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TitlePediatrics - Baby Nelson - Mohamed El Komy
File Size16.1 MB
Total Pages421
Table of Contents
                            Contents
Color Plates
	Growth
	Nutrition
	Genetics
	Infectious
	Neonatology
	Diarrheal
	Cardiology
	Hematology
	GIT
	Chest
	Nephrology
	Endocrine
	Neurology
Growth & Development
	Stages of Growth & Development
	Assessment of growth
	Assessment Of Development
Infant Feeding
	( Breast Feeding )
	Program of Breast Feeding
	Difficulties In Breast Feeding
	Contraindications of breast feeding
	(Artificial Feeding )
	Program of Artlfieial Feeding
	weaning)
Nutrition
	Normal Nutritional Requirements
	(Protein Calorie Malnutrition (PCM))
	( Kwashiorkor (KWO))
	(Marasmus}
	Management ofPCM
	Chi
ldhood Obesity
	Minerals Req
uirements
	Vitamin Metabolism
	( Disorders of Vitamin D Metabolism )
	Hypervita
minosis D
	Tetany
	Rickets
	(vitamin D Deficiency Rickets)
	( Vitamin D Resistant Rickets )
	(Renal Rickets]
	Vitamin D Dependent Rickets Type I
	( Vitamin D dependent rickets type II)
Genetics
	Basis of Genetics
	(Gene Expression J
	Cell Division
	Modes of Inheritance
	(Chromosomal Analysis)
	( Chromosomal Anomalies )
	( Kleinfelter Syndrome)
	(Turner Syndrome)
	(Down Syndrome J
	Other Trisomies
Infections
	( Scarlet Fever )
	Diphteria
	( Pertussis (whooping cough) )
	( Enteric Fever (typhoid fever) J
	Tetanus)
	Measles Rubella Roseola infantum Erythe
ma infectiosum
	( Infectious Mononucleosis )
	( Chicken Pox )
	Mumps
	Poliomyelitis
	Parasitic Diseases
	Vaccines
	(Non Compulsory Vaccines)
Diarrheal Disorders
	( Diarrheal Disorders )
	(Acute Diarrhea)
	( Persistent Diarrhea)
	Dehydration
	(Chronic Diarrhea)
	( Celiac disease )
Neonatology
	[Neonatal Resuscitation J
	(Developmental Reflexes)
	[ Birth Injuries)
	(Neonatal Septicemia )
	L Congenital Infections (TORCH) ]
	( Neonatal Jaundice)
	( Unconjugated Hyperbillrubinemia )
	( Kernicterus)
	( Conjugated Hyperbilirubinemia )
	( Hemolytic Disease Of The Newborn J
	( Hemorrhagic disease of the newborn )
	( Neonatal Polycythemia )
	( Neonatal Bleeding )
	( Neonatal Anemia )
	Necrotizing Enterocolitis (NEC)
	( Perinatal Asphyxia )
	( Neonatal Seizures )
	Neonatal Respiratory Distress
	( Respiratory Distress Syndrome (RDS) )
	( Neonatal Cyanosis J
	Abnormal Gestational Age And Birth Weight
	( Small for gestational age )
	Prematurity)
	( Management of Prematurity ( = ofLDW) J
	Postmaturity
	( Infant of diabetic mother )
	Examination Of The Newborn
Cardiology
	Abbreviations)
	( Diagnosis of a cardiac case )
	Common Valvular Lesions
	(Congenital Heart Diseases )
	Congenital A cyanotic Heart Diseases (80o/o)
