Pediatrics

PEDIATRICS
| r. . | t rr sIt i r , | r. !. | ri t 1 m ar , | r. | . 1 i ||i ar1 ,

| r. . !att | st r ar 1 | r. | . 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 |at 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
| t rI IaIa rt
a|| 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 | r 1 rt m t |k 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 r 1 rt m t
1 I| t r ri st m i t s
a rr t r r 1 rt m t
| |i r t It |It r 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 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 r 1 rt m t | |
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 r 1 rt m t M k
| 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 | |
a 1 1 t r | r Iar I | t aI| r 1 rt m t | |
M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts
NEUROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
t i ta rt | i st r1 t rs
| t r i ]r | t | ri |t 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 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
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
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
t | t rr| t i t | t rm aIi Ii s
| ar 1 i 1 a
| ttt m a
| m j t Ii ]t
ta| i t s
| rI| t m a M a |Ii It rm t
It tt r s-!t | r st r 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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
i t||t | t || | i st ast
j | t rt tIt 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| - t| t r |t i r | a rj a ra
| aasa|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| t ta a| | t tt |t j m t r I
| rt tt ti t a s | a | t rI
| t |at 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 r 1 rt m t
K t j | ri Ii t r 1 rt m t
K t j | rt Ii t 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
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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, !, , 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 ssIt 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 It t r 1- m t r I| s, j t sIt ri t r
| t It t r I-\ m t r I| s , sIra| i sm a s, ti si t r , Im 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 | . | 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 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 | | - st t a 1 1 t r | r Iar I | t aI|
r 1 rt m t 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 as 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 as m aIa rt m i || | !-\! 1 as
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 ], sa||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 - t | t r | i -Vi - 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 . 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| | , 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 as.
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 Iratt|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 1X 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 tIt s, |st tm 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 . aureusat| a i rt 1 Irt m | a| . Irt aI
i I| tt |1 tt m j rt sst s | t It 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 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- 1 ttI|]I1 a m i r i m a m
tt s | ast 1 It rm a |at , t .]. M k, 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 sr 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 tsm s t I i rri Ia| i |i I ar 1 tri r ] It r
- 1 | t a rsI1 a ar 1 - 1 1 asIt t | It r - 1 t t |s i r ar t I| t ri 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 as It 1 m t r I| s t I a]t , j t a| t- 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts !
K t It s
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 |aj t r | t It rt ar st 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 sra 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 si 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 tt|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 si 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 | | |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
m t r I| s | a| | | V1 i | | M
\-t t ars M M | |
| 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 ssIt 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, st ||i r ], i rri Ia| i |i I
m a}t r. j rt |t r ]t 1 tri 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 rar1 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 as, |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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts I
K t It s
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 Ij t s t I . 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 It 1 t st s \- 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 M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 as 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 rar1
\ 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 |as ]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 |as 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 ras a |i r t }ar]t r j t i r Is It r t t 1 s
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 tt|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 tt|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
K t It s
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 raa| 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 i r }a r
J asm 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
Galants 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 It 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 It t ars. | K
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 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 as
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, I 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- 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 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 It m a}t r j t rtt r Ii |t
ta rtt s, t r - 1X 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 st| 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, | | , \, 1 , a ri r a|si s
| t r t a]t t-ra
|art Ij 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, st 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 st| 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 st| 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 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 tm It r I | 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts
K t It s
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 |at 1 | t r t a]t , 1 t |at 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 sr 1 rt m t , 1 sm t rj | i t It aIa rt s
t I 1 t |at 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 sr 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 st| t st ti a| r t ]|t tI j st| 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 |art Ij t i r ]i r|s It ra |t t a I a rr t r sr 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-ras 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 sm 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 |at 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 sr 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 sr 1 rt m t
]t r t Ii t. t .]. M arIar , | |i r t It |It r sr 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
K t It s
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 sr 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 sr 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 It 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 |tsIi t t tari ar 1 i st ast , t ar| m t r art| t
j st| 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 t ti t I | k
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 st| t |t ]i ta| 1 sIa r tIi t r I j st| 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 aIj 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|, sm 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
CHILD ABUSE AND NEGLECT . . . CONT.
