PEDIATRIA RESUMENES

Pedia Respiratorio General: Laringe formada por cuatro cartílagos (tiroides, cricoides, aritenoides y

epiglotico)

Laringitis Diftérica

!dad "gente

Clínica

Progresivo.

=iere, deilidad, deterioro de estado general, tos bitonal,

disfonía y disnea+ !stridor inspiratorio !8ploraci3n 'emranas lanco gris2ceas en laringe, que sangran al desprender se+  Tratamiento  Tratamiento Penicilina o eritromici na y

antito8ina diftérica ron3stico

Crup Viral (laringitis aguda) $ a % a&os

 Traqueiti  Traqueiti s acteria 'enores de naa&os  Parainfuenza 1 aureus, 1, %, rino4irus, como my8o4irus, soreinfecci adeno4irus y 3n de Crup corona4irus+ 4iral Brusco. Disnea =iere alta con estridor y disnea inspiratorio y que puede tos perruna ocupar intermitente, intuaci3n+ 4o; gra4e+ Di>cultad respiratoria, espiraci3n alargada+ =ericula y empeoramien Cuadro 1ecrecion to nocturno. catarral es pre4io purulenta s+

Corticoides orales (de8a), neuli;ar con udenosida+ 9umedad, 0 y adrenalina<

!pigloti !piglotitis tis "guda #ronqui #ronquioliti olitiss aguda #ronquio #ronquioli li tis oliterant  a * a&os 'enores de  .uímicos e a&os+ ico (/01), meses+VSR f2rmacos, >50% "ntes por 9+ sarampi3n, inuen;ae, "deno4irus adeno4irus, a7ora por 1+ relacionado mycoplasma+ pneumo< a 5n6erto 4s complicacio 7uésped+ tos, nes Primero Brusco. =iere Progresivo. ele4ada, 5nfecci3n le4e de di>cultad postraci3n y 4ías aéreas respiratoria y dolor faríngeo, superiores, cianosis, aeo, 4o; anore8ia, >ere+ me6oría+ Después gangosa,  Tos  Tos siilante posici3n paro8ística+ disnea, sentada, e8pectoraci3n, cuello tos y 7ipere8tendid siilancias+ o+ /i&o se $?@ 1aAyer cansa, menos  Bames 'o eplorar 9iperinsuaci3n 8 puede respirara+ (7iperclaridad larin&e , solo y atelectasias en sugerir !stridor unilateral) en q8+ o6o r8+ Llega a  T#C miliar+ miliar+ inspiratorio cere;a con palparse a;o e  T"C  T"C patr3n patr3n edema+ 1igno 7ígado+ parc7eado del pulgar en !stertores 4idrio r8 lateral >nos, esmerilado+ sucrepitantes sucrepitantes y () 'antener 4ia 1oporte, /ada, #iopsia siilancias+o y lactamicos aérea+ 7umedad, corticoides si con>rma pero o *e+otaima, liquidos d8 preco;+ puede errar+ &lucopepti ce+triaona, paraenteral+ dos ampicilina. "caso , /ada mas+ roncodilatadores intuaci3 n #ueno, #ueno si d8 #uena+ eriodo 'ayoria electi4a+ pero se preco;+ critico sore4i4en, asocia a * 7rs+ pero con s7ocE "socia prolemas to8ico+ 7iperreacti4i cr3nicos+

 Tos  Tos ferina (ordetella) 'enores de $ a&o, ni&as+ #ordetella pertussi, parapertuss y ronc7iseptica+ 5ncuaci3n % a $ dias+ =ase catarral con >ere  semanas+ =ase de to paro!stica, en una misma espiraci"n, #sal$a &allo.

"compa&a de congesti3n D8 con C en facial, moco+ pausas !8oto8ina de apnea+ linfocitoestimula nte+ Culti4o en #ordet Gengou ritromicina $

dias, si se administra preco; camia el clínica, si no solo riesgo de contagio+ Vacunaci3n 'as gra4e a uni4ersal DT menor edad, %,$? y mortalidad ?@ $ menores de  en meses+ 1ecuelas

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ediatria 5nfectocontagiosas 5nfectocontagiosas comunes 'nemotecnia

!pidemiología

5ncuaci3 nJ Contagio rodromos

1arampi3n aramy8o4irus /"

uéola  Toga4irus  Toga4irus

ara, gracias a 4acunaci3n+ 'enores de $F meses (no 4acunados aIn)+ "dultos que no se 4acunaron+ $ días F dias antes y después de e8antema+ =iere moderada, tos seca, rinitis, con6unti4its con

