Problemen Van Klinische Genetica, Verloskunde, Pediatrie En Adolescentie
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Samenvatting Pediatrie - Problemen van Kind en Adolescent
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Course
Problemen Van Klinische Genetica, Verloskunde, Pediatrie En Adolescentie
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Universiteit Gent (UGent)
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Problemen Van Klinische Genetica, Verloskunde, Pediatrie En Adolescentie
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Pediatrie
• Voorbeeldvraag: Lisa w op 28w ZS geboren via vaginale bevalling omwille van incompetente
cervix bij mama. De ouders komen bij u omdat ze ongerust zijn over de evolutie op lange
termijn. Welke van de volgende elementen tijdens de neonatale intensieve zorgen periode zal
best correleren met de klinische outcome over 5 jaar?
o A. Toediening van surfactant
o B. Retinopathie graad I
o C. Apnoe van de prematuur
o D. Periventriculaire leukomalacie
o Opl:
• Epidemiologie NIET kennen, WEL een idee hebben (wat komt veel voor en wat minder)
Inhoud
1. Rechten van het kind ..................................................................................................................... 22
2. Algemeen....................................................................................................................................... 22
3. Normale ontwikkeling van het kind .............................................................................................. 23
3.1 Grove motoriek (mediaan) .................................................................................................... 24
3.2 Reflexen (mediaan) ............................................................................................................... 25
3.3 Fijen motoriek en visus (mediaan) ........................................................................................ 25
3.4 Taal, spraak, gehoor (mediaan) ............................................................................................. 25
3.5 Sociale vaardigheden (mediaan) ........................................................................................... 25
3.6 Alarmtekenen ........................................................................................................................ 26
3.6.1 Gehoor afwijkingen ....................................................................................................... 26
3.6.2 Visus afwijkingen ........................................................................................................... 27
4. De pasgeborene............................................................................................................................. 28
4.1 Definities................................................................................................................................ 28
4.2 Wat heb je nodig voor een succesvolle zwangerschap ......................................................... 29
4.2.1 Preconceptuele zorg ...................................................................................................... 29
4.2.2 Prenatale diagnostiek .................................................................................................... 29
4.2.3 Foetale geneeskunde .................................................................................................... 30
4.2.4 Maternele risicofactoren voor foetus ........................................................................... 30
4.3 Intra-uteriene infecties.......................................................................................................... 31
4.3.1 Toxoplasmose (toxoplasma gondii = parasiet) .............................................................. 31
4.3.2 Congenitaal rubella syndroom ...................................................................................... 32
4.3.3 Cytomegalie ................................................................................................................... 32
4.3.4 Varicella zoster .............................................................................................................. 32
4.3.5 Syfilis .............................................................................................................................. 32
4.4 Opvang pasgeborenen .......................................................................................................... 33
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, 4.5 Antropometrie bij de geboorte ............................................................................................. 34
4.5.1 IUGR: foetus die zijn groeipotentieel niet bereikt heeft ............................................... 34
4.5.2 Macrosome baby (te grote baby) .................................................................................. 34
4.6 Routine onderzoek bij de pasgeborene ................................................................................ 35
4.6.1 Afwijkingen die spontaan verdwijnen ........................................................................... 35
4.6.2 Significante afwijkingen ................................................................................................. 35
A. Naevus flammeus .............................................................................................................. 35
B. Caverneus hemangioom .................................................................................................... 36
C. Afwijkingen ontdekt bij routine onderzoek....................................................................... 36
4.7 Preventie ............................................................................................................................... 36
4.7.1 Medicatie: vitamine K .................................................................................................... 36
4.7.2 Neonatale screening ...................................................................................................... 36
4.8 Geboortetrauma.................................................................................................................... 37
4.8.1 Weke delen letsels......................................................................................................... 37
4.8.2 Zenuwletsels .................................................................................................................. 38
4.8.3 Fracturen ....................................................................................................................... 38
4.9 Icterus .................................................................................................................................... 38
4.10 Aangeboren afwijkingen........................................................................................................ 40
4.10.1 Hernia diafragmatica ..................................................................................................... 40
4.10.2 Gespleten lip en verhemelte ......................................................................................... 40
4.10.3 Pierre-Robin syndroom ................................................................................................. 40
4.10.4 Slokdarmatresie............................................................................................................. 40
4.10.5 Dunne darmobstructie .................................................................................................. 41
4.10.6 Dikke darmobstructie .................................................................................................... 41
4.10.7 Omfalocoele/ Gastroschisis ........................................................................................... 41
5. Pathologie van de pasgeborene .................................................................................................... 41
5.1 Perinatale asfyxie .................................................................................................................. 41
5.1.1 Oorzaken asfyxie ........................................................................................................... 42
5.1.2 Behandeling, preventie en prognose ............................................................................ 42
5.2 Pathologie van de prematuur................................................................................................ 43
5.2.1 Respiratory Distress Syndroom (vroeger: hyaliene membranen ziekte) ...................... 43
5.2.2 Apnoe en bradycardie ................................................................................................... 43
5.2.3 Voeding, metabolisme en infecties ............................................................................... 44
5.2.4 Intracraniële letsels ....................................................................................................... 44
A. Bloedingen ......................................................................................................................... 44
B. Ischemische letsels ............................................................................................................ 44
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, 5.2.5 Necrotiserende enterocolitis ......................................................................................... 44