J s| a|t r | a| sr 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 raa|, |at| t I Ira sI
j st| t st m aIi t sm 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, | 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 | , | | , j rt ]r ar t tt r si 1 t r | 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. Ij 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 | k 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| sa| 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 st| i aIr
J arrar ]t aj j rt j ri aIt It ||t -a j
J | I| 1 i rt tI| It | k t r It rt sj t r si | |t ]a ar1 i ar
a r 1 t r | k sa j t rti si t r
K t It s
DEVELOPMENTAL AND
BEHAVIORAL PEDIATRICS
DEVELOPMENTAL DELAY
Diffe re ntial Diagnos is
J t| rt m t st m a|. | t r sr 1 rt m t , Iri st m 1, Iri st m
J m t Ia| t |i t. a- 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, | |
J j rt r aIa| i r It tIi t r . 1 | | 1 , 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 sr 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
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 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 sr 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 sr 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 ri 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 ] -1X
t r st I j ri t r It 1 t ars t I a]t
J ksj t r]t rs sr 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 Ij 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
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 Ij 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 sm | 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
|k . 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 ssIt 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 | . 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 |k
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 st| 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 st| 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 st| 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 st| t st ti a| sIrt sst rs
i r 1 i ti 1 a a| ar 1 Iam i | j st| t I| t raj
K t It s
DEVELOPMENTAL AND
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 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 aIi m t t IIi r ] t1-1X 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 Ii 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 | sm 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 .]. 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
DEVELOPMENTAL AND
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 |as rt |aIi tt i r 1 i IIt rt r tt It sm j It m s
Irt aIm t r I. j st| 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 st j I aa | 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 tI|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- 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 ]| IIt 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-ras 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
tIt ]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 tm t assas
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 sr 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- 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 M | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 | | k
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
1-11X 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 t11-11 |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| 1X , |t | , 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
| V . \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 | . |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 . 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 | sm 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 . I111 |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 m a|It rm aIi t r , a rt ]t r i Ia|
a| r t rm a|i Ii t s trj It rt| i 1 i sm , j t |tsIi t |i 1 r t s
J |t j t i r I. sm a|| | a| i t s | 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
K t It s
TURNER SYNDROME
J m t sI tt m m t r ]t r t Ij 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
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, tsIi 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 tarri 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
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
| Ij 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
tIt ]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 Ij 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
| 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 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 ra
Be cke r's Mus cular Dys trophy
J 1 sIrt j | i r ]t r t a| r t rm a|, sm 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 | | , 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| sr 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 | | ssIt |i t !1-1, 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 | k. m t asa rt m t r Is - I | | t |t m t ar It r ]t sIaIi t r a| a]t | k
J k| k. i I| i r I | t I m t ar It r | k
J | | k. - I | 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 tt rt
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 | | , 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
| k i r Iar Is
asm 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 ]
sm 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 |tI| 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
sr 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 |tI| 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 , tri 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
Initial Re s us citation
J a|as 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 ri 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 ra It r sa tIi t r
sIi m a |aIt i r Iar I
J ki ra
]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 | arr 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
1 t r |t ss tt m j rt ss - i I | ra1 tar1 i t aj t t - 1 ar 1 r t
i m j rt tt m t r I i I| | a]]i r ] t r assIt |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 | - 1 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 assIt |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 rI| 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. | | | , 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 rai r ]
J r asa| I|ari r ]
J 1 a s|i r t ssItt r Ira| tar 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
J j a |m t r ar
rt sj i raIt r 1 i sIrt ss sr 1 rt m t | |
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts I1
K t It s
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 tar 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 |tI| 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 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 raa| sr 1 rt m t s
Uppe r Airway Obs truction
J | | t ar a| kIrt si a
J | i t rrt -| t | i r sr 1 rt m t
J |arr ]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| 11 t t |s, t!X ri s| 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 sr 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 Ii 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| sm 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 | I 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 sr I| t Ii t
| t 1 i aIri ts I\ M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 ] sr 1 rt m t
rt sj i raIt r 1 i sIrt ss sr 1 rt m t Ij t | |
Pathophys iology
J 1 t |at 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 k
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 ra 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 | arr 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|
rt sj i raIt r 1 i sIrt ss, tar 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
asm m t Iri t t| t sI m t tt m t r Is, Irat| t a 1 t ti aIt 1 aa 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts I!
