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Both the brain and spinal are inside a bony box formed by the cranial cavity and part of the spinal canal, but by virtue of their delicacy and functional importance, are involved by a special shock absorbers, represented by three membranes, the meninges: dura mater, pia mater and arachnoid.







Functions of Cranial Meninges

Biological-Protection: prevents as a filter, the input of chemicals and microorganisms harmful to our nervous system. It protects us from very serious infections (encephalitis) and brain damage produced by some substances.

-Mechanical protection: are 3, exactly, meningeal coverings surrounding the SN, such as plastic food wrap several times to delay its degradation. Between two covers a clear fluid that circulates absorbs shock, is the cerebrospinal fluid. This important feature allows small blows to the head does not involve a serious threat to life.

dura mater of the brain

The dura is the most superficial, also the most resistant (fibrous tissue) of the three and is conventionally described as consisting of two layers, layer endosteal and meningeal layer, the which are in close apposition except along certain lines, which separate to form venous sinuses.

endosteal layer is nothing more than the periosteum, which covers the inner surface of the skull bones. In the spinal cord was not continuous with the dura mater of the spinal cord.

Around the edges of all holes the skull is continuous with the periosteum on the outside of the skull bones. In the suture is continuous with sutural ligaments.

is more firmly attached to the bones of the skull base.

meningeal layer is the dura itself. Is a strong, dense membrane covering the brain and continues through the foramen magnum to the dura mater of the spinal cord. Provides tubular sheaths cranial nerves as they pass through the holes of the skull. Pods outside the skull fuse with the epineurium of the nerves.

meningeal layer sends inward four partitions, which divide the cavity cranial spaces that freely communicate and stay subdivisions of the brain. The function of these walls is to limit the movement of encéfalo0 movements associated with acceleration and deceleration when moving the head.

outer surface: It meets regularly rounded bony walls and ligaments of the spinal canal, from which is separated by the epidural space. Free at the back, above, is in contact with the posterior longitudinal ligament. Laterally, extending around each spinal nerve, which accompanies increasingly thinning out of the intervertebral foramen.

inner surface: is glossy and smooth and corresponds to the arachnoid.

Top End: Continue unlimited net with the cranial dura mater. On its outer surface, adheres to the foramen magnum and the atlas.

End Lower : constitutes the bottom of the dural sac, which stops at the level of S2-S3. Contains the cauda equina and filum terminal. This latest in the lowest part of the dural sac pierces the dura, which is applied to the sheathing. Descend into the first coccygeal vertebra. The dura mater adheres the anterior sacral canal.

The falx cerebri is a fold of dura mater with a sickle which is located in the midline between the two cerebral hemispheres. Narrow front end is attached to the inside front crest and the crista galli apophysis. His broad back is fused in the midline with the upper surface of the tentorium. The superior sagittal sinus runs in its concave free margin and the straight sinus runs along its insertion in the tentorium.

The tentorium is a fold of dura mater with crescent that forms a roof over the posterior cranial fossa. Covering the upper surface of the cerebellum and supports the occipital lobes of the hemispheres brain. At the edge there is a gap, notch store for the passage of the midbrain, which produces a free inner edge and an outer edge attached or fixed. Bound edge is attached to the posterior clinoid process, the upper edges of the margins and petrous portions of the grooves for the transverse sinuses on the occipital bone. The free edge running forward towards both ends, cross the border attached and fixed to the anterior clinoid process on each side. At the point where the borders are crossed, the third and fourth cranial nerves pass forward to enter the cavernous sinus lateral wall.

Near the apex of the petrous temporal bone, the Shop bottom layer of the cerebellum as a forward pocket below the superior petrosal sinus to create a break to the trigeminal nerve and trigeminal ganglion.

The falx cerebri and falx cerebelli are attached to the upper and lower surfaces of the store, respectively. The straight sinus runs along its insertion into the mouth of the brain, the superior petrosal sinus along its insertion into the petrous and cavernous sinus, alo during their insertion into the occipital bone.

The falx cerebelli, a small fold of dura mater with a sickle attached to the internal occipital crest, projecting forward between the two cerebellar hemispheres. Its rear fixed margin contains the occipital sinus.

Diaphragm (tent of the pituitary) of the sella is a small circular fold of dura mater that forms the roof of the sella. A small hole in the center allows the passage of the pituitary stalk.

spinal dura

completely encloses the spinal cord. Above, are continuous through the foramen magnum with the meningeal layer of dura covering the brain. And below, ending in the filum terminale at the bottom of the second sacral vertebra. The dural sheath was placed in loosely into the spinal canal and is separated from the canal walls by the extradural space. It contains loose areolar tissue and the internal vertebral venous plexus. The dura mater extends along each nerve root and continues into the connective tissue around each spinal nerve (epineurium). The inner surface of the dura mater is in contact with the arachnoid.

Innervation of the dura mater

branches of the trigeminal, vagus and spinal nerves and first three branches of the sympathetic trunk pass into the dura.
The dura has many sensitive nerve endings to stretching, which produces the sensation of headache. The stimulation of sensory trigeminal nerve endings above the level of tentorium produce referred pain in an area of \u200b\u200bskin on the same side of the head. Stimulation of dural nerve endings below the level of the tentorium produce referred pain to the back of the neck and scalp, along the greater occipital nerve distribution.

Irrigation Dura
Many arteries supplying the dura from internal carotid artery, maxillary, ascending pharyngeal, occipital and vertebral. From a clinical standpoint, the most important is the middle meningeal artery, which is commonly injured in head injuries.

middle meningeal artery arises from the maxillary artery in the infratemporal fossa. Enters the cranial cavity through the foramen spinosum and is located between the meningeal and endosteal layers of dura mater. Artery then runs forward and laterally in a groove located on the upper surface of the squamous part of temporal bone. The anterior branch crosses deep anteroinferior angle of the parietal bone and tour matches as rude to the line of the precentral gyrus underlying brain. The posterior branch curves backward and supplies the back of the dura.

meningeal veins are located in the endosteal layer of dura mater. The middle meningeal vein follows the branches of the middle meningeal artery and drains into the pterygoid venous plexus or within sphenoparietal. The veins are located outside of the arteries.

dural venous sinuses

The venous sinuses of cranial cavity located between the layers of the dura. Its main function is to receive blood from the brain through brain or spinal fluid from the subarachnoid space through arachnoid villi. The blood of the dural sinuses eventually drain into the internal jugular veins in the neck. The dural sinuses are lined by endothelium and lack muscle walls. They do not contain valves. Emissary veins, which also have valves, connect the dural venous sinuses with veins diploic skull and scalp veins.

