Clinical manifestations of Sickle cell anemia:
1-It is common in negros.
2-Starting after the 6th month of age. Because in this asymptomatic period high levels of HbF protect the patient.
3-Features of anemia"Non- specific":
-Fatigue, Headache, Poor feeding, Lethargy, Dizziness, Dyspnea, irritability, Arthralgias, abdominal pain.
Also signs such pallor, Jaundice, tachycardia and postural Hypotension.
4-Features of chronic hemolysis such as hepatospleenomegaly, GB stones, skeletal manifestations.
5-Renal disorders (CRF, NS, Proteinuria.).
6-Crisises such as splenic sequestration crisis, aplastic crisis, vaso-occlusive episodes such as stroke, pulmonary infarction hepatopathy or hematuria, acute chest syndrome.
May be the presenting features.
PP of crisis: hypoxia, dehydration, infection, stress, trauma..etc.
7-Increase susceptibility to overwhelming infection especially S.pneumoniae.
8-Late manifestations:
1-Long term consequences of chronic hemolytic anemia.
2-Tissue hemosiderosis.
3-Gallstones.
4-Leg ulcers.
5-Renal disease.
#Pediatrics
1-It is common in negros.
2-Starting after the 6th month of age. Because in this asymptomatic period high levels of HbF protect the patient.
3-Features of anemia"Non- specific":
-Fatigue, Headache, Poor feeding, Lethargy, Dizziness, Dyspnea, irritability, Arthralgias, abdominal pain.
Also signs such pallor, Jaundice, tachycardia and postural Hypotension.
4-Features of chronic hemolysis such as hepatospleenomegaly, GB stones, skeletal manifestations.
5-Renal disorders (CRF, NS, Proteinuria.).
6-Crisises such as splenic sequestration crisis, aplastic crisis, vaso-occlusive episodes such as stroke, pulmonary infarction hepatopathy or hematuria, acute chest syndrome.
May be the presenting features.
PP of crisis: hypoxia, dehydration, infection, stress, trauma..etc.
7-Increase susceptibility to overwhelming infection especially S.pneumoniae.
8-Late manifestations:
1-Long term consequences of chronic hemolytic anemia.
2-Tissue hemosiderosis.
3-Gallstones.
4-Leg ulcers.
5-Renal disease.
#Pediatrics
Why do newborns develop
physiological jaundice?
1-Decreased RBC life span.
2-Decreased Y protein and Ligandin in liver.
3-Decreased activity of UDP glucronyl transferase.
4-Increased enterohepatic circulation.
#Pediatrics
physiological jaundice?
1-Decreased RBC life span.
2-Decreased Y protein and Ligandin in liver.
3-Decreased activity of UDP glucronyl transferase.
4-Increased enterohepatic circulation.
#Pediatrics
-Minimal change nephrotic syndrome (MCNS) is most commonly seen in 85% of all cases of nephrotic syndrome in children.
#Pediatrics
#Pediatrics
Note
•Adult remnants of fetal circulation includes:
1- Umbilical vein = Ligamentum teres
2- Ductus venosus = Ligamentum venosus
3- Foramen Ovale = Fossa cialis
4- Umbilical arteries = Proximal part contribute to the internal iliac arteries and superior vesical arteries whereas the distal parts collapse and become fibrotic forming the medial umbilical ligaments.
5- Ductus arteriosus= Ligamentum arteriosum or Harvey's ligament.
#Surgery
•Adult remnants of fetal circulation includes:
1- Umbilical vein = Ligamentum teres
2- Ductus venosus = Ligamentum venosus
3- Foramen Ovale = Fossa cialis
4- Umbilical arteries = Proximal part contribute to the internal iliac arteries and superior vesical arteries whereas the distal parts collapse and become fibrotic forming the medial umbilical ligaments.
5- Ductus arteriosus= Ligamentum arteriosum or Harvey's ligament.
#Surgery
Remember:
-The term malnutrition is used to denote undernutrition, overnutrition and selective nutritional deficiencies.
However, the terms malnutrition, PEM and undernutrition are often used interchangeably.
-Undernutrition occurs due to inadequate intake, poor absorption or excessive loss of nutrients.
-Overnutrition occurs due to excessive intake of nutrients.
#Pediatrics
-The term malnutrition is used to denote undernutrition, overnutrition and selective nutritional deficiencies.
However, the terms malnutrition, PEM and undernutrition are often used interchangeably.
-Undernutrition occurs due to inadequate intake, poor absorption or excessive loss of nutrients.
-Overnutrition occurs due to excessive intake of nutrients.
#Pediatrics
Obesity is a condition with exceas amount of body fat.
-There is an increase in the number and size of adipocytes.
-A child whose weight for age is between 110% and 120% of the standard weight is known as overweight.
-While that more than 120% of the
standard weight is obese.
#Pediatrics
-There is an increase in the number and size of adipocytes.