K t It s
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 k , | | ,
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| tar t si s m t ar s j t t r t t]t r aIi t r - 1 t trt ast 1 a1 I
1 t trt ast 1 | a1 I
J j t ri j | t ra| tar 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 tar 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 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 a1 I, r t rm a| | a1 I
J a|as 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 ] t tIi t r
i I - 11 I| i r | rt sj i raIt r ai ra, 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 t tIi t r
Cardiovas cular
st t | t 1 i aIri t | ar1 i t |t ] 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 |tI| 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| sr 1 rt m t
s| t t|
| t 1 i aIri ts It M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 tar 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
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|as rt | a i rt s Ia || wI|
J | K
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 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 ar 1 1 i aj | ra]m ,
1 t taj ram 1 i rt tI | K 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 !- 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts II
K t It s
Figure 2. Approach and Diffe re ntial for Ne onatal Jaundice
< 24 Hours of Age
J a|as 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 tm 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 as aIIt r t r st I
1 t t sr I i r trt ast IasIt r I| ar ! 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, | & a ri r t ar 1 | |t t 1 , | |,
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 tIt 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 |tI| 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
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 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| tsI
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 |tI| 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 tIt si s | a tt | ri stt ||
j t i |i |t tIt si s
sj | t rt tIt si s
Intrins ic
| t| |
| | 1 t Ii ti t r t
a|j | a I| a|
1 | 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| tsI
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
Irt 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
Irt 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
K t It s
Ke rnicte rus
J | K 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-ras 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 It 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 It t r m i 1 r i ]| I ar 1 .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 | | 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 | |
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 ]
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 \- 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| sr 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 Ij 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 Ij 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|
| 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 tsm a| tt rIi ]t | | | , | |, | , k| |
| t a ]| sr 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| sr 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 raa|
K artt |t j s M t Ia| t |i t taa st s
| st a 1 t st i ta rt s | K 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 sr 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
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, si 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 ssIt 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 i r It tIi t r Ii r I|am m aIi t r t r ata It ssIt 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 Ij 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 Ij 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 , sm 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
IX 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 sm 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 aIj 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 | | | | K | kK | | | k | | kK | | 1 |k | | K kK | |k| | K
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!
K t It s
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 ssIt 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
ssIt 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 sr 1 rt m t s
tt r r t tIi tt Ii ssa t M arIar sr 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 sr 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 sm 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 sa||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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 ssIt 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 | | 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 | | 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 | | 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 | | 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| as 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 |at 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
| | 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
tari r ] 1 t ]rt t s
J sj i r a | i Ii 1 a t tta |Ia. tt rIt | rat t r | | !, , m a | att i 1 t r Ii Ii r ]
1 i m j |t t r Ia II t I | ai r, ]t r t ra|| asm 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 | I 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
K t It s
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 , | K , ti stt ra ar 1 s|i r
J K t a rt Ii | rt m aIt si s Ij 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
Ij 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 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 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 , | | , ssIt 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 sm 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, | I
rt ]a r]i IaIi t r . t ta|a aIt It r rt I|a t | ari a m sa||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, | |
a ri r t , | |t t 1 , sIt t | | &
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| Ij t
tt m i Ii r ], tt a ]| i r ] ar 1 ]a]]i r ]
tar t si s i I| It t 1 s
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 r t a m t r i a, |a r ] 1 am a]t , t| rt r i t rt atIi tt ai ras
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 sa||t i r ] It ||t i r ] rt j ai r
Duode nal Atre s ia
| 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 sr 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 .| = !.
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 | | 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 ri st
J 1X t tj t ri t r tt sm j It m s i r Ii rsI It m t r I| s t I |i It
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 | |
Othe r
J m t tt r i a m i |t a s st t | sIi t | i | rt si s 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 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts 1!
