Gespecialiseerde pediatrie
Inhoudsopgave
ORTHOPEDIE
1. Abnormale thorax.......................................................................................9
1.1 Pectus Excavatum..................................................................................................... 9
1.2 Pectus Carinatum...................................................................................................... 9
2. Standafwijkingen van de voet.....................................................................................9
2.1 Pes Cavus.................................................................................................................. 9
2.2 Pes Planovalgus......................................................................................................... 9
2.3 Pes Equinovarus Adductus......................................................................................10
4 vormafwijkingen...................................................................................................... 10
Behandelen............................................................................................................... 10
3. Verminderde beweeglijkheid van de heup..................................................11
3.1 Begrippen................................................................................................................ 11
3.2 Risicofactoren.......................................................................................................... 11
3.3 Diagnose................................................................................................................. 11
Heupluxatie................................................................................................................ 11
Heupdysplasie............................................................................................................ 11
handgreep van Ortolani.............................................................................................. 11
handgreep van Barlow................................................................................................ 11
Echografie.................................................................................................................. 12
3.4 Behandelen............................................................................................................. 12
Pavlikbandage............................................................................................................ 12
Tractie........................................................................................................................ 12
Artrografie.................................................................................................................. 12
Chirugie...................................................................................................................... 12
3.5 Aandachtspunten.................................................................................................... 12
Gipsbroek................................................................................................................... 12
Tractie........................................................................................................................ 12
4. Scoliose................................................................................................... 14
4.1 Types....................................................................................................................... 14
Niet-structurele, soepele scoliose...............................................................................14
Structurele, stugge scoliose.......................................................................................14
4.2 Symptomen............................................................................................................. 14
4.3 Behandelen............................................................................................................. 15
Korset......................................................................................................................... 15
Spondylodese............................................................................................................. 15
Postop aandachtspunten............................................................................................ 15
1. Afwijkende schedelvormen.......................................................................16
1.1 Belangrijkste complicaties.......................................................................................16
1
,Gespecialiseerde pediatrie
1.2 Non-synostotische plagiocefalie..............................................................................16
1.3 Crandiocynostose.................................................................................................... 16
1.4 Microcefalie............................................................................................................. 16
Cerebrale parese........................................................................................................ 17
RETT-Syndroom.......................................................................................................... 18
1.5 Macrocefalie............................................................................................................ 18
Alarmsignalen intracraniële drukverhoging................................................................18
Hydrocefalie............................................................................................................... 19
2. Epilepsie.................................................................................................. 19
2.1 Niet neurologische paroxysmale stoornis (≠ epilepsie)...........................................19
Breath holding spell.................................................................................................... 20
Syncope...................................................................................................................... 20
2.2 Epileptische aanvallen............................................................................................. 20
Classificatie ILEA (Internationale liga tegen epilepsie)................................................20
2.3 Focale aanval.......................................................................................................... 20
Complex partiële aanval............................................................................................. 21
Eenvoudig partiële aanval.......................................................................................... 21
2.4 Gegeneraliseerde aanvallen....................................................................................21
Absence (petit mal).................................................................................................... 21
Tonisch-clonische aanvallen.......................................................................................21
Myoclonische aanvallen.............................................................................................. 22
Juveniel myoclonische aanval.....................................................................................22
Gegeneraliseerde tonische aanvallen.........................................................................22
2.5 Epileptische syndromen.......................................................................................... 22
West-syndroom.......................................................................................................... 22
Dravetsyndroom......................................................................................................... 23
2.6 Status epilepticus.................................................................................................... 23
Doelen van spoedbehandeling...................................................................................23
Behandelen................................................................................................................ 24
2.7 Diagnostiek............................................................................................................. 24
2.8 Behandelen............................................................................................................. 24
3. Hoofdpijn................................................................................................. 25
3.1 Inzicht in type hoofdpijn..........................................................................................25
3.2 Primaire hoofdpijn: migraine...................................................................................26
3.3 Secundaire hoofdpijn: meningitis............................................................................26
Symptomen................................................................................................................ 26
Bacteriële meningitis.................................................................................................. 26
Virale meningitis......................................................................................................... 27
Complicaties............................................................................................................... 27
Ernstige acute complicaties........................................................................................27
Behandeling meningitis.............................................................................................. 27
Verpleegkundige observaties.....................................................................................27