	Cyanotic Congenital Heart Disease (CCHD)
	CCHD with increased pulmonary Blood Flow
	( Rheumatic Fever )
	[Infective Endocarditis )
	( Heart Failure J
	( Systemic Hypertension )
	Shock
Hematology
	Introduction
	Anemia
	(Bone Marrow Failure)
	( Pure Red Cell Anemia J
	( Aplastic Anemia )
	(Iron Deficiency Anemia )
	( Megaloblastic Anemia )
	Hemolytic Anemia
	( Glucose - 6 - Phosphate Dehydrogenase Deficiency J
	(Paroxysmal Nocturnal Hemoglobinuria J
	Chronic Hemolytic Anemia
	( Hereditary Spherocytosis )
	Thalassemia
	( B Thalassemia Major)
	( Sickle Cell Disease J
	( Auto Immune Hemolytic Anemia (AIDA) J
	Approach
 to a Case of Anemia
	Hemorrhagic Disorders
	Purpura)
	( Immune Thrombocytopenic Purpura )
	( Anaphylactoid Purpura (Henoch Schonlein Purpura) J
	Coagulation Disorders
	( HemophellaA)
	Vascular Hemophilia 
(Von Willbrand disease)
	( Dissiminated lntravasctdar Coagtdation ) (DIC)
	Leukemia
	Acute Lymphoblastic Leukemia (ALL)
	Acute Myeloid Leukemia
	Lymphoma
	( Hodgkin Disease )
	(Non Hodgkin Lymphoma)
	Wilms' Tumor
	Neuroblastoma
Gastroenterology & Hepatology
	Causes of Vomiting
	Causes of Abdominal pain
	( Gastro- Esophageal Reflux Disease )
	Congenital Hypertrophic Pyloric Stenosis
	( Congenital Aganglionic Megacolon J
	Achalazia
	Hepatology
	( Hepatitis]
	[ Acute Viral Hepatitis )
	( Chronic Hepatitis )
	( Liver Cirrhosis )
	( Portal Hypertension J
	Ascites
	( Veno Occlusive Disease )
	( Budd Chiari Syndrome )
	Gastrointestinal Bleeding
Pulmonolgy
	Acute Pharyngitis
	Acute Otitis Media
	Stridor
	Acute Infectious Stridor
	Lower Respiratory Diseases
	Pneumonia
	Recurrent pneumonia
	Slowly Resolving Pneumonia
	( Acute Bronchiolitis )
	( Bronchial Asthma
	{ Wheezy Chest )
	Foreign body aspiration
	( Dry Pleurisy )
	( Pleural Effusion )
	Empyema
	( Hydropneumothorax J
	Pneumothorax
	( Tuberculosis )
Nephrology
	Glomerulonephritis
	( Acute Post Streptococcal Glo•nertdonepllritis )
	( Hemolytic Uremic Syndrome (BUS) )
	Hematuria
	Proteinuria
	( Nephrotic Syndrome }
	(Idiopathic nephrotic syndrome )
	Treatment of Nephrotic Syndrome
	( Acute Renal Failure )
	( Chronic Renal Failure )
	( Urinary Tract Infections )
	( Systemic Lupus Erythematosis )
Endocrinology
	Hypopituitarism
	Thyroid Gland
	Congenital hypothyroidism (cretinism)
	Acquired Hypothyroidism
	Short Stature
	Puberty
	Diabetes Mellitus
	( Insulin dependent diabetes mellitus )
	(Diabetic Keto Acidosis (DKA))
	( Polyuria )
	Diabetes Insipidus
Neurology
	Meningitis
	Seizures
	Hydrocephalus
	Microcephaly
	( Cerebral Palsy)
	Mental Retardation
	Acute post infectious polyneuropathy
	Coma
Pediatric basic life support (BLS)
                        