K t It s
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 Ii 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 | 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 sm 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 rI| rt m ti r , I| t t j | ||i r t
J j st| t ]t r i t. t .]. ra m i r aIi t r sr 1 rt m t , | a |i m i a, ar t rt ti a, tt|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 atart , Iratt |, 1 ra ]s, It t 1 s, t I| t r sm 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 as
J | atIt ri a| i r It tIi t r
a|m t r t ||a, | am j |t | atIt r, | 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 | & ar 1 1 & |, | |t t 1 ar 1 w| | , | . difficileIt ti r , | t Iatm 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 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
II1 | !w I1 K
K . 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 | | | | 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 t j Ira , | . difficile t ra| | |a]|IVar tt m ti r , Campylobacter
| rI| 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 - 1 m m t |I|] II 1 t Ii ti I t tt r sI | 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 \-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|| Ij 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts 1I
K t It s
CHRONIC DIARRHEA
Clinical As s e s s me nt
J - \ 1 as
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 | & , 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-ras
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 It 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 It 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 )
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 It 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 & |, | & , | . 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|, | | , 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, | , |
st aI t| |t ri 1 t
K t It s
i I i r 1 i taIt 1 , -ar Ii Irj 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 , rt , t aIs, | t aI
J It ti t t r i m m a r t |t ]i t rt atIi t r
j rt st r Is aI ar a]t , a sa a|| t- 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 tm 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--|i j t j rt It i r t m i a
J s| t rI ]a I sr 1 rt m t
J | |i r 1 |t t j sr 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 t tIi t r
J |t ss t I t tt tri r t j ar trt aIi t Ia r tIi t r
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 sm j It m s, r asa| j t |j s
J 1 i a]r t si s. t |t taIt 1 st 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 tm 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 tt|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
K t It s
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
| | |
k| |
J r t t j |asIi t
j | t t t| rt m t tIt 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 sm j It m s
K 1 Y|
| 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| K 1
| t r si 1 t r M ass!
aj j t r 1 i ti Ii s
K 1 Y|
| 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
]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| - 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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
|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 | |
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 IsIt a r ] t| i |1 rt r
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 It 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 st ||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
sa 1 1 t r t r st I t I rt ta rrt r I, j art tsm 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
| I
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 st| 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 aa Irt m m i 1 |i r t ar t m i a
|t ta|i tt 1 j ai r aa|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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts \
K t It s
Functional, Re curre nt Abdominal Pain (RAP) (90%)
J st| t t | a]t , j t a| - 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 aa|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
| | | , | | , a ri r a|si s, sIt t |s It r 1 & |, | & , 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 sm 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
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 sr 1 rt m t
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 ]
|
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 |tsIi 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 tsIs 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 sm 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
sa||t t 1 | |t t 1 , It t 1 tt |t a ri r ]
| | | , 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts \1
K t It s
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| - t| t r |t i r | a rj a ra
| t m t |Ii t-a rt m i t sr 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 || w|
Irt aI j t r 1 i r ] rt sa |Is 1 X| | K 1 K - 1 X| | ar 1 K 1 | 1 | |
or
IF J a]t I-11 1 as J a1 m i I, - 11.!| - 11.!|
J r t r -It ti t ar 1 | a || 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 | & J t | st rtaIi t r
m a tt r si 1 t r t | st rtaIi t r J a ri r t | & 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
w| I k| t J I k| t
NOTES:
. | a || st j Iit t r|a j - | |t t 1 | & , | | | ar 1 1 iIIt rt r Iia|, a rir t | &M , | & , | |, t| t sI t-ra iI rt sj iraIt r t, sIt t | | & iI | | 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 >37.5C 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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| | | , | | 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 tIt si sI t| t ri t am r i t r i Ii s pneumococcus, meningococcus, 1 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
| | , E. coli, Listeria,
Klebsiella
Signs of Se ps is
rt sj i raIt r 1 i sIrt ss, tar 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. | | , E.coli, Listeria, . 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 . 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 . aureus
> 3 months tt Ia rt ti m t
j r t a m t tt tta s, 1 . influenzaeIj 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 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
sm 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts \!