4. Autisme Spectrum Stoornis (ASS)..............................................................28
2
,Gespecialiseerde pediatrie
4.1 Kenmerken.............................................................................................................. 28
Basiskenmerken ass volgens de dsm5.......................................................................28
4.2 Diagnose................................................................................................................. 29
Comorbiditeit.............................................................................................................. 29
4.3 Behandelen............................................................................................................. 29
Wat heeft men waargenomen, welke interpretatie?...................................................29
Kind met ASS ervaart meer stress door overgevoeligheid zintuigelijke prikkels.........29
4.4 In het ziekenhuis..................................................................................................... 30
Tips voor contact kind met ASS..................................................................................30
5. Attention Deficit (Hyperactivity) Disorder (AD(H)D)....................................31
5.1 Kenmerken.............................................................................................................. 31
3 types/beelden afhankelijk van vooropstaande gedragskenmerken.........................31
5.2 Diagnose................................................................................................................ 31
5.3 Behandeling........................................................................................................... 31
1. Oedeem................................................................................................... 32
1.1 Nefrotisch syndroom............................................................................................... 32
Symptomen................................................................................................................ 32
Minimale-laesies nefrotisch syndroom (mcd: minimal change disease)......................32
Congenitaal nefrotisch syndroom...............................................................................33
2. Oligurie.................................................................................................... 33
3. Acute nierinsufficiëntie.............................................................................33
3.1 Oorzaken per niveau............................................................................................... 33
Pre-renaal................................................................................................................... 33
Renaal........................................................................................................................ 33
Post-renaal................................................................................................................. 33
3.2 Symptomen............................................................................................................. 34
3.3 Diagnose................................................................................................................. 34
3.4 Behandeling............................................................................................................ 34
3.5 Hemolytisch Uremisch Syndroom (HUS)..................................................................35
Symptomen................................................................................................................ 35
Complicaties............................................................................................................... 35
Prognose..................................................................................................................... 35
3.6 Henoch-Schönleinpurpura (HSP)..............................................................................35
Symptomen................................................................................................................ 35
Diagnose.................................................................................................................... 36
Behandeling............................................................................................................... 36
4. Chronische nierinsufficiëntie.....................................................................36
4.1 Stadiëring cni volgens gfr........................................................................................36
4.2 Oorzaken bij kinderen..............................................................................................36
4.3 Polycysteuze nierziekte........................................................................................... 36
3
, Gespecialiseerde pediatrie
Autosomaal Dominante Polycysteuze Nierziekte (ADPKD)..........................................36
4.4 Vesico-uretrale reflux (vur)......................................................................................36
4.5 Complicaties cni...................................................................................................... 37
4.6 Behandeling............................................................................................................ 37
Algemeen................................................................................................................... 37
Specifiek..................................................................................................................... 37
5. Terminale nierinsufficiëntie.......................................................................37
5.1 Hemodialyse............................................................................................................ 38
Aandachtspunten....................................................................................................... 38
5.2 Peritoneale dialyse..................................................................................................39
Principes..................................................................................................................... 39
Soorten PD................................................................................................................. 39
Voor- en nadelen....................................................................................................... 39
5.3 Niertransplantatie.................................................................................................... 39
Donor.......................................................................................................................... 39
Ingreep...................................................................................................................... 39
Medicatie.................................................................................................................... 40
1. Vernauwde voorhuid.................................................................................41
1.1 Fimosis.................................................................................................................... 41
1.2 Parafimosis.............................................................................................................. 41
2. Hypospadie.............................................................................................. 41
2.1 Behandeling............................................................................................................ 41
3. Niet-ingedaalde/scrotale testis..................................................................42
3.1 Behandelen: orchidopexie.......................................................................................42
Argumenten................................................................................................................ 42
Ingreep....................................................................................................................... 42
4. Torsio testis............................................................................................. 42
4.1 Symptomen............................................................................................................. 43
4.2 Behandelen............................................................................................................. 43
1. Braken (emesis).......................................................................................44
1.1 Slokdarmatresie...................................................................................................... 44
Diagnose.................................................................................................................... 44
Behandelen................................................................................................................ 44
VACTERL..................................................................................................................... 45
2. Feacesincontinentie..................................................................................45
5.4 Anorectale afwijkingen: ziekte van Hirschsprung....................................................45
Symptomen................................................................................................................ 45
Diagnose en behandeling........................................................................................... 45
5.5 Neuralebuisdefecten............................................................................................... 46