5.2.6 Retinopathie (ROP) ........................................................................................................ 45
6. Groei en puberteit ......................................................................................................................... 45
6.1 De 4 fasen van groei .............................................................................................................. 45
6.2 Antropometrische parameters .............................................................................................. 46
6.3 Puberteit ................................................................................................................................ 46
6.3.1 Meisjes: puberteitskenmerken...................................................................................... 46
6.3.2 Jongens: puberteitskenmerken ..................................................................................... 47
6.4 Groeistoornissen ................................................................................................................... 47
6.4.1 Kleine gestalte ............................................................................................................... 47
A. Primaire oorzaak van groeiretardatie ............................................................................... 48
B. Secundaire oorzaak van groeiretardatie ........................................................................... 48
C. Aanpak groeiretardatie ..................................................................................................... 49
D. Behandeling groeiretardatie ............................................................................................. 50
E. Wanneer doorverwijzen .................................................................................................... 50
6.4.2 Grote gestalte ................................................................................................................ 50
A. Primaire oorzaken van grote gestalte ............................................................................... 50
B. Secundaire oorzaken van grote gestalte ........................................................................... 51
C. Idiopathisch ....................................................................................................................... 51
D. Diagnose grote gestalte ..................................................................................................... 51
E. Behandeling grote gestalte ............................................................................................... 51
6.4.3 Abnormale hoofdomtrek ............................................................................................... 51
6.4.4 Abnormale puberteitsontwikkeling............................................................................... 52
A. Pubertas Praecos (vroege puberteit) ................................................................................ 52
B. Vertraagde puberteit ......................................................................................................... 53
6.4.5 Stoornissen in geslachtsdifferentiatie ........................................................................... 53
6.5 Examenvraag ......................................................................................................................... 54
7. Kleine gestalte en groei ................................................................................................................. 54
7.1 Kleine gestalte ....................................................................................................................... 55
7.1.1 Skeletdysplasie .............................................................................................................. 55
7.1.2 Wie verwijzen ................................................................................................................ 55
7.1.3 Genetische consultatie .................................................................................................. 55
7.2 Groei ...................................................................................................................................... 56
7.2.1 Normale lengtegroei...................................................................................................... 56
A. Normale lengtegroei.......................................................................................................... 56
B. Samenvatting normale lengtegroei ................................................................................... 57
3
, 7.2.2 Oorzaken groeivertraging en kleine lengte ................................................................... 57
8. Voeding.......................................................................................................................................... 59
8.1 Nutritionele kwetsbaarheid .................................................................................................. 59
8.2 Voeding zuigeling .................................................................................................................. 59
8.2.1 Borstvoeding.................................................................................................................. 59
A. Voordelen borstvoeding .................................................................................................... 59
B. Nadelen borstvoeding ....................................................................................................... 60
C. Verloop borstvoeding ........................................................................................................ 61
8.2.2 Kunstvoeding ................................................................................................................. 61
8.2.3 Bijvoeding ...................................................................................................................... 62
A. Introductie gluten en andere ............................................................................................ 62
B. Bijvoeding en allergie ........................................................................................................ 62
8.2.4 Supplementen bij gezonde kinderen............................................................................. 63
8.2.5 Bijzondere voedingen .................................................................................................... 63
8.3 Failure to thrive ..................................................................................................................... 63
8.3.1 Oorzaken failure to thirve ............................................................................................. 64
A. Onvoldoende voedselinname............................................................................................ 64
B. Onvoldoende retentie ....................................................................................................... 64
C. Malabsorptie ..................................................................................................................... 64
D. Verhoogde energiebehoeften ........................................................................................... 64
E. Inadequaat gebruik nutriënten ......................................................................................... 64
8.3.2 Uitwerking failure to thrive ........................................................................................... 65
8.4 Malnutritie............................................................................................................................. 65
8.4.1 Diagnose ondervoeding................................................................................................. 65
8.4.2 Therapie ondervoeding ................................................................................................. 65
8.4.3 Marasmus en Kwashiorkor ............................................................................................ 65
8.4.4 Deficiënties .................................................................................................................... 66
8.4.5 Rachitis: vitD deficiëntie ................................................................................................ 66
8.5 Obesitas ................................................................................................................................. 67
9. Infectieziekten ............................................................................................................................... 67
9.1 Kind met koorts ..................................................................................................................... 67
9.2 Virale infecties ....................................................................................................................... 68
9.2.1 Mazelen ......................................................................................................................... 68
A. Kliniek mazelen .................................................................................................................. 69
B. Verwikkelingen mazelen: bij ondervoeding en immuundeficiëntie.................................. 69
C. Diagnose, behandeling en preventie mazelen .................................................................. 69
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