K t It s
Diagnos is
J | | It r | |
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-I1 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 tIt 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 1-11X t I tast s
| | 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 | 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 | | 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
| 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 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 , att|t ti r It r | t rj t s
J I|a i 1 rt sIri tIi t r i I | 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 . influenzaeIj 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
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 sm 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 It 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 - | | | 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 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 | I M X It r | | |
I | V| |
J r sIaIi r , tt Iri m t tatt |t , |t It tt r att |t , att|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 st ||i r ] i I| t rI| 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 ssIt 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 | &
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts \I
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 |arr ]t |t ] K t It s
Etiology
J . pneumoniae 11X
J r t r Ij a| |t 1 . influenzae I1X
J M . catarrhalis I1X
J ]rt a j k Irt j !X
J ti ra| I1-I!X
Ris k Factors
J 1 atart 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 sr 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 Im 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 \ | 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 rI| 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 Im 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 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 sm 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
J - 1 t ars t |1 , ta |Ia rt | t It rt Irt aIm t r I t r 1 t raj i 1 Irt j kr Ii ]t r It sI
J raj i 1 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 as
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 rI| rt m ti r t 1 1 as
Indications for Tons ille ctomy
J j rt tt r , rt ta rrt r I Irt j It r si ||i Ii s
J j t ri It r si ||ar a| stt ss rart
J sm 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 rI| rt ]t r i t sIrai r t I | rt a j k | t m t |Ii t 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\-\ | t a rs aIIt r j | arr ]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 as, m a | t It ||t t 1 | j t t |i r ]
J j t r i ti ||i r t r t rI| 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 | | | t ti 1 t r tt t I
j rt tt 1 i r ] Irt j i r It tIi t r i r trt ast 1 k 1 , I| rt aI sa| , rt tt r I
star|t I It tt r
m a}t r tri It ri a. |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 1 t r | am s
t rI| 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 | | t r | rt atIi tt j rt It i r t r |t a |t tIt 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 k k
m i Ira| i r sa IIi ti t r tIsIt r t si s
at rIi t i r sa IIi ti t r tIsIt 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 sr 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 rI| rt m ti r t r t|i r 1 am i ti r
5. Impe tigo st t | t rm aIt |t ] 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts \1
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 as I 1 as - 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 as 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 | | i r It tIi t r . | V am j i ti ||i r ar 1 ]t r Iam i ti r
a r Ii | | | 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 | | . | V j t r i ti ||i r t \ 1 as 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 as
J tt m m a r i ta| |t Irt m t t | | t It rt j art tsm 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 rta, m i |1 tt a ]| , |t ]ra1 t It tt r
J j art tsm a| sIa]t
I-\ t t |s
j art tsm 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 sm 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 tsm 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|. | | | sm j It m s It ||t t 1 | j art tsm s t I tt a ]| i r ar aIt | ri |t t| i |1
J |m j | t tIt si s
J ta |Ia rt t I r ast j | arr ]t a| sa| t r asj i raIt
J I|a t rt stt r I ar Ii | t 1 sIai r i r ] t I j | arr ]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 tsm s t I tt a ]| art asst ti aIt 1 i I| tar t si s ar 1 It r aj r t a
J t rI| rt m ti r t \ 1 as
i st |aIt a r Ii | ! 1 as 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 rI| rt m ti r It r a|| | t a st | t |1 tt r IatIs
| t 1 i aIri ts !1 M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
INFECTIOUS MONONUCLEOSIS
J I| t ]rt aI i m i IaIt r
J | j sIt i r -| arr ti ra s | | V
J ssIt m i t ti ra| i r It tIi t r I| aI aIIt tIs m ar t r]ar ssIt 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 aIj i ta| |m j | t tIt s, |m j | t tIt si s, | t r t tt ||s
J ar t m i a
J I| rt m | t tIt 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 | arr ]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 ra 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 | . - 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 as t ]. M | I 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 | | sIt ar
J |aIt r i r tt sIi ]aIi t r s
| I 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| sm j It m aIi t | | , a||
| t s, a|| It | ri |t | | s i I| si ]r i Ii tar I ssIt m i t sm 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 | | sIt ar
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 tar 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 |at 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 It t r -\ t ars t I a]t
J t rI| t m a It ti ta m i s ar t rI| 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 as 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. 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], k 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 1-!X t I I| t st aIIt tIt 1
| t 1 i aIri ts !I M | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 Ij 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 rI| 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 ssIt 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 ssIt 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 ssIt m i t sIt rt i 1 s
Complications
J st tt r 1 ar i r It tIi t r 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 | . aureusar 1 | rt a j k 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 rI| 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 -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 tti 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 rI| 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 tar t Ii t
|t si t r i .t . Iar]t I |t si t r s
J sm 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 ssIt m i t si ]r s
M | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 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, sm j It m aIi t
J r t ar Ii | i sIam i r t s, K 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, ssIt 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 as 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 as I 1 as 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 tIt j t r i a
! 1 as 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 .