The superior sagittal sinus occupies the upper fixed edge of the falx cerebri. Begins earlier in the knockout, which is sometimes called a vein from the nasal cavity. Run back plying the vault of the skull and the internal occipital protuberance it deviates to one side or the other (usually the right) and continues with the corresponding transverse sinus.

The breast is communicated through small holes, with two or three irregular venous lakes on either side. Numerous villi and meningeal arachnoid granulations project into the gaps, which are also diploic and meningeal veins.

The superior sagittal sinus in its course receives the superior cerebral veins. In the internal occipital protuberance swells to form the confluence of the sinuses. Here usually the superior sagittal sinus is continuous with the right transverse sinus, is connected to the opposite transverse sinus receives the occipital sinus.

The inferior sagittal sinus occupies the bottom free of the falx cerebri. Runs back and joins the more cerebral vein in the free margin of the tentorium, to form the straight sinus. Brain receives some veins from the surface medial cerebral hemispheres.

The straight sinus occupies the line of junction of the falx cerebri with the tentorium. It is formed by the junction of inferior sagittal sinus with the more cerebral vein. Ends turn left (sometimes right) to form the transverse sinus.
The transverse sinuses are paired structures and start at the internal occipital protuberance. Usually, the right breast is continuous with the superior sagittal sinus and the left continues the straight sinus. Each occupies within the margin of the store joined the cerebellum, plying the occipital bone and the posteroinferior angle of the parietal bone. Receive superior petrosal sinus and the cerebral veins and inferior cerebellar veins and diploic. They end up turning down as the sigmoid sinus.

sigmoid sinuses are a direct continuation of the transverse sinuses. Each breast down and turns medially and crosses the mastoid portion of temporal bone. This post is located within the mastoid antrum. Then comes back and then down through the back of the jugular foramen to continue with the superior bulb of internal jugular vein.

The occipital sinus is a sinus occupies small room attached to the falx cerebelli. Begins near the foramen magnum, where it communicates with the vertebral veins and drains into the confluence of the sinuses.

The cavernous sinuses are located in the cranial fossa half on each side of the body of the sphenoid bone. Numerous trabeculae cross inside, which gives it a spongy appearance, hence its name. Each sinus extends from the superior orbital fissure in front to the apex of the petrous temporal bone behind.

The internal carotid artery, surrounded by sympathetic nerve plexus, runs forward through the breast. The abducens nerve also passes through the breast. The internal carotid artery and nerve separated from the blood by an endothelial lining.

The third and fourth cranial nerves and the ophthalmic branch and maxillary trigeminal nerve running forward in the lateral sinus wall. They are located between the endothelial lining and the dura. Tributaries are the superior and inferior ophthalmic veins, cerebral veins inferior parietal and spheno within the central retinal vein. The sinus drains

later in the superior and inferior petrosal sinus, and inferiorly into the pterygoid venous plexus.

The two sinuses communicate with each other through both breasts intercavernous front and back running in the diaphragm sellae in front and behind the pituitary stalk. Each breast has a significant communication with the facial vein via the superior ophthalmic vein (this is a route by which infection can spread from the skin of the face to the sinus).

petrosal sinuses upper and lower small breasts are located on the top and bottom edges of the petrous temporal bone on either side of the skull. Each sinus drains into the cavernous sinus than in the transverse sinus and draining each breast below the cavernous sinus in the internal jugular vein. Arachnoid

brain

The arachnoid is a delicate waterproofing membrane covering the brain and lies between the pia mater internally and the dura mater externally. She is separated from the dura by a potential space subdural space, filled with a liquid film, and the pia mater by the subarachnoid space, which is filled with cerebrospinal fluid. The external and internal surfaces of the arachnoid are covered with flattened mesothelial cells.

The arachnoid bridges over the grooves form the surface of the brain and, in certain situations, the arachnoid and pia mater are widely separated to form the subarachnoid cisterns.

cerebellomedullary The tank is located between the lower surface of the cerebellum and roof of the fourth ventricle. The interpeduncular cistern is located between the two pendulums brain. All tanks communicate freely among themselves and with the rest of the space subcaroideo.

arachnoid In some areas the project into the venous sinuses forming arachnoid villi. These are more numerous along the superior sagittal sinus. The groups are called arachnoid villus arachnoid granulations. Arachnoid villi serve as sites from which the cerebrospinal fluid diffuses into the bloodstream.
The arachnoid is connected with the pia mater through the fluid-filled subarachnoid space by delicate bands of fibrous tissue.

is important to remember that the structures that pass into the brain and down into the skull or holes must traverse the subarachnoid space. All arteries and veins brain located in space, like the cranial nerves. The arachnoid membrane fuses with the epineurium of the nerves at their point of exit from the skull. In the case of the optic nerve, the arachnoid forms a sheath that extends into the orbital cavity through the optic foramen and fuses with the sclera of the eyeball. Thus, the subarachnoid space extends around the optic nerve to the eyeball.

Arachnoid Spinal Cord
The arachnoid is a waterproof membrane, which covers the delicate spinal cord and pia mater is located between the inside and outside the dura mater. The pia mater, separated by a wide space, the subarachnoid space, that is filled with cerebrospinal fluid.
The subarachnoid space is crossed by some thin bands of connective tissue. The arachnoid is continued upward through the foramen magnum with the arachnoid membrane covering the brain. At the bottom, ending in the filum terminale at the bottom of the second sacral vertebra. The arachnoid continues along the spinal nerve roots and forms small lateral extensions of the subarachnoid space.

Pia mater of the brain.
The pia mater is a vascular membrane covered by flattened mesothelial cells. Of closely covering the brain convolutions and down in the grooves deeper. It stretches out over the cranial nerves and merged with its epineurium. Cerebral arteries entering the brain substance are pial sheath with them.
The pia mater velum forms the roof of the third and fourth ventricles of the brain and fuses with the ependyma to form the choroid plexus in the lateral ventricles, third and fourth of the brain.

spinal part in its jagged walls arranged in a festoon, called denticulate ligaments. Between the arachnoid and pia mater is the subarachnoid space containing cerebrospinal fluid and appears crossed by a large number of thin trabeculae. Pia Mater
Spinal Cord.

is a vascular membrane that lines closely the spinal cord is thickened on each side between the nerve roots to form the denticulate ligament that runs laterally to join the arachnoid and dura. In this way the spinal cord is suspended in the middle of the dural sheath. The pia mater extending along each nerve root and is continuous with the connective tissue surrounding each nerve cord.