Document Text Contents
Page 2

Baby Nelson
.1n

Illustrated Pediatrics

Editor

Dr. Mohamed A. EL Komy
Lecturer of pediatrics , Zagazig university

MRCPCH Pt II (London)

Contact me
Dr. Mohamed Abd El Hakam El komy
Mobile: +2 01000 8 9045
Home : +2 055 2332 877
Clinic : + 2 050 692 11 66

Page 210

~ 197 ~

(ventricular septal defect (VSD) J

Definition: Defect in interventricular septum.
Types ofVSDs:

1- Perimembraneous defect: The commonst type (70%)
2- Outlet defect; (also called infundibular or subarterial

or supracristal or subpulmonary).
3- Inlet defect.
4- Muscular defects: Either single or multiple (Swiss cheese).

Hemodynamics
Blood is shunted from left ventricle to right ventricle
___.t pulmonary blood flow ___.t input to left atrium
and left ventricle.

General manifestations
1- Small VSD: Usually asymptomatic, discovered accidentally.
2- Large VSD: - Features of increased pulmonary blood flow

- Congestive heart failure with tachypnea, tachycardia
& enlarged tender liver.

Precordial Examination
- Evidence of biventricular enlargement (L VH & RVH)
- Systolic thrill on lower left sternal border.

Auscultation
1- Murmer ofVSD:

- pansystolic.
- on lower left sternal border.
- propagate all over the heart.
- Harsh (louder if small).

2- Pulmonary area: Accentuated P2 & soft systolic murmer indicate pulmonary
hypertension.

3- Apical: Soft mid diastolic murmer may be heard due to relative mitral stenosis.
Investigations

1- Chest X-ray:
-Large VSD ~Cardiomegaly with biventricular enlargement (LVH & RVH).

& increased pulmonary vascular markings (Plethora).
2- ECG:

-Large VSD ~ Biventricular enlargement (LVH & RVH) & LAD.
3- Echo: diagnostic
4- Cardiac catheter: pre operative.

Complications
- Recurrent heart failure common with large defects.
- Recurrent pulmonary infections
- Infective endocarditis common with small defects.
- Reversal of the shunt.

Page 211

~ 198 ~

Treatment
1- Medical:

-Control heart failure (diuretrics, digoxin, vasodilaters).
- Prophylaxis against infective endocarditis.
- Antibiotics for chest infections.
-Follow up with ECG & Echo to confirm spontaneous closure.

2- Surgical:
-Types:

a- Palliative: Pulmonary artery banding (less favoured).
b- Direct closure of the defect.

- Indications:
a- Symptomatic large defects.
b- Growth failure uncontrolled medically.
c- Pulmonary hypertension. .
d- Supracristal VSD (aortic cusp may herniate inside resulting in aortic

regurge).
Prognosis

30-50% of small defects (especially muscular) close spontaneously within I 51 2-years.

(Atrial septal defect (ASD) )
_,
\" ~ ...

svc
Siuu:> vtmo:;u:; ASO

!.iecumlurn ASD
Definition: Defect in interatrial septum. Primum ASD •:'.

Types of ASDs: ~ ·. . ,··· Tricuspid
1- Ostium secundum defect : ~ · 1 ~:.; valve

- The commonest type. 1 vc ---t( o. ·~
-Lies in the middle part ofthe septum at the site of fossa ovalis.
- Association: may be with Holt Oram syndrome (Absent radii , l 51 degree

heart block , ASD).
2- Ostium primum defect: (Partial ECD)

- Lies in the lower part of the septum
- Association: usually with cleft of mitral valve leaflet. -+ mitral regurge.

3- Sinus venosus defect:
-Lies in the upper part of the septum near orifice of superior vena cava.
- Association: usually with partial anomalous pulmonary venous return.

Hemodynamics
Blood is shunted from left atrium to right atrium
-+right ventricle -+j pulmonary blood flow
(more with primum defects).

General manifestations
1- Asymptomatic in most cases.
2- Large ASD (especially primum defect) may present with

features of increased pulmonary blood flow .

Precordial Exnmination
-May be evidence ofRVH.

Page 420

Nephrology

systemic lupus erythematosis Cushingeod features.
( malar rash).

Endocrine

Ascites & Scrotal oedema
(nephrotic syndrome).

Achondroplasia.

Cretinsm (Congenital hypothyriodism)
----~~~~~---------------------~

Page 421

Neurology

meningitis ( septicaemic form ) before & after treatment.

Oxycephaly. hydrocephalus hydrocephalus
(sunset appearance).

Dandy Walker malformation (prominent occiput & meinengeomyelocele).

r

Tetanus
(tonic convulsions) ""

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