a | -t tti j i Ia|-
|m j | a1 t r t j aI|
m t as|t s 1- \ 1 as \ 1 as 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 rta, 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, | |
| 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 as -I 1 as 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 sr 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 as I 1 as 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 as 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 sm 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 rI| t m a \- \ 1 as 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 sm 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 rI| 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
CARDIOLOGY
HEART MURMURS
J !1-1X 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| asm j It m aIi t sm j It m s ar 1 si ]r s
t I tar1 i at 1 i st ast
Ii m i r ] ssIt |i t t }t tIi t r m a rm a r a|| 1 i asIt |i t, j ar ssIt |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 I Ii tt 1 sj |i IIi r ] t r
si r ]|t 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
Ii ||s m a rm a r ti | raIt r, | | | t r aj t t sa | at rIi t sIt r t si s, sm a|| V |
j a |m t r ar t }t tIi t r st II, | |t i r ], | | | k | , |
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 k , | 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, |
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 I 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 tar 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 sr 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 . V |
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 .]. V | , k | , | | k, t r 1 t tar1 i a| ta s| i t r 1 t It tI
tar 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 sr 1 rt m t
J sa | ata It | atIt ri a| t r 1 t tar1 i Ii s | | 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 k | , tt rrt tIt 1 V | 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 It 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 Ij t s
t sIi a m j ri m a m - tt m m t r i r | t r sr 1 rt m t
t sIi a m st ta r 1 a m - m t sI tt m m t r Ij 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 V| i r It ri ]| I aIri a m
J t IIt r asm 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 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. 1- 11X sj t r Iar t t a s t|t sa rt raIt i I k | 1 i am t It r - 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 It 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|| V | m a}t ri I
asm 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| ssIt |i t It | t |t ssIt |i t, | t sI | t ar1 aI | | |
| | | 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 V |
1 t |at 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 ssIt |i t aI | | | 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| 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 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 It 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 asm 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 | | , 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 V | ar 1 t sIi a m j ri m a m k | 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 sr 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 ssIt m i t tt r t a s rt Ia rr rt -t r It rs ssIt 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 tar t si s 1 I saI - I!X
J 1 i IIt rt r Ii aIt | t It t r tar1 i at ar 1 t I| t r taa st s t I tar 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 .]. k | , V | , | | 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 tar 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 ssIt m i t ti rta |aIi t r s | i ]a rt
J r t | t rr j rt st r Is i I| j rt ]rt ssi tt tar 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 It t r I| t It
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 V | j rt st r I, tar 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| | 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| si It| j rt tt 1 a rt
| k | k
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 tar t Ii t | t arI 1 t It tI
| t t r 1 i r Iar t
J t m | rt |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 ].