5gual a amos se8os+

+oto+obia. -opli J'anc7as

lanquecinas sore 7alo eritematoso+ =ugaces !8antema

$J$ días * dias antes y después de e8antema+ Cuadro catarral le4e, ferícula o >ere moderada, con/unti$itis sin +oto+obia + orscneimer  manc7as en paladar lando+ "denopatias retroauriculares, cer4icales posteriores y o no+ 'oriliforme, conuente posteroccipitales, apida e4oluci3n+ dolorosas+ Retroauricular con

'aculopapuloso, conuente, ro6o intenso, no blan2uea , ;onas tendencia laterales de cuello y retroauriculares+ retroauriculares+ Descendente descendiente 3 centri+u&a. espeta y centrifugo+ Palmo)plantar palmas y plantas+ yJgloulina antisarampion

Varicela VVHoster

 a K dias+ Contagio m28imo antes de e8antema+ =ericula, =ericula, cefalea, síntomas de 4ías aéreas superiores+

$?J$ días

4+ebril,

en tres etapas+ $+J!ritema li4ido en me/illas

5nmunogloulina 5nmunogloulina 7asta *

'enores de $? a&os

$ día antes d e e8antema 7asta

todo este en costra+ que =iere, malestar general, síntomas catarrales le4es+

5nicia en t3ra8, se e8tiende a cara, zonas de presi"n , cuero caelludo+ almo plantar ruriginoso, secuencia.

+J!8antema maculopapuloso poco aculas)papulas pruriginoso en tronco 3 eritematosas) $esiculas miembros, respetando palmoplantar

"compa&a de >ere ro>la8is y

'egaloeritema !ritema infeccioso, Fta enfermedad, ar4o4irus F J$F a&os #$

1 intom2tico de lesiones %+JDesaparici3n

blan2uecinas) pustulas en 67 rs 8 costras. 5Polimor+o, nmunoglouprurito, lina VH * 7oras

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ediatria infectocontagiosas infectocontagiosas continuadas

arotiditis arami8o4irus /"

!pidemiol ogí a 5nfo

5gua 5guall a am amos os se8o se8os, s, 17)6; dias incubaci"n *onta&ia ) 1 a < dias de inicio de cuadro.

rodromos ara, >ere, cefaleas, y malestar general y "fectaci3n mialgias+  Tumefacci3n  Tumefacci3n glandular en par3tida (paperas)+ #orra angulo mandiular #ilateral pero asimétrica+ uede afectar sumandiulares sumandiulares y sulinguales+ Despla;a ore6a+ /o afecta piel+ ro>la8is y 1intom2tico  Tratamiento  Tratamiento

NaAasaEi 1uperantigeno, síndrome mucocotaneo generali;ado 'eno 'enorres de de F a&o a&os, s, ni&o ni&oss 6a 6apo pone nese ses+ s+ Causa de cardiopatía cardiopatía adquirida+ Vasculitis necroti;ante de mediano 3 pe2ue=o $aso, a+ecta coronarias #aneurismas en rosario. L"#+ V1G

O? C O%+ #7 linf $F,???, plaq OF?,???, anemia normo normo, !G0 Oleuco, en;imas 7ep2ticas ""T OF?, alumina séricamas P%,de ecocardio e cocardio+ + no =iere =iere ele4ada F dias que responde a antitérmicos+ *on/unti$itis bilateral no purulenta+ "fectaci3n mucosa orofaringea, labios eritematosos secos 3 a&rietados, lengua en

fresa+ 4denopatia cer$ical >1.5cm, unilateral, no dolorosa.

!8antema 4ariale, no 4esicular de inicio en tronco+ !dema yQeritema de manos y pies en fase aguda+ Descamaci3n periungeal fase tardia+ " In con la minima sospec7a para pre4enir secualas cardiacas+ Gammagloulina Gammagloulina 5V en primeros $?

!scarlatina !streptococo !streptococo #J7emolitico grupo " o FJ1$Fpyogenes a&os

!8antema 1Iito, roséola infantum, -ta enfermedad V9- " 3 # !n(@) tre -J$oF*meses

5ncuaci3n $J* días Contagioso en fase aguda 7asta $ dias después de iniciar t8+

FJ$F dias

5nicio rusco de fiere, malestar general, cefalea, escalofrío, 43mitos+ Lengua en fresa lanca por papilas 7ipertr3>cas, se descama y da lengua en fresa ro6a+

=iere alta con uen estado general y sin foco aparente+ "socia o no faringitis, rinitis, adenopatías+

4m!&dalas ipertr"+icas con eudado blan2uecino. nantema pete2uial en paladar blando. !8antema

!8antema

micropapular mas palpale que 4isile en pliegues #l!neas de pastia ) respeta Conuye cara, enicilinaen oral $? dias o nariz #+acies de lato$ #en;atinica Descama en ? dias.