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ACUTE ABDOMEN IN CHILDREN

can be defined as the set of signs and symptoms that demonstrate the alteration of intra-abdominal organs and reflect different pathologies.

Its special features
* acute suffering of Structures, This requires a quick resolution of the problem
* Rapid progression of symptoms
* may endanger the patient's life

* Classification

ö ö Medical Surgical

Medical Acute Abdomen (AAM), we refer to this when the structures that are affected are susceptible to medical treatment (oral or parenteral), ie resolution and treatment is from the medical point of view, includes general measures, any treatment that will put the patient by oral or rectal etc. Nothing that

Surgical acute abdomen (AAQ), any set of signs and symptoms from the cavity intraabdominal and whose decision or whose treatment for improving survival is imminently or surgical, there is no other resolution. This medical treatment is also important (medicines, intravenous tto) but if the problem is not resolved surgical patient's life may be endangered.

Surgical Clinic Acute Abdomen

ö PAIN, cardinal symptom, as assessed through Dr. ALICIA all semiological characteristics if the pain is colicky, dull and continuous, if its intensity is increasing or sharply and has strong intensity, if you have radiation, whether calm or no drug (usually AAQ pain does not subside with any medical treatment can improve relatively), this is very important to do the interview because can guide us to a presumptive diagnosis.

or Vomiting, its characteristics, if they are eating, bilious or fecaloid as we talk about different diseases depending on the group treasury, if post-feeding or not has nothing to see.

ö FEVER, we can refer to an infectious process or changes to the digestive tract that may be accompanying the other symptoms.

ö NO EVACUATION or decrease of the same and we see when we face a case of intestinal obstruction

ö Bloating , and the presence or otherwise of this is independent of whether or not an intestinal obstruction
All this clinic will vary depending on the organ affected and causal agent that is causing the problem, the time evolution and age group (this is very important because it may indicate the presence of certain types of diseases)

Diagnosis

ö Clinic, is fundamentally a good history, a good reason for questioning consultation and the actual disease may give us a large percentage of presumptive diagnosis without the need for other data, all based on a good interview with the parent or representative and we're talking about pediatric patients that we can offer good information. Ö


Laboratory Hematology Complete (hemoglobin, leukocytes Hematocrocrito and its differential)
-electrolytes, if the Px is presenting vomiting
-Bilirubin directly or indirectly dependent on the clinical Px, if jaundice or no coagulation
-Times
-Urea Liver Enzymes
-creatinine

ö Radiological Diagnostic Methods:
-plain abdominal X-ray , referring to an anteroposterior radiograph of the abdomen with the Px standing (not lying as it is not assessable) This allows us to see the distribution of air in the abdomen

- Intestinal Transit, is a study Dynamic radiology, which gives Px is radiopaque contrast orally and in making the Rx at different times we will evaluate how you diseminadose contrast to rule out or make a diagnosis of obstructive picture. Gives us information on upper gastrointestinal tract (esophagus, stomach, small intestine)

- barium enema, is also a contrast study, but the contrast is applied rectally. Information gives us the lower digestive tract (large intestine)

- Ultrasound is very useful because it is inexpensive, easy to perform, does not have any kind of disease the patient (as opposed to earlier by the administration of contrast)

- TAC, three-dimensional type we use when we want to show structures in greater detail. AGE


AAQ

-RN

AAQI Necrotizing enterocolitis, here is more characteristic

AAQO: Congenital Malformations: Atresia Intestinal Megacolon, Congenital Ano - Rectal, hypertrophic pyloric stenosis, meconium ileus

AAQT: Obstetric Trauma

-INFANT

AAQI Necrotizing enterocolitis

AAQO intussusception, Inguinal Hernia stuck

AAQT: Direct trauma

-PRESCHOOL

AAQI: Appendicitis

AAQO : Inguinal Hernia stuck, ascaris intestinal obstruction, NO ascariasis may obstruct

AAQT: Direct trauma

-SCHOOL

AAQI: Appendicitis

AAQO: intestinal obstruction by Ascaris

AAQT: Direct Trauma

NOTE:
* inguinal hernia by itself causes no obstruction AAQ has to be complicated or stuck
* When it comes ascaris intestinal obstruction due to ascariasis is very different because the latter may be present without obstruction and its treatment is a physician, while Ascaris obstruction is surgical medicines that we give in each case are different.
* does not mean that a preschooler has no place intussusception but what is more common for the age group. It is very rare in preschool and one school lot weirder, with intussusception but if you have seen, but when it comes within the Dx approaches we will go by more often, however when we get a infant first thing we think of intussusception.
Another cause is included for all ages, AAQ obstruction are tumors at any age can cause an intestinal blockage, what happens is that its frequency is now very low, but must be taken into account.

Obstructive Acute Abdomen is divided into:

-Mechanical, eg intussusception
-Functional and Neurological Megacolon eg RN In all causes are congenital or metabolic
-Paralytic

ACUTE ABDOMEN POST - TRAUMATIC

is a series of signs and symptoms from the abdominal cavity and has a history of abdominal trauma level.
So are all the signs and symptoms arising from the abdominal cavity are produced by trauma, whether direct or indirect.

* AA rankings Posttraumatic

AA ö ö Traumatic nonpenetrating AA


Traumatic penetrating Traumatic Penetrating AA: when the injury caused by trauma, irrespective of the object that has been direct contact with the abdomen, compromises the whole abdominal wall, including peritoneum (which is what I'm going to differentiate the non-penetrating), ie, I have committed the skin, subcutaneous tissue, fascia, muscle and peritoneum . At that time we talk about AA traumatic penetrating because they committed all layers of the abdominal wall to the parietal peritoneum comes
This can be classified into
Complicated. Complicated No


Nonpenetrating Traumatic AA: is one that does not involve the peritoneum, but may involve the skin, subcutaneous tissue, NO penetrates the Parietal Peritoneum Eg. With a knife make it a wound in the abdomen, abdominal wall, and bleeding and get it examined and if there is a wound, a discontinuity at the level of the abdominal wall and realize that involve the skin and subcutaneous tissue, but inside there for nothing else, this is a non-penetrating injury.
Depends on whether injured or not any viscera, as it can be AAPNPenetrante but endangers the viscera can be divided into
traumatismoEsta Complicated.
not complicated.

* Epidemiology
-represent 5% of injuries among children admitted to trauma units.
-14% mortality rate have AA disorder.
-The highest percentage is given by motor vehicle trauma or because the child comes in or be run over.
-falls, direct blows and child abuse, post-traumatic common cause of AA.
"Unfortunately, every year you go see that all the issues of insecurity, increased penetrating type injuries by firearms, stab, which before was not so much.