V |
| V t a II|t IratI t | sIra tIi t r | V1 1
M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts !I
K t It s
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
tar 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 tar 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
tri r ] | i t| 1 t trt ast s ssIt m i t rt si sIar tt
j art tsm t I raj i 1 ar 1 1 t t j | rt aI| i r ], i rri Ia| i |i I ar 1 tri r ]
i r trt ast 1 tar 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 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 V | 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|as 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 asm j It m aIi t i I| a j j t r t tIrt m i I ssIt |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, V | , tar taa st | 1 |
J m a rm a r. a| st r I t r ssIt |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 !X
J t IIt r asm 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 , sr tt j t t r sa 1 1 t r 1 t aI|
J m a rm a r. | M aI | | | 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 | | 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 sr 1 rt m t s t .]. tt r ]t r i Ia| ra | t ||a, K t t r ar sr 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
tar t si s
J j rt st r IaIi t r tari t s Irt m asm j It m aIi t It | 1 |
J m a rm a r. i 1 t sj |i I I m ati m a| t r t tj i raIi t r , | M aI | | | ,
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 ssIt 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 ! M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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], tar 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, sr 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 tsm 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, tar 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| sr 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 as |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 k |
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts !1
K t It s
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 sm 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 , sr 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 tsIt 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 tIt 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 asm 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 rI| 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 | , | t arI ta|tt
ir Irir sit
- m t m | rar t 1 ist r1 t rs. sj | t rt tIt sis
- t r tm 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
HEMATOLOGY. . . CONT.
Etiology
J 1 i t Iar, Ij i ta|| | t It 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- 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\-\ | t a rs
i r trt ast 1 rt Ii ta |t tIt tt a r I i r \-II | t a rs
i r trt ast 1 | t m t ]|t | i r i r \-11 1 as
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 sr 1 rt m t t I | t m t ]|t | i r , -| 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 Ij 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, Ij 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 - asm 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 , 1 atI|i Ii s st ||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 sm 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 ta 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts t
K t It s
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 tm 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 tIt 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, k 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 |
| |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 k 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 ] sm j It m t I
aa It i m m a r t 1 i st ast t .]. | |
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 Ij 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 ri 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 1X 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 tIt j t r i a, 1 | V, |t a |t m i a,
i r It tIi t r ti ra| , | |
| t 1 i aIri ts tI M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 tIt j t r i a i I| r t rm a| | | | , w| |
J i I aIj 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 tIt 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 It Ij t s
r t t r aIa| a||t i m m a r t I| rt m | t tIt 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 tIt j t r i t r t | t rr | t i s t I| t ri 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 as 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 as 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 |as 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 Ii 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| , trt j rt ti j i IaIt
M | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts t1
K t It s
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 tIt 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 sr 1 rt m t s t| rt m t st m a| sr 1 rt m t s
i m m a r t 1 t Ii ti t r t sr 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, Ij t s. k| | 1X , 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 sm 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 tIt 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 , 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 Ij 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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|
| sm 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 sm 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 tIt 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 sm 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
1X i I| asm 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 |tsIi 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 sm 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 sm 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 sr 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 | , | | , | V 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 , st ||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, | |
J X-ras 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, sr 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 sr 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
| | t
1 t rm aIt m t si Ii s t
1 t r t t| - 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 sr 1 rt m t s
]rt i r ] j ai r s t
Ii | rt m a|]i a t
rt I|t t sm j aI| t Ii t 1 sIrt j | t
K t It s
| t 1 i aIri ts tt M | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 aa|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 ssIt m i t sm 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 Ij 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
ssIt 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 , 1X | att ]t t 1 t a Itt m t , t rsI j rt ]r t si s
i I| ssIt 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 = | 1X | 11X M 11X | 1X |
a]t t I t r st I ar - ! - - ! -
| | 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 1.!| It r aI |t asI I t t |s
J t tIra-arIi ta |ar It aIa rt s. t rI| 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 tIt si s, I| rt m | t tIt 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 | Ij 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 tt|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 st ||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 asm 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts tI
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 , sm 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 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, ssIt 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-SCHNLEIN 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 sm j It m s
J It aIa rt s
s|i r . j a|j a| |t , r t r -I| rt m | t tIt 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| st ||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