4l a espinal) cuierta o no de piel+ Defectos cer4icales y tor2cicos incompatiles con la 4ida "umento de "= preparto '"1 =!CR!/T! S mielomenigocele mielomenigocele

Lu8acion atlantoa8ial atlantoa8ial 1indroma de doAn, doAn, morquio, morquio, displasia espondiloepi>saria espondiloepi>saria y "

'alformaci3n de C7iari

!l ulo y cereelo inferoposterior se proyectan caudalmente por agu6ero occipital+ 5mpresi3n asilar !le4aci3n del agu6ero occipital, da clínica irritati4a y síntomas periféricos por lesi3n cereelosa+

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/eonato e8ploraci3n

!8plora anormal ci 3n física

06os 06os

Verni8 caseoso en Cr2n Cr2neo eo /T Lanugo en /T "crocianosis "crocianosis y arlequín por pedos 4asomotores 4asomotores (>siol3gico) Cutis marmorata por uctuaci3n de temp, que tamién puede aparecer en 1!151+ 1 !151+ "L"'"1  palide;, plétora, ictericia, cianosis generali;ada+ !demas  periférico es >siol3gico, locali;ado en e8tremidades de Turner o linfangiectasis, generali;ado /T, 9emo 9e morr rrag agia iass con con6u 6unt nti4 i4al ales es y en ede edema ma palp pa7ydrops, lpe era rall en en par parto toss  T3ra8  T3ra8 7urler (mucopolisacaridosis), (mucopolisacaridosis), 7ipoproteinamia 7ipoproteinamia di>cultosos (nefrosis congénita) 5ntegridad del iris (descartar coloomas) o 7eterocromias

Cran Craneo eota tae ess es es 2re 2rea a ose osea a la land nda, a, =515 =5150L 0L0G 0G5C 5C" " !/ !/ "5!T"L, típica de /T y de /T comprimido in utero+ atol3gico atol3gico cuando occipital, alteraciones oseas, doAn+ =ontanelas =ontanelas  "nterior o regmatica al """"0 (J$K meses) y osterior osterior o La'oidea a los % 'eses+ 1uturas  su acaalgamient oes >isiologico en partos dist3cicos+ Craneosinostosis Craneosinostosis  fusi3n premadura que produce alteraci3n enpuede la forma del lec7e, cr2neo+ 9ipertro>a 9ipertro> a mamaria, 7aer no'as frecuente en sutura sagital (escafocefalia) manipular+ e;ones supernumerarios (11Turner)

(Uaardenurg) o aniridia (Uilms) / respiraci3n diafragm2tica, /T irregular y

0re6as

#oca #oca

Leucocoria  cataratas congénitas, retinolastoma, coriorretinitis, retinopatía del prematuro, " pendices o del fosa4ítreo s  altprimario eraciones renales persistencia

Dien Diente tess neo neona nata tale less (11 (11!l !lli lis4 s4an an Gre4el Gre4eld, d, 119a 119all ller erma man n 1trei), suelen caer antes de los diente de lec7e+ =isura palatina, laio leporino+

peri3dica+

Cora;3n

Cuello

Valorar soplos sugerentes de cardiopatía congénita, palpar pulsos, / taquicardia >siol3gica, >siol3gica, mas en en /T itmo emriocardico  Dos tonos igual de intensos y separados por mismo tiempo+ Descartar masas cer4icales+ 9ematoma de esternocleidomastoideo esternocleidomastoideo (//1troemayer), (//1troemayer), tras parto traumatico, masa con mo4imiento trans4erso, t8 >sioterapia+

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/eonato respiratorio

"pnea !tiologia  idiop2tica de la prematuridad, relacionada con 1DG, inicialmente ostructi4a y después central+ 1i se presenta en /T siemrpe es patol3gica+

Clínica y diferenci al

D8 y 8

D8 diferencial ausas de apnea  cese de la respiraci3n O$?J? seg, peor pronostico+ espiraci3n peri3dica  aumenta en fases % y de sue&o, cese espontaneo, sin camios de coloraci3n+

!nfermedad de memrana 7ialina 1D/ tipo $ atogenia y >siopatología  dé>cit de surfactante, tendencia a colapso al4eolar, 7ipertensi3n pulmonar + !fecto s7unt DJ5 D", =oramen o4al+