4
Inhoudsopgave
ORTHOPEDIE
1. Abnormale thorax.......................................................................................9
1.1 Pectus Excavatum..................................................................................................... 9
1.2 Pectus Carinatum...................................................................................................... 9
2. Standafwijkingen van de voet.....................................................................................9
2.1 Pes Cavus.................................................................................................................. 9
2.2 Pes Planovalgus......................................................................................................... 9
2.3 Pes Equinovarus Adductus......................................................................................10
4 vormafwijkingen...................................................................................................... 10
Behandelen............................................................................................................... 10
3. Verminderde beweeglijkheid van de heup..................................................11
3.1 Begrippen................................................................................................................ 11
3.2 Risicofactoren.......................................................................................................... 11
3.3 Diagnose................................................................................................................. 11
Heupluxatie................................................................................................................ 11
Heupdysplasie............................................................................................................ 11
handgreep van Ortolani.............................................................................................. 11
handgreep van Barlow................................................................................................ 11
Echografie.................................................................................................................. 12
3.4 Behandelen............................................................................................................. 12
Pavlikbandage............................................................................................................ 12
Tractie........................................................................................................................ 12
Artrografie.................................................................................................................. 12
Chirugie...................................................................................................................... 12
3.5 Aandachtspunten.................................................................................................... 12
Gipsbroek................................................................................................................... 12
Tractie........................................................................................................................ 12
4. Scoliose................................................................................................... 14
4.1 Types....................................................................................................................... 14
Niet-structurele, soepele scoliose...............................................................................14
Structurele, stugge scoliose.......................................................................................14
4.2 Symptomen............................................................................................................. 14
4.3 Behandelen............................................................................................................. 15
Korset......................................................................................................................... 15
Spondylodese............................................................................................................. 15
Postop aandachtspunten............................................................................................ 15
1. Afwijkende schedelvormen.......................................................................16
1.1 Belangrijkste complicaties.......................................................................................16
1
,Gespecialiseerde pediatrie
1.2 Non-synostotische plagiocefalie..............................................................................16
1.3 Crandiocynostose.................................................................................................... 16
1.4 Microcefalie............................................................................................................. 16
Cerebrale parese........................................................................................................ 17
RETT-Syndroom.......................................................................................................... 18
1.5 Macrocefalie............................................................................................................ 18
Alarmsignalen intracraniële drukverhoging................................................................18
Hydrocefalie............................................................................................................... 19
2. Epilepsie.................................................................................................. 19
2.1 Niet neurologische paroxysmale stoornis (≠ epilepsie)...........................................19
Breath holding spell.................................................................................................... 20
Syncope...................................................................................................................... 20
2.2 Epileptische aanvallen............................................................................................. 20
Classificatie ILEA (Internationale liga tegen epilepsie)................................................20
2.3 Focale aanval.......................................................................................................... 20
Complex partiële aanval............................................................................................. 21
Eenvoudig partiële aanval.......................................................................................... 21
2.4 Gegeneraliseerde aanvallen....................................................................................21
Absence (petit mal).................................................................................................... 21
Tonisch-clonische aanvallen.......................................................................................21
Myoclonische aanvallen.............................................................................................. 22
Juveniel myoclonische aanval.....................................................................................22
Gegeneraliseerde tonische aanvallen.........................................................................22
2.5 Epileptische syndromen.......................................................................................... 22
West-syndroom.......................................................................................................... 22
Dravetsyndroom......................................................................................................... 23
2.6 Status epilepticus.................................................................................................... 23
Doelen van spoedbehandeling...................................................................................23
Behandelen................................................................................................................ 24
2.7 Diagnostiek............................................................................................................. 24
2.8 Behandelen............................................................................................................. 24
3. Hoofdpijn................................................................................................. 25
3.1 Inzicht in type hoofdpijn..........................................................................................25
3.2 Primaire hoofdpijn: migraine...................................................................................26
3.3 Secundaire hoofdpijn: meningitis............................................................................26
Symptomen................................................................................................................ 26
Bacteriële meningitis.................................................................................................. 26
Virale meningitis......................................................................................................... 27
Complicaties............................................................................................................... 27
Ernstige acute complicaties........................................................................................27
Behandeling meningitis.............................................................................................. 27
Verpleegkundige observaties.....................................................................................27