* most frequently injured organs
ö
First, the spleen, is a structure that is suspended and has a fold that suspends him back into the peritoneal cavity but is very labile, and is a friable body and any direct trauma the person has abdominal level may suffer an injury, breakage or any damage is structure. Then ö

the liver, although that is protected in part by the rib cage, is an organ frequently suffer trauma because it is a body high volume and some of it is in the anterior abdominal wall.

or kidney, but not intraperiotoneal but retroperitoneal organ, but we will include it as part and giving us the clinic is projected as a problem of abdominal organs is one of the most frequently injured.

or pancreas, which are injured less frequently because it is a body type and is protected by retroperitoneal organs that lie ahead of him, however if you are injured is very serious injuries.

or the intestinal tract, are in last place because they are the least injured, because is a hollow organ that receive direct trauma, certain opportunities may dampen shocks and avoid injury as such. However, when there are weapons or injured by gunshot, is one of the major structures involved. Remember also that the thin bowel loops are a mobile structure and to trauma, their mobility can contribute to that damage is not as severe.

The viscera are injured more Solid organ and the least injured are the hollow viscera.

* Clinical Picture

ö Obviously the first thing to investigate is the BACKGROUND OF THE ACCIDENT, it is important to ask how was the fall of the patient, as was the blow in that area received it, figuring that with the parents or the person bringing the child. Ö

Let's examine quickly the patient's hemodynamic status, heart rate, blood pressure, pulse and capillary refill, all that to show at first what the patient's hemodynamic status, if we are suspecting that the patient has a serious injury where there is massive bleeding us signs of more severe hypotension or hypovolemic shock.

ö If signs of hypovolemic shock, extremely low pressure, tachycardia, pallor important, altered level of consciousness of the patient in a few minutes, all these signs we must take into account.

ö If there is direct injury ABDOMINAL WALL This is important from the standpoint of physical examination, obviously if there is an injury, an injury or a continuum and if we are faced with a patient with a wound as noted above, examine the wound, before, after washing, place the gloves and do hemostasis, we must see whether the injury involves only the skin or subcutaneous tissue goes in, or is contaminated, we are playing, we to see if the finger progresses inward.

ö

We also need to evaluate the rest of the system, the body, if there are injuries. INJURIES, FRACTURES IN OTHER AREAS OF THE BODY, to consider the patient and not as an abdominal injury but as a polytrauma Px in Most cases are treated as such.

ö And assessing whether abdominal pain is generalized PRODUCT OR REFERRED TO IN OTHER AREAS OF INJURY. Whenever there is trauma or a trauma patient, or receives a direct blow, we must assess whether the pain is the px has abdominal or extra-abdominal. For example, if there comes a px a child who had an accident, saying that it hurts where it hurts, but there may be abdominal pain for a hip Fx, where Fx is a hip produces abdominal pain and separate type makes a big bruising of the abdominal wall and often confused with an abdominal type of problem and it is a hip Fx. To this we must study well and do think that imaging studies may be a fracture at this level or injury elsewhere in the body. Ö

paralytic ileus may occur as a reflex, or defense of the intestinal loop to the trauma, paralyze its peristalsis, this happens during the first hours after trauma.

* Diagnostics Posttraumatic AA First

ö detailed history, where we will find the history of the accident he had, where we will find someone who can tell how the accident occurred. Ö

We will perform a good physical exam to check for lesions in other parts of the body or only a problem of abdominal. Pulse, temperature, blood pressure, heart rate.

or laboratory tests, which we ask a patient posttraumatic
-hemoglobin and hematocrit, to guide us if there is a problem because remember that active bleeding in children is the problem of hydration and dehydration very frequent then we have to consider also this, because if the child is dehydrated, the hematocrit is not altered, not hemoconcentrado. Normally when we have a patient with abdominal trauma have to request a review Serial hemoglobin and hematocrit, to the extent that the Px This more or less affected we will ask for a greater or lesser interval of time. Usually one calls Hg and Hct every 2, 3 or 4 hours that will be checking if there is a problem or an injury to a viscus with a major bleeding than other common signs and symptoms, the Hg and Hct will help us because if the low-Hg in 2 hours 1 gr. something is happening and if in the third as low as one gram is any bleeding that is causing lower Hg.

Then in the laboratory the most important thing is to Hg and Hct.
-Another laboratory we can ask when abdominal trauma are amylases, thinking that there is a problem at the pancreas, initially not going to give some positive amylases in blood but in urine.
or later, we make RADIOLOGY chest and abdomen, as many times as a trauma patient may have a problem chest and abdominal level because we ask for, ideally, plain abdominal request with the patient standing, depending on same conditions will be placed in this position is ideal, but open to hacérsela projections lying. We want to see, or we're going to find? That has been a perforation of a hollow viscera that Rx is expressed as a Pneumoperitoneum, at the time of trauma and there is a hollow organ breaks through that structure will air out and will be open cavity that is going to visualize in a Rx and a pneumoperitoneum, this is an indication for surgery without ecuanon. Then pneumoperitoneum equals viscera perforation. We can also display a total opacity of the abdomen that does not draw the small bowel, and that when there is a product of free fluid in the cavity, we are talking about a trauma where there may be bleeding of a structure of some viscera and that will give a total opacity in the abdomen. Those are the most important things we'll see if we can find no lines or preperitoneal or display the lines of the psoas, when not displayed either means that there is an air or free fluid in the cavity and I are producing this opacity .

ö The study can not provide more information in the case of AA is the ULTRASONOGRAPHY traumatic or sonography, is a relatively easy study to do not have any mobility, it is easily transported because there are laptops in skilled hands and we will to give a lot of information, we can see if there is injury one of the solid organs like the spleen, liver, kidney etc., also whether there is cavity free fluid or collections Alguita bleeding in the abdomen. And within the instruments in an area of \u200b\u200bShock this is one of the methods Dx should not miss.

or CT / COIL, likewise, because it goes through its different sections, we see that there are at intra-abdominal injury or if there is fluid or air in the cavity. These two studies today have become more important in a polytrauma px. Ö

paracentesis, abdominal puncture is done when we doubt whether there is bleeding in adults is widely used but Pediatric almost no, because today we Dx methods are not as aggressive as ecosonografla and TAC, but obviously we sometimes find ourselves at a point where we can not count any of them and we have to make an abdominal puncture see if you have abnormal air or fluid in the cavity, to try to remove it, can be urine that the bladder has ruptured. The puncture will be done using as guide points in adults: the iliac spines of one side or the other drawing an imaginary line to the umbilicus, and can puncture the outer half, or one or two inches below the umbilicus, but in the Infants School to do in the imaginary line line and this is done only in adults because children and here is a stationary member that is the blind while the children are mobile. I will put a needle, a trocar or Yelco, the size depends on the age of Px, and I hope to see if fluid comes out, if air comes out and if nothing comes out.

that does not leave anything does not mean that there is no abdominal trauma, it might be small the injury, or simply did not fall where I should have fallen, it may be that when I came I fell into a glass and I'm taking the blood and not bleeding, and differentiate because the blood does not clot is accumulated. When you puncture we have the possibility of complication of perforation of a viscus, we must be careful, so today is more widely used ultrasound or CT scan, and also the Dx is not reliable if I aspire not to get any liquid does not mean that does not have an injury.

