Specific of pediatric surgery III. Year - volume dite_diskuse Anamnesis •Family anamnesis •Personal anamnesis •Epidemiological anamnesis •Farmacological anamnesis •Allergic anamnesis •Fyzilogical functions •(Gynecological anamnesis) upoutavka_recepty_narrow Anamnesis •About birth •Contact with infection •DMO, PMR, obezity •Psychical and social status •Undirect anamnesis •With child only supplementary qeustions •Child abuse and negleck (CAN) – be carefull • • 3_280_25186NWLRGB75 •State of consciousnesd •We can weak up it from the sleep •Infants don´t respond to verbal irritation •We examine reflexes (mammilingus, defense,...) 2_8864_25304NWLRGB1 •Behaviour •spontaneous •Fear •Change reactions without parents •Hematoma - CAN •Head - shape, size – congenital deformties •Chest - pectus excavatum x carinatum •Abdomen – ventral hernias, umbilicus • oci1 Aspection 3_4529_terezka2 Percussion •Head – pain, impression •Chest –Hypersonorous •pneumothorax –Hyposonorous •Hydrothorax, infiltration –Cardial shadow – change of index,location •Kardiomyopahia, big vessels transposition •Abdomen –Hypersonorous •Pneumoperitoneum, ileus, enteral colic - tormina –Hyposonorous •Ascites, hemoperitoneum, infiltration – • Auscultation •Neck – a. carotis communis - stenosis •Chest –Pneumothorax •Dimininshed breathing or nothing –Hydrothorax •Damped breathing –Inflamatory or spastic fenomens • •Abdomen –Normal peristalsis –Intensive peristalsis •Ileus obstructive –Deadly silence •Ileus - paralysis Palpation •Head • – Big fontanella, impressions •Chest –Ribs fracture, lymphatic nodes •Abdomen –First we examine supposed painless region –Blumberg, Plenies, Murphy, Tapott •Extremities – – Specialities of children •Injuries •Congenital defects •Infections •Tumours • – – Head •Hydrocefalus – head circumference •Craniostenosis – premature closing of big fontanella, small head circumference •Fissures – lip, palate, mandible, jaw bone • – – Neck •Persistant branchial arcus (cysts, fistulas) •Congenital torticolis • • – – Chest •Pectus excavatum x carinatum •Peristalsis in chest cavity – diaphragmatic hernia •Congenital heart defects •CAN - multiple ribs fracture • – – Abdomen •Ventral hernias •Omfalocele – persistant yolk sac •Gastroschisis • • – – Limbs •Luxatio perianularis (RU joint) •Willow stick fracture •Epiphyseolysis • •Good and fast healing •Great ability of remodelation • – – Gastrointestinal •Atresia of oesophagus – salivation after the birth polyhdramnion, we can´t establishe NG tube •Atresia of duodenum – double bubble on X ray vomiting, polyhydramnion •Necrotic enterokolitis •Meconious ileus – CF •Atresia of anus •Burn of GIT •Foreign body of GIT • – – Respiratory system •Cystic fibrosis •Bronchopulmonal dysplasia (33. w.g.) •Laryngitis •Foreign bodies • – – Excretory system •Hydronephrois •Wilms tumour •VUR •Hypospadia •Stenosis of urethra •Testicular retention Nervous system •Hydrocephalus •Meningomyelocele •Tumours – gliomas •Craniostenosis •Child cerebral palsy •Light cerebral dysfunstion Musculosceletal system •Coxa vara •Aseptic necrosis of femoral head •Pes equinovarus •Morbus Oosgod – Schlatter •Spatic contractures •Cysts and tumours (Ewing) Diagnostic test Case 1 •Bend over •Subfebrilia •Emesis •Pain in right hypogastric region •Anamnesis cca 3 hours •Sonografic examination negative •CRP 12 •WBC 6,4 •Appendicitis acuta Case 2 •Age 3 years •Diarrhoea with blood •Abdoinal bloating •Emesis •Intensive peristalsis •Sonografic examination positive •Intususception Case 3 •Header •4 s unconsciousnesd •Somnolence •Emesis •Headache •X ray negative •CT positive •Epidural hematoma Case 4 •Fall from a tree •Left side of body impact •Urina without erytrocities •Pallor •Pain of left shoulder •Ultrasonography positive •CT positive •RBC decline •Lienal rupture • Radiodiagnostic test 1 1 Oblique tibial and fibular fracture Elastic stable intramedullary nailing (ESIN) Prevot nails 2 2 Femoral fracture – proximal diaphysis Proximal femoral nail – possible by older children 17 years old boy 3 3 Green stick fracture 4 4 Distal metaphyseal fracture of forearm Only reposition and část is first choice method 5 5 Supracondylar fracture of humerus Close reduction and percutaneous pinning - CRPP 6 6 Radial condyle fracture of humerus 7 7 Epiphyseolysis SH II of proximal humerus ESIN 8 8 Epidural hematoma typical lenticular shape 9 9 Baterry in stomach - need to early endoscopic extraction 17.4.2005 10 10 Fluid levels by standing or hanging position = ileus Pneumatosis without levels Thank you for your attention