4. Autisme Spectrum Stoornis (ASS)..............................................................28
2
,Gespecialiseerde pediatrie
4.1 Kenmerken.............................................................................................................. 28
Basiskenmerken ass volgens de dsm5.......................................................................28
4.2 Diagnose................................................................................................................. 29
Comorbiditeit.............................................................................................................. 29
4.3 Behandelen............................................................................................................. 29
Wat heeft men waargenomen, welke interpretatie?...................................................29
Kind met ASS ervaart meer stress door overgevoeligheid zintuigelijke prikkels.........29
4.4 In het ziekenhuis..................................................................................................... 30
Tips voor contact kind met ASS..................................................................................30
5. Attention Deficit (Hyperactivity) Disorder (AD(H)D)....................................31
5.1 Kenmerken.............................................................................................................. 31
3 types/beelden afhankelijk van vooropstaande gedragskenmerken.........................31
5.2 Diagnose................................................................................................................ 31
5.3 Behandeling........................................................................................................... 31
1. Oedeem................................................................................................... 32
1.1 Nefrotisch syndroom............................................................................................... 32
Symptomen................................................................................................................ 32
Minimale-laesies nefrotisch syndroom (mcd: minimal change disease)......................32
Congenitaal nefrotisch syndroom...............................................................................33
2. Oligurie.................................................................................................... 33
3. Acute nierinsufficiëntie.............................................................................33
3.1 Oorzaken per niveau............................................................................................... 33
Pre-renaal................................................................................................................... 33
Renaal........................................................................................................................ 33
Post-renaal................................................................................................................. 33
3.2 Symptomen............................................................................................................. 34
3.3 Diagnose................................................................................................................. 34
3.4 Behandeling............................................................................................................ 34
3.5 Hemolytisch Uremisch Syndroom (HUS)..................................................................35
Symptomen................................................................................................................ 35
Complicaties............................................................................................................... 35
Prognose..................................................................................................................... 35
3.6 Henoch-Schönleinpurpura (HSP)..............................................................................35
Symptomen................................................................................................................ 35
Diagnose.................................................................................................................... 36
Behandeling............................................................................................................... 36
4. Chronische nierinsufficiëntie.....................................................................36
4.1 Stadiëring cni volgens gfr........................................................................................36
4.2 Oorzaken bij kinderen..............................................................................................36
4.3 Polycysteuze nierziekte........................................................................................... 36
3
, Gespecialiseerde pediatrie
Autosomaal Dominante Polycysteuze Nierziekte (ADPKD)..........................................36
4.4 Vesico-uretrale reflux (vur)......................................................................................36
4.5 Complicaties cni...................................................................................................... 37
4.6 Behandeling............................................................................................................ 37
Algemeen................................................................................................................... 37
Specifiek..................................................................................................................... 37
5. Terminale nierinsufficiëntie.......................................................................37
5.1 Hemodialyse............................................................................................................ 38
Aandachtspunten....................................................................................................... 38
5.2 Peritoneale dialyse..................................................................................................39
Principes..................................................................................................................... 39
Soorten PD................................................................................................................. 39
Voor- en nadelen....................................................................................................... 39
5.3 Niertransplantatie.................................................................................................... 39
Donor.......................................................................................................................... 39
Ingreep...................................................................................................................... 39
Medicatie.................................................................................................................... 40
1. Vernauwde voorhuid.................................................................................41
1.1 Fimosis.................................................................................................................... 41
1.2 Parafimosis.............................................................................................................. 41
2. Hypospadie.............................................................................................. 41
2.1 Behandeling............................................................................................................ 41
3. Niet-ingedaalde/scrotale testis..................................................................42
3.1 Behandelen: orchidopexie.......................................................................................42
Argumenten................................................................................................................ 42
Ingreep....................................................................................................................... 42
4. Torsio testis............................................................................................. 42
4.1 Symptomen............................................................................................................. 43
4.2 Behandelen............................................................................................................. 43
1. Braken (emesis).......................................................................................44
1.1 Slokdarmatresie...................................................................................................... 44
Diagnose.................................................................................................................... 44
Behandelen................................................................................................................ 44
VACTERL..................................................................................................................... 45
2. Feacesincontinentie..................................................................................45
5.4 Anorectale afwijkingen: ziekte van Hirschsprung....................................................45
Symptomen................................................................................................................ 45
Diagnose en behandeling........................................................................................... 45
5.5 Neuralebuisdefecten............................................................................................... 46
4
