Specialities of pediatric surgery III. Year - volume Morning activation surgery test • Interval of normokalamia? • Name the five main symptomes of local inflamation • Interval of normoglycemia? • The first aid in fracrures? • Wich is interval of normal pH of plasma? Moarning activation surgery test conclusions • Interval of normokalamia? • 3,8 – 5,3 • Name the five main symptomes of local inflamation • Calor, rubor, Tumor, Dolorů, Functio laesa • Interval of normoglycemia? • 3,6 - 54 • The first aid in fracrures? • Imobilisation, transport • Wich is interval of normal pH of plasma? • 7,36 – 7,44 Anamnesis • Family anamnesis • Personal anamnsis • Epidemiological anamnesis • Farmacology anamnesis • Allergic anamnesis • Fyzilogical functions • (Gynecological anamnesis) Anamnesis • About birth • Contact with infection • DMO, PMR, obezity • Psychical and social status • Undirect anamnesis • With child only supplementary qustions • Battery child syndrom – be careful • State of consciousnesd • We can weak up it from teh sleep • Infants don´t respond to verbal irritation • We examine reflexes (mammilingus, defense,...) Aspection • Hematoma - BCS • Head - shape, size – congenital deformties • Chest - excavatum x carinatum • Abdomen – ventral hernias, umbilicus 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 Auskultation • 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, lymphytic nodes • Abdomen – First we examine supposed painless region – Blumberg, Plenies, Murphy, Tapott • Extremities Specialities of children • Injuries • Congenital defects • Infections • Tumoürs Children specialities 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 • Perstalsis in chest cavity – diaphragmatic hernia • Congenital heart defects • BCS 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 Speciality 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 Excretory system 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 • Inususception 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 ruptura Thank you for your attention