PERITONEAL WASHING ö Another method, very common in adults, it is followed by abdominal puncture if positive or if I have doubt. Through the same hole, I will introduce a catheter, trocar or Yelco, which will instill solution I've put in a drainage system and I'm putting a lot of liquid to enter the abdominal cavity, after has entered the fluid, gravity, I put that same system below the level where the patient to return. And let's see what kind of content back, if it is clear, or if it is dark with blood and will be positive. Remember that everything in pediatrics I fence to give the patient by mouth, vein or straight or whatever has a dose, then I will use a dose of 20 to 25 cc / kg body weight for children weighing 5 kg I will multiply by 20 cc and that total is what I put for washing. Be careful because the setting of a large amount of fluid in the abdominal cavity will cause organ damage, damage to the circulation. For that there is a dose, which is the amount of liquid that I will introduce. This is a Dx very invasive method. Today almost never performed because there are other methods (ultrasound and CT scan)

ö DISPOSAL urography, dynamic Rx is a study which uses intravenous contrast (water soluble) will give us Visualization renal function, the Excretion of that kidney, as soon as the dye is injected, the kidney is concentrated and begins to eliminate. Then it will take a number of different time Rx for how this contrast will be removed at the time of renal injury, such as hematuria, in the study that I should point out is the elimination urography, to see if the damage is a level of kidneys o a nivel de uréter, ya que esta me va a dar información de riñón, uréteres y vejiga porque aquí se va acumular.

Manejo del Px con Traumatismo Abdominal

ö Lo primero que vamos hacer es ver si el paciente está respirando, tener una Vía Aérea Permeable.

ö Debemos tomar una Vía Central O Periférica, lo ideal es una vía central por si hay necesidad de colocarle líquido parenteral tenemos que asegurarnos de tener una buena vía central o periférica para pasar hemoderivados, solución. Se dan líquidos de acuerdo a su peso. En pediatría se realiza más la Flebotomía.

ö Colocar SIEMPRE una Sonda Nasogátrica, es una condición sin ecuanon (nunca duden en colocarla NO va a pasar nada si lo hacen), pero OjO NO SIEMPRE UNA Sonda Vesical, cuando a ustedes le llega un paciente con un traumatismo abdominal siempre se le debe colocar sonda nasogátrica, porque ella independientemente de que haya o no una lesión intrabdominal les va a ayudar a descomprimir el tubo digestivo, además que si hay alguna lesión del estoma o de asas intestinales altas, vamos a ver a través de la sonda ese daño, la salida de sangre. Siempre colocar sonda nasogátrica porque me va a aliviar la distensión de asas y me va a evitar la distensión abdominal. Siempre que haya un traumatismo abdominal injury but is not any structure in, it will cause bloating because it handles for the gut, is a means of reacting the body and paralyzes the intestine and begins to build up happen in the air, and that begins to thaw intestinal loops and gives us an abdominal strain, so we must always place a nasogastric tube. Now, with the Foley catheter must be careful with children, if the patient is conscious and conditions we see that urine voluntarily and can measure and quantify this diuresis, no problem, although it is bloody indeed obey, even if hematuria, no matter, the child is urinating, because the problem is that if we have an injury at the lower abdomen, urethra can be compromised, and if I injured the urethra and bladder catheter placed at risk is made more serious because an injury could have been easy to correct by itself or with a simple surgical treatment and I introduce the probe compounds the problem, then we must be careful with the catheters. If the patient arrives with a distended bladder and I have doubts whether the patient has an injury to the urethra, we performed a suprapubic tap, 2 or 3 cm above the pubic symphysis. Ö

In most cases we make a conservative management, the patient enters the emergency area and we began to observe, and as long as hemodynamically stable, we observe it and study it, you do your lab tests, Hg and Hct serial, sonography, CT, his Rx, etc., will give us chance to observe and that is the appropriate behavior in a patient with abdominal trauma , but whenever hemodynamically stable.

serial Hg and Hct as mentioned earlier.

Parenteral or placement of liquid is needed, also according to patient weight parenteral solution we will tell you, and you more or less know as hydration of children and obviously a child who is with abdominal trauma and have more years dose will be greater by weight.

The placement of the blood also has a dose, when we put total blood erythrocyte concentrate, derived platelets, plasma, etc., We must place it at a dose of 10-15 cc / kg as a medical treatment if the patient needs to be carried flag because we assume that there is an injury to a viscus with important bleeding will be higher dose, 20 cc / kg as a surgical treatment, but that I have to have a central or peripheral, generally central line or phlebotomy. If these methods are not feasible can be done in the latter case through the intraosseous route, through the bone, the tibia at the tibial tuberosity of it about 2 or 3 cm below I will drill a large Yelka to fall into the bone marrow and hydrate the patient there, allow maximum 24 hours, with easy access and with it we can prevent the Px die of hypovolemic shock. Ö

Vital Signs Strict rating DECIDE TO CHANGE BEHAVIOR THERAPY, the patient under observation where we're monitoring your heart rate, BP, pulse, et., At the time that there is a variation on one of these signs, Our behavior will change.

ö Finally, exploratory laparotomy, to the extent that the patient did not improve or that there are clear signs that there is an abdominal problem hypovolemic shock, there are signs of active bleeding, we take an exploratory laparotomy. We open the abdomen to explore it, I'm going to open because that structure is not damaged, when I do exploratory laparotomy, a surgical exploration of the abdomen, I open the anterior abdominal wall to reach the peritoneal cavity and I will explore all all organs and structures that are inside to verify where the damage. When I have a patient with acute appendicitis, laparotomy also do, but does not explore, because I open the abdomen and also examine, when I have a patient with an intestinal blockage, but I also do not exploratory laparotomy. The Explorer is used when I have to open the abdominal wall to reach the cavity to see which of the structures is what is giving me the symptoms. And that's all I have to do when nothing else has worked for me when none of the studies has helped me when handling it and given to the patient, conservative, and I have not served the patient's clinical conditions have not improved, then do exploratory laparotomy.

