, driske s primesjo sluzi in krvi<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 laboratorij – anemija, levkocitoza, \u2193serum.beljakovine<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 terapija : kortikosteroidi,sulfasalizin,dieta<\/p>\n

\u00de\u00a0\u00a0\u00a0 prognoza : v 30-40% ugodna,recidivi do pet let po za\u010detku, v 20-40% potrebno operativno zdravljenje.Mo\u017ene ,maligne alteracije !!<\/p>\n

40. Ileitis terminalis !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" ali Mb.Crohn<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 kroni\u010dni vnetni infiltrati v steni \u010drevesja<\/p>\n

\u00de\u00a0\u00a0\u00a0 klini\u010dna slika: abdominalne bole\u010dine, recidivne driske s sluzjo, krvjo in gnojem<\/p>\n

\u00de\u00a0\u00a0\u00a0 laboratorij: \u00ad SR, \u00ad levkociti, anemija, \u00af belakovin<\/p>\n

\u00de\u00a0\u00a0\u00a0 terapija: specifi\u010dna terapija ne obstaja, le simptomatska (kortikosteroid)<\/p>\n

\u00de\u00a0\u00a0\u00a0 prognoza:resna, vendar z velikimi individualnimi variacijami<\/p>\n

41.Znaki vnetja se\u010dil !<\/em><\/strong><\/p>\n

\"*\" DOJEN\u010cEK IN MALI OTROK:<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 povi\u0161ana telesna temperatura, mrzlica<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 bledica odklanja hrano,tudi teko\u010dino,bruha<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 neuspevanje v te\u017ei, bole\u010dina v trebuhu, jok<\/p>\n

\u00de\u00a0\u00a0\u00a0 smrde\u010de plenice<\/strong><\/p>\n

\"*\" PRED\u0160OLSKI IN \u0160OLSKI OTROK<\/strong><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 povi\u0161ana\u00a0 telesna temp., lahko mrzlica<\/p>\n

\u00de\u00a0\u00a0\u00a0 bole\u010dine v trebuhu in\/ali ledveno<\/p>\n

\u00de\u00a0\u00a0\u00a0 pogoste,peko\u010de in urgentne mikcije<\/p>\n

\u00de\u00a0\u00a0\u00a0 gost, moten, smrde\u010d urin spremenjene barve<\/p>\n

\u00de\u00a0\u00a0\u00a0 bruhanje,lahko driska<\/p>\n

\u00de\u00a0\u00a0\u00a0 bledica, lahko rumenkast nadih ko\u017ee<\/p>\n

42.Prirojene anomalije se\u010dil !<\/em><\/strong><\/p>\n

\"*\" Vezikouretralni refluks = VUR<\/strong><\/p>\n

\"*\" Obstrukcije(stenoze)<\/p>\n

\u00de\u00a0\u00a0\u00a0 HYDRONEPHROS<\/strong> = stenoza pyeloureternega spoja<\/p>\n

\u00de\u00a0\u00a0\u00a0 HYDROURETER<\/strong> = stenoza juxtavezikalnega spoja<\/p>\n

\u00de\u00a0\u00a0\u00a0 URETRE<\/strong><\/p>\n

\"*\" agenezije<\/p>\n

\"*\" hipoplazije (ledvica manj\u0161a a morfolo\u0161ko spremenjena) ali displazije(napa\u010dna,slabo razvita ledvica, ne deluje normalno)<\/p>\n

\"*\" policisti\u010dne ledvice(jetra!!)<\/p>\n

\"*\" valvula uretre(fantki) – zaklopka v penisu, ki pritiska na urosistem<\/p>\n

\"*\" podkvasta ledvica = ren arcuatus<\/em><\/strong><\/p>\n

\"*\" ektopije – ena ledvica ne le\u017ei na pravem mestu<\/p>\n

\"*\" podvojitve votlih sistemov – zgornji in spodnji del ledvice ima svoj meh \/4 ledvice in \/4 se\u010devodi<\/p>\n

43.Druga obolenja se\u010dil !<\/em><\/strong><\/p>\n

\"*\" hemoliti\u010dno – uremi\u010dni sindrom<\/strong><\/p>\n

\"*\" akutna renalna insuficienca<\/strong><\/p>\n

\"*\" kroni\u010dna renalna insuficienca in dializa<\/strong><\/p>\n

44.Epilepsiji podobni napadi so :<\/em><\/strong><\/p>\n

\"*\" metabolne motnje :\u2193Ca, \u2193Mg, \u2193KS, \u2191Na<\/p>\n

\"*\" hipoksija C\u017dS : V.C.C z D\u2192L Shuntom, tromboze, ishemije<\/p>\n

\"*\" akutna vnetja C\u017dS : Meningitis purulenta, Meningoencefalitis<\/p>\n

\"*\" po\u0161kodba glave<\/p>\n

\"*\" neoplazme(tumorji in metastaze), hematomi, ciste, abscesi<\/p>\n

\"*\" zastrupitve<\/p>\n

45.Spolne \u017eleze !<\/em><\/strong><\/p>\n

\"*\" Kriptorhizem<\/em><\/strong> = retencija testisov<\/p>\n

\u00de\u00a0\u00a0\u00a0 zastane v ingvinalnem kanalu<\/p>\n

\u00de\u00a0\u00a0\u00a0 mo\u017enost sterilnosti<\/p>\n

\u00de\u00a0\u00a0\u00a0 maligne spremembe<\/p>\n

\u00de\u00a0\u00a0\u00a0 terapija : korekcija do drugega leta !!, hormonske injekcije(Primogonil) ali operacija<\/p>\n

\"*\" Pubertas precox<\/em><\/strong> – sekundarni spolni razvoj pred 10.letom<\/p>\n

\u00de\u00a0\u00a0\u00a0 specialisti\u010dna obravnava<\/p>\n

\u00de\u00a0\u00a0\u00a0 psiholo\u0161ki problemi<\/p>\n

\u00de\u00a0\u00a0\u00a0 idiopat – ski pri deklicah v 80-90%,pri de\u010dku v 50%<\/p>\n

\u00de\u00a0\u00a0\u00a0 ostalo resna patologija<\/p>\n","protected":false},"excerpt":{"rendered":"

Th\/zdravljenje respiratornih obolenj(simptomatska,vzro\u010dna,podporna…) ! simptomatska : \u00de\u00a0\u00a0\u00a0 antipiretiki oz. zni\u017eevanje telesne temperature \u00de\u00a0\u00a0\u00a0 hidracija \u00de\u00a0\u00a0\u00a0 respiratorna fizioterapija \u00de\u00a0\u00a0\u00a0 kisik \u00de\u00a0\u00a0\u00a0 antitusiki ??!<\/p>\n","protected":false},"author":336,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[781],"tags":[782,802,804,799,803,801,800,805,783,798,806,797],"class_list":["post-643","post","type-post","status-publish","format-standard","hentry","category-2-letnik-pediatrija","tag-2letnik-pediatrija","tag-colitis-ulcerosa","tag-dehidracija","tag-epilepsija-pri-otroku","tag-malabsorbcija","tag-mb-crohn","tag-obolenja-secil-pediatrija","tag-obstipacija","tag-pediatrija","tag-pubertas-precox","tag-stenoza-pilorusa","tag-vaja-za-izpit-pediatrija"],"_links":{"self":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/643","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/users\/336"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/comments?post=643"}],"version-history":[{"count":0,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/643\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/media?parent=643"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/categories?post=643"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/tags?post=643"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}