Pediatrics as discipline. Department of pediatrics. Pediatrics. Pediatrics is a Greek term , which proceeds from two words : παῖς ( pais = child) ἰατρός ( iatros = doctor ). History of pediatrics.
Pediatrics as discipline
Department of pediatrics
B) measureapplied individually
creation ofabilitiesforphysical and neuropsychical health state assessmentin children and adolescents
Studyof child’s physiologic and pathologic changes, knowledge of child’s diseases evolution, diagnosis, treatmentandprophylaxis, development ofclinical reasoning and medical synthesis – defining elementsin the training of eachphysician.
semeion – sign
logos – science, speech
Semeiologyis the fundamental basisofdiagnosis which can beestablishedon the basis of anamnestic datawhichorientates, of clinical datawhichsubstantiateand oflaboratory data which confirm it.
EXAMENATION OF TEGUMENTS, MUCOSAE ANDDERIVATES
- volumeof skin and mucous capillaries, thickness and transparence of cutaneo-mucous layer (best observed on ears lobes, cheek bones, lips and nail bed).
-skin pigmentation (in black race or other skin hyperpigmentations) itis better seen on palms or conjunctival mucosa
-associationwith other pigments in the same time, for ex. with jaundice
-concentration of Hemoglobin in blood, appearing more rapidly in polyglobuliathan in anemia
-intoxication with carbon oxide (carboxyhemoglobinemia), which has a bluish color with carmine tint
-polycytemia vera, when the cyanosis has red-violet aspect
-methemoglobinemia and sulphhemoglobinemia (intoxication with nitrites, nitrotoluene, benzene etc)
-argiria – deposition of silver salts in teguments, giving abluish-grey colouring
In the cyanosis appearance the absolutelevel of redused Hemoglobin has importance. La anemics, especially at values ↓5 g. /100 ml bloodthe cyanosiscan’t be distinguished.
Causes of centraltype cyanosis:
-affectionswhich reducethe circulation bed: massive pneumonias, bronchopneumonias, miliarTBC, extended pulmonary fibroses, massivepleuresies, pneumothorax, fibrothorax, kypho-scoliotic thorax, etc.
- Affections which produce the respiratory pathways obstruction: laryngo-tracheal diseases, tumorswhich compress respiratory pathways, bronchial asthma, chronic broncho - pulmonal obstructive diseases, etc.
2. Cardiac causes:
3. Mixt causes: cardiac and respiratory. The chronic cor pulmonalein which the right heart failure consecutively some broncho - pulmonal affection appearing, is typically.
-Generalized cyanosis:appears after exposure to cold or in congestive cardiac failure, when the cutaneous compensatory vasoconstrictionis associated. It is more pronounced on the limbs which are cold and in the right and congestive cardiac failure the edemas can appear.
-Localized cyanosis– appearsin venous or arterial trunks obstructions and is strictly localized at corresponding area. If the obstacle is in superior vena cava thecyanosisof cephalic extremity, of superior members, of neck and of thorax superior part appears(cyanosisin pelerinewith or without edema).
Disorders of pigmentation:
-Hypomelanosesare characterized by melanic pigment decreasing or absence. The albinism characterized byabsence of pigment in skin, hairand eyes and vitiligo characterizedbylight color with hyperpigmented contour spotsappearance take part from this group.
-Hypermelanosesappearthrough numeric increasing of melanic cellsand their overloading with pigment and are due to hormonal causes: chronic insufficiencyof suprarenal glands (Addison disease), hyperthyroidism (Basedow disease). Ephelides- small brown – redish spots on cheeks, shoulders, back, dorsal part of hands appearthroughpigmentation of skin under the form of frecklesand have familial and constitutional character.
-Icterusis the yellow colouring of the skin, mucosae and scleresdeterminedby theirimpregnation with bilirubin when it has increased values in blood (over normal value by1mg at 100 ml of blood).
Vascular lesions at the skin level:
The form, thickness, friablityand their color are examining.
Adiposeand muscular system:
Faciescan offer important data about thepresence ofsome respiratory diseasessuch as:
Examen of tegumentsand mucosae – revealdescribed facies modifications in which the labial herpes characteristic in viral pneumonias or in lobar pneumonia is adding.
Don’t forget to examine the inferiormembers teguments.
-Congestion – redish coloring of tegumentsaround articulations appears in the case of arthrites (articular inflammation).
-Tumefaction of periarticular tissues leads to articular deformation, spontaneous painat movement and limitation of articular mobility.
-Articular pain – sensibilityisfoundat articulations palpation and at active or passive movements effectuated by patient.
-Articular deformationsare observing at attent inspection, having significance in arthritesor în arthroses (degenerative articularprocesseswith chroniccharacter).
-Articular mobility isevidencingat active or passive movements ofarticulations, articular diseases determining thereducingor disappearance ofonearticulation mobilityboth from pains cause, and from articular ankylosisor semiankylosiscause
Other signs/symptoms: local: objective articular (signs of inflammation: swelling, local warmth, redness at palpation, spontaneous pain andfunctional impotence) orperiarticular modifications;
vicious positions due to bones, articular, periarticular changes: knees (varus, valgus), hip (varus, valgus), foot (plate, hollow, equine), halux valgus, vertebral column (scoliosis, kyphosis, lordosis)
Articular deformations: nodules Heberden, Bouchard, neuropathic articulation (Charcot)
articulation in certain position andwhichcan’t be
reducingactively or passively; can be antalgic, due to muscular contracture, mechanical irritation due to some intraarticular free body (fragment ofcartilage, forexamplebroken meniscus), functionaldue to sinovial inflammation (rarely until block, de regulă remains at the level of stiffness);
irreversible process; after tbc arthritis, SA