Indications For Laparotomy Explorer:

acute deterioration of Vital signs after entering the patient. Where patients can enter and immediately he can come with signs of hypovolemic shock, blood pressure across the floor, tachycardia, rapid pulse, pale skin or mucosa important acute deterioration of vital signs, that's an indication to be taken to immediately flag, of course, the patient should have a central or peripheral to be able to laparotomy and know what the structure is damaged. Peritoneal penetration

stab wound or gunshot, without ecuanon what we talked about non-penetrating and penetrating injuries. Penetrating injury, peritoneal penetration is an indication absolute lead the patient to laparotomy, once I see the wound, examined it and realized at once because I put the finger with the glove or with the probe or the wound is so large that the patient is eviscerated, I have not to do anything just to take a central line and take the patient to the flag.


Evidence of a hollow viscera perforation, pneumoperitoneum translated as (open air in the peritoneal cavity)

persistent bleeding with haemodynamic instability, replace fluids through a good central line put him intravenous fluids at appropriate doses and even if be ye patient blood and hemodynamic instability persists, Vital signs are unstable.

transfusion requirement greater than half the estimated blood volume or in excess of 40 cc / kg of body weight, ie position and put blood and the patient does not improve, or I exceeded 40 cc / kg and the patient not obviously improved and there is persistent bleeding, hemodynamic instability, deterioration of vital signs, is a patient who required laparotomy because it does not get better.

Blogalaxia Tags: acute abdomen + + + in + pediatric acute appendicitis acute abdomen + medical + acute abdomen pediatric hernia + + stuck + necrotizing enterocolitis intestinal intussusception +

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CEREBELLUM.

THE CEREBELLUM

It is located within the posterior cranial fossa, behind the pons and medulla, and covered by the tentorium.

consists of two hemispheres connected by a middle portion, the vermis. The cerebellum has an ovoid shape and is connected to the midbrain peduncles superior cerebellar, to bump the middle cerebellar peduncles and the medulla oblongata by the inferior cerebellar peduncle.

At the top we have the raw fissure or groove on the back or flocculonodular posterolateral fissure.

The cerebellum is divided into three main lobes: the anterior lobe, middle lobe and the lobe flocculonodular.

The anterior lobe can be seen on the upper surface the cerebellum and the middle lobe is separated by a V-shaped fissure called the fissure prima; vermis level corresponds to the lingula, central lobule and culmen, and cerebellar hemispheres correspond to the wing of central lobule and the quadrangular lobule above.

middle or posterior lobe , is the largest part of the cerebellum, is located between the premium and flocculonodular fissures, a level corresponding to the decline vermis, folium, tuber, pyramid and uvula , and cerebellar hemispheres correspond to simple or quadrangular lobule posterior superior lunate, inferior semilunar, gracile, and amygdala digastric cerebellum.

flocculonodular lobe is located behind the fissure flocculonodular, in the vermis have the nodule in the cerebellar hemispheres and the flocculus. A deep horizontal fissure is located along the margin of the cerebellum separating the upper surfaces of the bottom.

The cerebellum is composed of an outer shell called the cortex gray matter and white matter internally. Inside the white matter in each hemisphere there are three masses of gray matter forming the cores intercerebelosos.

Phylogenetic Division Cerebellum of .

Arquicerebelo.
- flocculonodular lobe. Balance.

paleocerebellum.
- anterior lobe. Muscle tone.
- uvula and pyramid of the vermis. Gross movements.

neocerebellum .
- middle lobe and vermis.
voluntary movement control (except uvula and pyramid). Fine movements.

INTERNAL STRUCTURE the cerebellar cortex.

can be considered a large sheet folds located in the coronal or transverse plane. Each fold or folium contains a center of white matter covered by gray surface. A cut parallel to the median plane divides the folia at right angles and the cut surface looks branched tree called life.

The gray matter of the cortex in its entirety has a uniform structure. Can be divided into 3 layers:

molecular layer. contains two types of neurons: stellate cells and the cell external in inner basket. These neurons are scattered among the dendritic arborizations and numerous thin axons that run parallel to the axis of the folia. Glial cells were found between these structures.

middle layer of Purkinje cells or . Purkinje cells are Golgi type 1 neurons larger. Flask-shaped and are arranged in a single layer. At the base of these cells, the axon arises and passes through the granular layer to enter the white matter. By accessing the the axon acquires a myelin sheath and terminated by a cell synapse in the nuclei intracerebelosos. The branches of Purkinje axon collaterals make synaptic contacts with dendrites of basket and stellate cells in the granular layer in the same or distant folia.

granulosa layer. is full of small cells with densely stained nuclei and have scant cytoplasm. Each cell gives rise to 4 or 5 dendrites that have endings like claws and make synaptic contact with mossy fiber afferents. The axon of each granular cell passes into the molecular layer where it bifurcates in a T-junction, whose branches run parallel to the axis of the cerebellar folium. Over this layer are glial cells and golgi.

functional areas of the cerebellar cortex.

vermis cortex influences the movements of the body axis, ie, neck, shoulders, chest, abdomen and hips. Immediately lateral to the vermis is the intermediate zone of cerebellum, an area that controls the muscles of the distal parts of limbs. Nuclei

intracerebelosos.

are 4 masses of gray matter included in the white matter of cerebellum on each side of the midline. The cores are intracerebelosos composed of large multipolar neurons with simple branching dendrites, axons grow in the efferent cerebellar superior and inferior cerebellar peduncles. From outside to inside, the kernels are:

dentate nucleus, the largest of the cerebellar nuclei. It's shaped like a crumpled bag with the opening facing the inner side. Inside the bag is filled with white substance formed by efferent fibers leave the nucleus through the hole to form much of the superior cerebellar peduncle. Has information neocerebellum (middle lobe and vermis).

emboliforme Core or anterior interpositus is oval and is located medial to the dentate nucleus and partially covers the hilum. Paleocerebellum has information.

globose nucleus, consisting of one or more groups of rounded cells that are located within the nucleus emboliforme. Paleocerebellum has information.

fastigial core, is located near the midline in the vermis and near the roof of the 4th ventricle, is larger than the spherical core. Has arquicerebelo information.

white substance.
There is a small amount of white matter in the vermis and closely resembles the trunk and branches of a tree: the tree of life. There is a large amount of white matter in each hemisphere of the cerebellum.