 Taquipnea  Taquipnea transitoria transitoria 1D/ tipo  o 11 de "4ery =alta de reasorci3n de liquido pulmonar fetal, típico en /T o /T con partos rapidos o cesarea, donde no se e8prime al ni&o+

1urfacante producido por neumocitos tipo 55 a partir de las ? semanas+ 'adures pulmonar pulmonar se alcan;a a las % semanas+ LecitinaQes>ngomielina O+ "gente tensioacti4o S lecitina *?J*F@, aumenta con 1DG+ !s>ngomielina, Clinica  !mpeoramiento progresi4o 7asta progresi4o fosfatidilglicerol fosfatidilglicer (mas sensile los tres días y ol después me6oríaygradual, especi>co), aumento deapoproteina, necesidadescolesterol+ "dicci3n de 0 a opi2ceos es ="V0"#L!W 0'GUT=##. D8 diferencial  proteinosis proteinosis al4eolar(letal), al4eolar(letal), malformaciones malformaciones congénitas, taquipnea transitoria de recién nacido+ re4enci3n re4enci3n  corticoides a la madre KJ* 7oras antes de parto en fetos J% 1DG D8  auscultaci3n estertores disminuidos en ases, ruidos normales+

ecuperaci3n ecuperaci3n r2pida (7oras), no 7ay estertores ni roncus+

8  4idrio esmerilado y roncograma aéreo

Gasometria  7ipo8emia, 7ipercapnia,

8  trama 4ascular prominente, liquido en cisuras, 7iperinsuacion, diafragma aplanada y derrame pleural+

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/eonato respiratorio respiratorio continuado

Clínica

9ipertensi3n pulmonar persistente del / 1ecundaria a patología neonatal como !'9, aspiraci3n de meconio, 7ipoplasia pulmonar, oligoamnios+ oligoamnios+ Da lugar a s7unt DJ5, manteniendo D" y foramen D eterioroo4al aierto+ respiratorio, respiratorio, cianosis, mala respuesta a 0

1indrome de aspiraci3n meconial "sociado a sufrimiento fetal e 7ipo8ia+ Tipico de R' postermino , gra4edad depende de espeso del meconio que es irritante y esteril+ 'eumonitis 2u!mica, actua como $al$ula dando lu&ar a neumot"ra o neumomediastin

Displasia Displasia #roncoJpulm #roncoJpulmonar onar /eumot3r /eumot3ra8, a8, neumomedia neumomediastino stino,, enfisema intersticial pulmonar+ / de muy a6o peso que requiere o8igenoterapia, 4entilaci3n mec2nica prolongada+  To8icidad  To8icidad por por 0, inmadure; Di>cultad pulmonar y arotrauma+ respiratoria, siilancias, estertores, aumentan J-

ueden aparecer espont2neamente, espont2neamente, pero son por lo general complicaci3n de patología pulmonar pre4ia o secundarios a 4entilaci3n asistida+ Varones+ !scape de aire a intersticio, disecando 4ainas, con su>ciente presi3n se 7aceX 'eumotora suele ser unilateral, inicio rusco, tora8 asimétrico+ 'eumomediastino, usualmente asintom2tico, asintom2tico, prominencia prominencia línea media, distensi3n 4ascular cer4ical, 7ipotensi3n+ !n>sema sucut2neo

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arasitosi

Giardia s + +

Gloito con carita feli;, 17igella  T' sulfa o ciproo8 contagia por agua con o quistes+ 1e desenquistan salmonel adentro, en intestino delgado la (duodeno< es forma m34il+ 9aitan 10#! 4ellosidades intestinales, diarrea con moco, no sangre porque no es in4asi4o+ 18 de malasorci3n, malasorci3n, "D!N  liposolules, $ 7ierro grasas, lactasa+ D8  espirado duodenal

Liendres

9umanis capis, capis, 4a por sangre, sangre, deposita 7ue4os en ase+ Tratamiento  peine de dientes >nos+ ermetrina de elecci3n no causa tantos f8 ad4ersos (reposar media 7ora)+ Lindano ya no+ Tamien i4ermectina

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edia cardiopatías generalidades Cardiopatia Cardiopatia congénita mas frecuente en polaci3n general es Val4ula aortica icIspide

ero en /!0/"T01 /!0/"T01 es C5V, adultos C5"+ De las cian3ticas en el recién nacido es  TGV, $er a&o es =allot+ =allot+ "gu6ero o4al cierra por diferencia de presi3n, presi3n, C" por ? (estimula radicinina) Cardiopatias Cardiopatias congénitas se diferencian en el sentido de su u6o Cortocircuitos Cortocircuitos 5;quierdaJDere 5 ;quierdaJDerec7a c7a 5D

