KINDERGENEESKUNDE
PROF. JAAN TOELEN
Te kennen: wat er op de slides staat en wat er in de lessen verteld wordt + semeiologie (foto’s) uit
klinische lessen
Tekstboek: niet verplicht
Casusgebaseerde integratieweek: handig om de MCQ te leren oplossen
INHOUDSOPGAVE
H1: THE CHILD IN SOCIETY – CHILD PROTECTION .......................................................................... 6
1. WAAROM “THE CHILD IN SOCIETY” BELANGRIJK IS ......................................................................................6
2. THE CHILD’S WORLD: MEER DAN DE CONSULTATIE .....................................................................................6
3. ONMIDDELLIJKE EN BREDERE OMGEVING .................................................................................................6
4. PREVENTIEVE GEZONDHEIDSZORG VOOR KINDEREN IN VLAANDEREN ..............................................................7
5. BESCHERMENDE STRUCTUREN BIJ RISICO ................................................................................................8
5.1 Vertrouwenscentra Kindermishandeling (VK) .............................................................................8
5.2 Comité Bijzondere Jeugdzorg (CBJ) ...........................................................................................8
5.3 Jeugdrechtbank .......................................................................................................................8
6. MEDICOLEGALE ASPECTEN IN PEDIATRIE..................................................................................................9
7. WET PATIËNTENRECHTEN (WPR) – BELGIË ..............................................................................................9
8. MINDERJARIGEN EN BESLISSINGSRECHT ..................................................................................................9
9. TYPISCHE CASUSSEN (EXAMENGERICHT) ............................................................................................... 11
10. KINDERMISHANDELING EN VERWAARLOZING ........................................................................................ 11
11. KLINISCHE TEKENEN VAN MISHANDELING............................................................................................. 12
11.1 Hematomen (meest frequent) .............................................................................................. 12
11.2 Brandwonden ...................................................................................................................... 12
11.3 Fracturen (hoog specifieke!) ................................................................................................. 12
11.4 Niet-accidenteel hoofdtrauma ............................................................................................. 12
12. SEKSUEEL GEWELD ........................................................................................................................ 13
13. GLOBAL CHILD HEALTH .................................................................................................................. 13
14. TAKE HOME MESSAGES (EXAMEN) .................................................................................................... 13
H2: PERINATAL MEDICINE ............................................................................................................14
1. PRE-PREGNANCY CARE .............................................................................................................. 14
2. ANTENATALE DIAGNOSE ............................................................................................................. 15
3. OBSTETRISCHE AANDOENINGEN MET FOETALE IMPACT .............................................................. 15
4. MATERNALE AANDOENINGEN MET FOETALE IMPACT ................................................................... 15
4.1 Diabetes mellitus .................................................................................................................. 15
4.2 Hyperthyroïdie (Graves) ......................................................................................................... 16
4.3 Systemische lupus ................................................................................................................ 17
, 4.4 Rh iso-immunisatie ................................................................................................................ 17
4.5 Auto-immune TTP .................................................................................................................. 17
5. MATERNALE DRUGS DIE DE FOETUS BEÏNVLOEDEN .............................................................................. 18
6. CONGENITALE INFECTIES ........................................................................................................... 18
6.1 Rubella ................................................................................................................................. 18
6.2 CMV ..................................................................................................................................... 19
6.3 Toxoplasmose ....................................................................................................................... 19
6.4 Varicella zoster ..................................................................................................................... 20
7. ADAPTATIE NA GEBOORTE .......................................................................................................... 20
7.1 Longen.................................................................................................................................. 20
7.2 Circulatie .............................................................................................................................. 21
7.3 Glucosehomeostase ............................................................................................................. 21
7.4 Temperatuur ......................................................................................................................... 21
7.5. de lever ................................................................................................................................ 21
8. NEONATALE RESUSCITATIE ......................................................................................................... 22
9. SIZE AT BIRTH ............................................................................................................................. 22
10. ROUTINE POSTNATALE ZORG .................................................................................................... 23
11. NEONATALE SCREENING .......................................................................................................... 23
H3: NEONATAL MEDICINE ............................................................................................................25
1. HYPOXIC-ISCHEMIC ENCEPHALOPATHY (HIE) ............................................................................. 25
1.1 Pathofysiologie ...................................................................................................................... 25
1.2 Klinische ernst....................................................................................................................... 25
1.3 Behandeling .......................................................................................................................... 26
2. GEBOORTELETSELS .................................................................................................................... 26
2.3 Fracturen .............................................................................................................................. 27
3. PREMATUUR INFANT ................................................................................................................... 28
3.1 Respiratory Distress Syndrome (RDS) ..................................................................................... 28