The white substance is formed by 3 groups of fibers: intrinsic, afferent and efferent.
- intrinsic fibers. Do not leave the cerebellum.
- afferent fibers. Information reaches the middle and inferior cerebellar peduncles.
- efferent fibers. Sale information superior cerebellar peduncle, except the information from the kernel of the roof that goes from the lower stalk.

cerebellar peduncles.

Superior, connects with the midbrain. Middle connects to the pons. Bottom, is connected to the medulla.

grooves, flakes and fissures.

The surface of the cerebellum appears crossed by a series of narrow grooves arranged crosswise. The portion between the grooves is called cerebellar foil or foil. The cracks are deeper than the grooves and move from one to the other hemisphere through vermis, dividing the body into several lobes. We consider the lobes and fissures in both hemispheres and in the vermis, stepped in anteroposterior. The divisions of the vermis but different names to the lobes, the divisions of the vermis are

Lingula, anterior portion of the vermis and is attached to the anterior medullary velum. Lingula laterally continuous with the hemispheres by 2 small side extensions, links. The lingula and the links are limited by the precentral fissure that separates the central lobe.

central lobe, is among the precentral fissure and preculminar. Their lateral extensions are small and are called wings of central lobe.

Culmen, behind the central lobe of the vermis than rises to form the mound, the anterior slope of these is called summit and lies between the fissure and fissure preculminar higher premium or above. The extension hemispheric summit comprised of the same fissures lobe called the anterior semilunar.

Decline, the posterior side of the mound where their hemispheric extensions are called semilunar lobes later. These portions are between the crack or fissure anterior superior premium and the posterior superior fissure.

Folium, the following division of the vermis is very thin folium vernis and is located in the depth of the posterior cerebellar notch, links 2 large hemispheric portions. Superior semilunar lobules as are between the posterior superior fissure and horizontal.

Irrigation.

superior cerebellar artery, anterior and posterior.

venous drainage.
great cerebral vein or dural sinus neighbors rectum and anterior occipital.

Blogalaxia Tags: cerebellum parts + of + cerebellum cerebellar nuclei + irrigation + of + cerebellum

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Brain Atlas of Skull and pelvic girdle



















Blogalaxia Tags: atlas + of + bone + of + skull brain images + of + skull + and + bone + system + of + skull brain

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The lower member comprises four segments: the girdle (waist) pelvic, femoral region (thigh), leg and foot.

pelvic girdle

It consists of two iliac or innominate bones, articulated with the sacrum behind and joined together before the pubic symphysis.

the innominate bone is a pair, articulated, then to the sacrum, below and in the median line with his counterpart, down and laterally with the coxal fémur.Cada consists of three separate bones: the ilium, ischium and pubis. In the early years of the three bones are separated, but later fuse and form a single structure, ie a single bone, which shows two faces, four edges and four corners ..

cavity formed by this belt, serves as shelter to the intestines, rectum, bladder and internal reproductive organs.

It is noteworthy that in women the pelvic bones is formed by light, which facilitates the placement of the uterus during pregnancy and expansion in the output of the fetus at delivery.

lateral

- or acetabulum Acetabulum. It is a rounded cavity, deep, consists of a circular flange outgoing edge acetabular acetabulum eyebrow. Acetabular notch. The acetabulum has two distinct parts: a non-articular (bottom of the cup) in a quadrilateral, its lower edge corresponds to the acetabular notch. the other is to articulate fascie lunata.

above the acetabulum

expands gluteal face reveals two rough: gluteal line anterior and posterior gluteal line.

medial or internal

A ridge run from top to bottom and from back to front, the arcuate line (unnamed) divide this face into two:

-superolateral is the iliac fossa (internal), as one looks back the foramen (holes) nutrient bone, down and sideways dirijiso

-Below and behind is on, from top to bottom: iliac tuberosity, roughness intended for the insertion of the posterior sacroiliac ligaments, auricular face; quadrilateral surface

Borders Previous

Superior Posterior Inferior

angles

1_) anterosuperior, anterior superior iliac spine

2 -) posterior: posterior superior iliac spine

3 -) Medial : Formed by the angular surface of the pubis

4 -) Posterior: Formed by the body of the ischium and ischial tuberosity, is one of the most dense aprtes innominate.

Types of Pelvis Bone

gynecoid


• AP diameter similar to the transverse position
• Normal Sacro
• Straight Sides • Thorns No prominent

• 60% open subpúbico Angulo good prognosis






Android

• AP diameter <> forward

• Holy • converging side walls

• C. Thorns • Angle subpúbico very prominent closed 20% bad

Forecast

Ape

AP diameter> Transverse
• Sacred long, straight
•
converging sidewalls something very prominent spines
• • subpúbico somewhat narrow angle Forecast 5%

Well

Platipeloide

• AP diameter <>

• Holy

short curved side walls straight

• • Spines prominent

• 15% open angle Forecast subpúbico bad

Assessment Methods Pelvis

Pelvimetry

Lateral and AP Rx Radiopelvimetría

Blogalaxia Tags: waist + pelvic pelvis bone + pelvis coxal ilium ischium pubis acetabulum lower member +

Painful Glands After Drinking A Lot Of Alchohol

can be defined as the rupture of the integrity of the mucosa of the stomach and duodenum due to active inflammation caused by acid and pepsin, which extends at least to the muscularis-mucosa.

Histological Classification of injuries Gastroduodenal Mucosa

-Erosions-ulcers
Acute-chronic ulcer.

Erosion superficial lesions are rounded, less than 5 mm in diameter, margins slightly raised, brown or red background, multiple. Histologically, the loss of substance is limited to the mucosa, where there are necrotic debris, fibrin, neutrophils and red cells with infiltration by polymorphonuclear cells in the periphery. These erosions usually heal completely without scarring.





Acute ulcer. single or multiple lesions similar in appearance but larger than erosions. It extiense to musc mucosa. At the bottom of the ulcer may be seen some granulation tissue with little fibroblastic reaction. The lining and glandular epithelia show peripheral active aspect because from them there is regeneration.









chronic ulcers.
- Fibrosis in the base
- Healing
area - prevents regeneration total. Abarca mucosa, submucosa, musc, muc.4 CPAs from outside to inside
- Layer fibroleucocitario exudate
- Tej. eosinophilic necrotic
- Tej granulation
- Cel inflammatory.