-A child whose weight for age is between 110% and 120% of the standard weight is known as overweight.
-While that more than 120% of the
standard weight is obese.
#Pediatrics
Remember:
-PDD "Postdiarrheal abdominal distension"
It occurs as a complication after diarrhea due to hypokalemia, paralytic ilius.
#Pediatrics
-PDD "Postdiarrheal abdominal distension"
It occurs as a complication after diarrhea due to hypokalemia, paralytic ilius.
#Pediatrics
Subacute sclerosing panencephalitis:
-It is a rare form of chronic progressive brain inflammation caused by slow infection with certain defective strains of hypermutated measles virus.
-Cause: Measles virus.
-Usual onset: 6-20 years after infection with measles.
-Frequency: About 1 in 10,000 people infected by measles.
-Symptoms: Behavior changes, seizures, spasticity, poor coordination,ataxia, coma.
-It's also divided into 4 stages
-Diagnostic: EEG, Serologic testing, brain biopsy.
-Prevention:
Measles vaccine
-Treatment:
Supportive treatment,
Intrathecal interferon alpha, intravenous ribavirin.
-Prognosis: usually fatal.
#Pediatrics
-It is a rare form of chronic progressive brain inflammation caused by slow infection with certain defective strains of hypermutated measles virus.
-Cause: Measles virus.
-Usual onset: 6-20 years after infection with measles.
-Frequency: About 1 in 10,000 people infected by measles.
-Symptoms: Behavior changes, seizures, spasticity, poor coordination,ataxia, coma.
-It's also divided into 4 stages
-Diagnostic: EEG, Serologic testing, brain biopsy.
-Prevention:
Measles vaccine
-Treatment:
Supportive treatment,
Intrathecal interferon alpha, intravenous ribavirin.
-Prognosis: usually fatal.
#Pediatrics
Splinter haemorrhage:
It is not a specific sign of infected endocarditis
D.D:
Trauma...is the most common cause
Infective endocarditis.
Subungual haematoma.
Hemophilia.
Leukemia.
Meylobleroprative disorders.
Vasculitis.
DIC.
SLE.
Sepsis.
#Medicine
It is not a specific sign of infected endocarditis
D.D:
Trauma...is the most common cause
Infective endocarditis.
Subungual haematoma.
Hemophilia.
Leukemia.
Meylobleroprative disorders.
Vasculitis.
DIC.
SLE.
Sepsis.
#Medicine
Role of QRS complexes in ECG diagnoses:
A-LVH
B-Dextrocardia or limb leads reversal
C-STEMI
D-HOCM
E-RBBB
F-LVH e Strain
G-Pacing Rhythm
H-LBBB
I-WPW
J-RVH e Strain.
#Medicine
A-LVH
B-Dextrocardia or limb leads reversal
C-STEMI
D-HOCM
E-RBBB
F-LVH e Strain
G-Pacing Rhythm
H-LBBB
I-WPW
J-RVH e Strain.
#Medicine
Quick Notes
Clinical manifestations of Sickle cell anemia: 1-It is common in negros. 2-Starting after the 6th month of age. Because in this asymptomatic period high levels of HbF protect the patient. 3-Features of anemia"Non- specific": -Fatigue, Headache, Poor…
Investigations in case of SCD:
•CBC:
-Low Hb, low Ht value
-Normocytic normochromic anemia,
Leukocytosis is common.
-Evidence of hemolysis:
Reticulocytosis- increased erythropoiesis
↑Unconjugated bilirubin
↑Fecal sterobilonogin
↑LDH
↑Urinary urobilinogen.
•Blood film:
-Crescent-shaped sickled RBCs ; sickle cells
-Howell-Jolly bodies
•Skull x-ray :
-May show hair-on-end (“crew cut”) sign
•Hemoglobin electrophoresis:
-Shows 80-99% HbS, HbF may be elevated 2-10%.
-This test confirms the diagnosis.
Note: The HbA2 is not increased, (unlike beta-thalassemia in which HbA2 is increased).
•Prenatal:
-By CVS "chorionic villous sampling" and DNA analysis.
#Pediatrics
•CBC:
-Low Hb, low Ht value
-Normocytic normochromic anemia,
Leukocytosis is common.
-Evidence of hemolysis:
Reticulocytosis- increased erythropoiesis
↑Unconjugated bilirubin
↑Fecal sterobilonogin
↑LDH
↑Urinary urobilinogen.
•Blood film:
-Crescent-shaped sickled RBCs ; sickle cells
-Howell-Jolly bodies
•Skull x-ray :
-May show hair-on-end (“crew cut”) sign
•Hemoglobin electrophoresis:
-Shows 80-99% HbS, HbF may be elevated 2-10%.
-This test confirms the diagnosis.
Note: The HbA2 is not increased, (unlike beta-thalassemia in which HbA2 is increased).
•Prenatal:
-By CVS "chorionic villous sampling" and DNA analysis.
#Pediatrics