9iperau6o pulmonar, infecciones pulmonares de repetici3n, insu>ciencia cardiaca e 7ipertensi3n pulmonar con aumento de 1!GR/D0 ruido+  Tras  Tras a&os de sorecarga se dan camios irre4ersile irre4ersiless en arteriolas arteriolas pulmonares, se re4ierte re4ierte el sentido sentido del s7unt y da cianosis S !isenmerger S t8 S transplante Cortocircuitos Cortocircuit os Derec7a 5;quierda D5

pulmonar pulmonar, 9ipoau6o pulmonar, 7ipo8ia cr3nica con crisis 7ipo8émicas 7ipo8émicas y cianosis+ c ianosis+ 1e da policitemia con riesgo de tromosis cuando 9tc O-F@, e4itar des7idrataci3n y corticoides+ c orticoides+ 5ncidencia de ascesos cererales y emolias+

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edia cardiopatías congénitas no cianogenas (5OD) C5"

/o 7ay que confundir con foramen o4al permeale (=0) 4ariante de la normalidad (pero se asocia a emolias parad36icas (tromos llegan a "D desde territorios 4enosos y no 4an a pulmones sino a sistémico) y aneurisma de taique interauricular)+ D8 con ecocardio transesofagico, t8 cerrando Clasi>caci3n de C5" segIn locali;aci3n foramen+ 0stium 1ecundun ?@ !6e derec7o en !NG, prolapso 1ituado en ;ona 4al4ula mitral+ central rimum 0stium 'enos frecuente, !6e i;quierdo en del taique arte mas 5" a6a gra4e si canal "V !NG+ 9endidura de taique 5", comIn, C5V y 4al4ula en 42l4ula mitral cerca de "V Inica+ anterior que da 42l4ulas "V "sociado a 11 doAn+ insu>ciencia

Clín Clínic ica a

=recue ecuent ntem emen ente te asi asint ntom om2t 2tic ica, a, se se pres presen enta ta en infecciones pulmonares de repetici3n, puede dar !isenmerger "uscultaci3 Desdolamiento del 1!GR/D0 ruido n "umento del 5'! ruido 1oplo sist3lico eyecti4o por 7iperau6o pulmonar 1oplo pansistolico en si canal "V comIn+ !NG \

1ecundum S !6e Derec7o con #D rimum S #D M 9emiloqueo anterior i;quierdo S !6e C i;quierdo i i t d id d d 7 lét

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C5V Cardiopatia Cardiopatia congénita mas frecuente después de "3rtica icIspide, defecto en la

porci3n memranosa+ =isiopatología  Gran nImero cierra espont2neamente, si C5V grande 5OD da el

7iperau6o pulmonar+ C5V peque&as  !! de oger son asintom2ticas, las grandes producen insu>ciencia cardiaca cardiaca en los primeros meses de 4ida+ ecuerda ecuerda C5V S soplo pansistolico paraesternal paraesternal i;quierdo+ 1olo d8 diferencial con

insu>ciencia mitral+ elaci3n in4ersa con el tama&o del defecto, desaparece cuando !isenmerger+ !isenmerger+ 5ntensas en oger

Diagn3stico "uscultaci "uscultaci3n 3n 1oplo 1oplo pansistolico pansistolico paraestern paraesternal al i;quierdo i;quierdo aspero y fuerte, notale en defecto mas peque&o+ !NG 1 orecarga 4entricular y de "5 8 Cardiomegalia con plétora pulmonar !co D8 de elecci3n Catete Cateteris rismo mo 1alto 1alto o8im o8imetr etrico ico en en VD  Tratamiento  Tratamiento 0ser4aci3n estrec7a y pro>la8is de endocarditis infecciosa Ciru Cirugí gía a si si 1int 1intom omat atic ico, o, reali eali;a ;arr ent entrre %J%J-

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!l ductus permanece permeale, persistiendo un conducto que une

de 4als 4alsal al4 4a

adult dulta a, dolo dolorr tor2 or2cico cico inte inten nso, so, sop soplo continuo, cirugía necesaria+

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Cardiopatias Cardiopatias congénitas

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Caput 1ucedanum !dema difuso de te6ido celular suutaneo, equimosis, atra4iesa suturas, inmediato al parto+

Cefalo7ematoma /o alteraciones de piel, respeta suturas, puede asociar fractura y anemia, 7emorragia intracraneal+

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