sm 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 as 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 rI| t m a t I t rt j | arr 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 rI| 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 aIj i ta| | aasa|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
K t It s
Complications
J tt rt r ar arIt r tasta |i Ii s i I| ar t a rsm 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 , \-X i I rt tt i tt | V| | i I| i r 1
1 as 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 as
J t I I| t st i I| ar t a rm s. !1X t I ar t a rsm 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 k k | i |t It | ri |t
J |t ar Ii j |aIt |t I 1 t st t I k 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 Ij 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 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 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 , \- m m t |I|
1 i t I, t tt rti st
t 1 a taIi t r , j st| t st ti a| sa j j t rI
| j t ]|tt m i a
taa st . m i sst 1 I1 t |at 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|| asm 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 sm 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 |at 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 sr 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 sm 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. 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 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
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 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
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. sm 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 , | 1 , 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 tj 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 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
tt r sIi Ia Ii t r a| | t r t a]t 1 t |at 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 IarI| 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 sm 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
]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
K t It s
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 , | 1 , 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 |art Ij 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. tt|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 sm 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 |,
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 |, | |
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 sr 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 sr 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 tIt 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 | 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 as | 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 tIt 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 \- 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 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 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 !1-1X kr Ii | | M 1 i st ast
j t I - 1X
Sys te mic | | | t |arIt ri Ii s
| | wt ]t r t rs
| a r I r t j | ri Ii s | t t 1 j asIa rt s
| rt ]|t | a |i r t m i a 1 t r t t| - 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 X
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 It t r I-t t ars t |1
11X art sIt rt i 1 -rt sj t r si tt

K t It s
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 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 tIt It ti t a]t r Is
J t| i |1 rt r i I| r t j | rt Ii t sr 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 sm 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. | I , 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. | I , 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 sm 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| | I , V| | | , It-| M k It asst ss rt r a| starri r ]
J 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
Ia]t | -| | | . m t rt I| ar 1X rt st |tt i I| Ii m t
t | st rtt i I| rt j t aI V| | | , | I , 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 | I M l , r i Irt Ia rar It i r
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 sIarm rt t m
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 ,
| I , | , sa r]i ta| t tj |t raIi t r , |art Ij 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 | arr ]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 |arr ]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.influenzaIj t |
| 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 ] st ||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 | | | I111 | t ti t K t It s ar 1 | t tIa rt 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 |arr ]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 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
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 ra 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 | 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 | arr ]t a| sa|
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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s
K t It s
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 . aureus | M V, | V Chlamydia trachomatis
1 . influenzae | r I|a t r ta ti ra s Ureaplasma
. pneumoniae | arai r I|a t r ta ti ra s
1 m t r I| s - . pneumoniae | V |
! t ars . aureus k1 t r t ti ra s
1 . influenzae | r I|a t r ta ti ra s
- ! t ars . 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 rI| rt m ti r
-1 m t r I| s
am j i ti ||i r I t rI| 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 rI| rt m ti r
ASTHMA
J t| aratIt ri tt 1 | ai ra | 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 ra 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 | | | I111 | t ti t K t It s ar 1 | t tIa rt t ri t s | t 1 i aIri ts II
K t It s
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 , -| |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 |
sm 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| sm 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| sm 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
I-a]t r i sIs. sa|| a Iam t | Vt r It |i r 1.11ttI|] i r 1tt K | 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 as
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 .]. si m m i r ]
m t r i It ri r ] i I aj j rt ti aIi t r t I sm 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 | !1 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 ] . aureus,
|. aeruginosa, H. influenzae
| t m t j Isi 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 sr 1 rt m t , rt tIa| j rt |aj st
t|a | | i r ] t I Ii r ]t rs
K t It s
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 st 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 sr 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 sr 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 st 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 tm 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 | & , 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 st| 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
| 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
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 aa!
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| | | . 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 | | | | . Ij 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 | X| k| | Y. 1 aIi r ], atIi tt , j rt It rt r tt , Ij 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, | s, st ta a| a| a st
J | | | | | | . 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 asm 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 It t r
j t ri t 1 s, t r att ra]t i I Ia|t s 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 i t| | | i |1 rt r , t rt r It
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| r. . | t rr sIt i r , | r. !. | ri t 1 m ar , | r. | . 1 i ||i ar1 ,

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