Etiopathogenesis

Peptic ulcer is the result of an imbalance between aggressive factors and defensive factors in the gastroduodenal mucosa. The importance of acid secretion and peptic activity of gastric juice in the pathogenesis of peptic ulcer disease is evident because in the absence of acid no ulcer. There is also a good correlation between the effectiveness of antisecretory therapy on ulcer healing and suppression of gastric acidity

defensive mechanisms of the mucosal barrier

The gastroduodenal mucosa has a number defensive mechanisms that contribute to the maintenance of mucosal integrity in the acidic environment of the stomach. The factors involved in this process is the secretion of mucus and bicarbonate, blood flow and gastric mucosal cell regeneration capacity against damage to the mucosa (see Chap. Anatomy, Physiology and exploration disease).
The importance of each of these factors has been well characterized in experimental models of acute injury of gastric mucosa, but their exact involvement in the pathogenesis of chronic ulcers is less well known.

Pathogenic Factors

infection H. pylori and NSAIDs are the most common factors that compromise the strength of the mucosal barrier against peptic activity of gastric juice and are independent factors in the pathogenesis of ulcer disease.

Other factors

Smoking slows healing of ulcers, promotes recurrence and increases the risk of complications, but not a primary pathogenic factor. The mechanisms involved in the effect of smoking on ulcer disease have been attributed to increased basal and stimulated acid secretion, alteration in mucosal blood flow and gastric motility and reduced pancreatic secretion of bicarbonate. Although alcohol at high concentrations or stress can trigger the development of acute lesions of the mucosa, has not been shown to be risk factors for development chronic ulcers.

Clinic

• abdominal pain, localized in the epigastrium and is often described as burning, corrosive pain or painful sensation of hunger.

• The pain is usually related to a rate schedule intake.

• Anorexia and weight loss are not uncommon, and only 20% of duodenal ulcer patients referred increased appetite.

• Nausea and vomiting may occur in the absence of pyloric stenosis.

• dyspeptic symptoms such as belching, bloating, intolerance to fat or heartburn.

The physical examination in uncomplicated ulcer is usually normal or may show pain on deep palpation in the epigastrium, a finding which is completely nonspecific. However, the physical examination may reflect the occurrence of complications.

Thus, the presence of cutaneous and mucosal pallor suggests hemorrhage, palpation of abdomen table with signs of peritoneal irritation reflect the existence of a perforation and the presence of fasting gastric pigeage will suspect pyloric stenosis.


The physical examination should also look for signs of associated diseases, especially cardiac, respiratory or liver that increase the risk of surgical complications in these patients.


Regarding the natural history of ulcer disease, it is noteworthy that this is a relatively benign condition, chronic relapsing course with spontaneous remissions and exacerbations.



80% duodenal ulcers and 50% of gastric will relapse during the 12 months of healing.




Approximately 20% of patients suffer some complication in the course of their disease. Overall mortality is 2.5% and is due to the complications and surgery.




GASTRIC ULCER

pain after meals.
is more difficult to settle down with.
antacids or eating food.

Less Frequent Night Awakenings

Frequent weight loss

DUODENAL ULCER

-Two-Three hours after eating. He
mitigated by Antacids and Food.
-Night Awakenings. Avoid prolonged periods of fasting, weight loss
not

Frequent

Diagnosis

-Anamnesis


-Physical Exam-Endoscopy





-Rx-chemical characteristics

Gastric serum pepsinogen Determinations I and gastrin (see Chap. Anatomy, Physiology and exploration disease)

-Diagnosis of Helicobacter pylori infection


H. Diagnostic Methods pylori

Direct (invasive) endoscopic
-Histology-Farming

-urease test.

Indirect (Non-Invasive) Serology

-breath-test (C13 C14)

treatment and eradication of H. pylori

IBP + Amoxicillin + Clarithromycin

Blogalaxia Tags: peptic ulcer + erosion acute ulcer + ulcer + + and + chronic + gastric ulcer + duodenal ulcer clinical + + of + peptic ulcer diagnosis + of + peptic + ulcer + Helicobacter pylori

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Tonsillopharyngitis


is an infectious process can be considered the common denominator in the pathology of the upper respiratory tract and is characterized by edema and inflammation of the pharynx and tonsils.





is a disease that can affect anyone, regardless of age, sex, race.

is very common in our environment and causes of absenteeism.



can porducirse pharyngitis due to the invasion of a variety of microorganisms such as:



1 - Virus: where it is called: Viral Tonsillopharyngitis and is important to note that 85% of the Tonsillopharyngitis produced are of this type.


2 - Bacteria: Bacterial Faringoamigdalits


3 - Fungi: Fungal Tonsillopharyngitis

Tonsillopharyngitis Viral

-Rhinovirus, Coronavirus

-Coxackievirus

-Influenza

-Parainfluenza-Adenovirus

is a condition in which symptoms persist for 3-4 days, the patient may have a fever early Odynophagia mild anorexia , and is usually accompanied in some cases by rhinitis and conjunctivitis, and stomatitis

Bacterial Tonsillopharyngitis

-S. B-hemolytic streptococci It is the main causal agent of this disease.

-

Staphylococcus aureus, Streptococcus pneumoniae

-Moraxella

catarralis

Symptoms

marked
• Sore throat • Odynophagia

• Fever 39 , 40oC
• Headache, chills

• Abdominal pain • Pharynx bright red
• grayish yellow exudate on the tonsils uvula
• Edema pronounced cervical lymphadenopathy

•

Pathogenesis

-Climate Change.
-virulence of the organism.
-host resistance.

The M protein determines the degree of virulence of bacteria.

are more resistant to phagocytosis.

S. B-hemolytic group A produced extracellular products (Hemolysins O) that antibodies occur in humans are titratable (ASO).

acquired human immunity to streptococcal infection is based on the development of opsonic antibodies against the protein portion antiphagocytic M.

anti-M antibodies are mainly IgG, which appear slowly.

Diagnosis

1-Clinical History

2-Clinical

3-Lab:
Acct. and makes white throat swab
VSG

Title ALSO

Complications

Viral

• Otitis media.
• pharyngeal ulcerations. Bacterial



• retropharyngeal abscess.
• Rheumatic fever.
• glomerulonephritis.

Treatment Tonsillopharyngitis

F. Viral

• Rest.
• Analgesics.
• Gargle.
• Anti-inflammatory.
• Vitamin C and decongestants.

F. Bacterial (S. B-hemolytic group A)

• Bacterial Tonsillitis:
- Benzathine penicillin (Benzetacil) 600000unid <> 25 kg
VIM-1 Dose Amoxicillin 15 mg / kg 8hrs.
-Amoxi + clavulanate + sulbactan

-Clindamycin, Erythromycin
-Tonsillectomy.

Blogalaxia Tags: pharyngitis + bacterial + viral pharyngitis