3.2 Pneumothorax....................................................................................................................... 29
3.3 Apneu, bradycardie en desaturatie van prematuriteit ............................................................... 30
3.4 Necrotiserende enterocolitis (NEC) ........................................................................................ 30
3.5 Bronchopulmonale dysplasie ............................................................................................ 31
4. ICTERUS ..................................................................................................................................... 32
5. RDS BIJ TERME INFANT ................................................................................................................ 33
6. NEONATALE INFECTIES ............................................................................................................... 34
7. HYPOGLYCEMIE ......................................................................................................................... 35
8. CRANIOFACIALE AFWIJKINGEN ................................................................................................... 35
9. GASTRO-INTESTINALE AANDOENINGEN ...................................................................................... 35
9.1 Oesofagusatresie .................................................................................................................. 35
9.2 Dunne darmobstructie ........................................................................................................... 36
9.3 dikke darm obstructie ............................................................................................................ 36
9.4 Omfalocoele vs gastroschisis ................................................................................................. 36
H4: PEDIATRIC EMERGENCIES & ACCIDENTS AND POISONING .....................................................37
1. DE ERNSTIG ZIEKE KINDERPATIENT .............................................................................................. 37
1.1 Eerste beoordeling = ABCDE .................................................................................................. 37
1.2 Shock bij kinderen ................................................................................................................. 39
2. ANAFYLAXIE ............................................................................................................................... 41
3. EPILEPSIE / NEUROLOGISCHE URGENTIES .................................................................................. 41
4. SIDS / ALTE / SUDI ....................................................................................................................... 42
, 5. REANIMATIE (BLS) ....................................................................................................................... 43
6. CHOKING (ASPIRATIE) ................................................................................................................. 44
7. FOREIGN BODY INGESTION......................................................................................................... 45
8. HOOFDTRAUMA ......................................................................................................................... 45
9. BRANDWONDEN ........................................................................................................................ 46
10. INTOXICATIE – PARACETAMOL ................................................................................................... 47
11. POISONING ALGEMEEN ............................................................................................................ 48
12. DROWNING .............................................................................................................................. 48
H5: GROWTH & PUBERTY .............................................................................................................49
GROEI ............................................................................................................................................. 49
1. NORMALE GROEI .................................................................................................................... 49
2. METINGEN VAN GROEI ............................................................................................................ 49
3. ABNORMALE HOOFDGROEI .................................................................................................... 49
4. BIOMETRIE TIJDENS KINDERLEEFTIJD ...................................................................................... 53
5. KLEINE GESTALTE (SHORT STATURE)........................................................................................ 53
6. GROTE GESTALTE (TALL STATURE) ........................................................................................... 56
groeicurves................................................................................................................................. 56
PUBERTEIT ........................................................................................................................................ 57
1. Definitie .................................................................................................................................. 57
3. HORMONALE REGULATIE ........................................................................................................ 57
3. TANNER SCORE ...................................................................................................................... 58
4. PUBERTEIT BIJ MEISJES............................................................................................................ 59
5. PUBERTEIT BIJ JONGENS ......................................................................................................... 60
6. PREMATURE PUBERTEIT .......................................................................................................... 60
7. VERTRAAGDE PUBERTEIT ........................................................................................................ 61
8. BEHANDELING ........................................................................................................................ 62
H6: DIABETES, ENDOCRINOLOGIE, DERMATOLOGIE EN GENETICA ................................................63
1. DIABETES MELLITUS TYPE 1 ......................................................................................................... 63
Pathofysiologie ........................................................................................................................... 63
Klinische presentatie................................................................................................................... 63
Diabetische ketoacidose (DKA) .................................................................................................... 64
2. SCHILDKLIER.............................................................................................................................. 67
Congenitale hypothyreoïdie ......................................................................................................... 67
3. BIJNIEREN................................................................................................................................... 67
A. Congenitale adrenale hyperplasie (CAH) .................................................................................. 67
B. Primaire verworven bijnierinsufficiëntie .................................................................................... 69
C. Cushing syndroom .................................................................................................................. 70
4. DISORDERS OF SEX DEVELOPMENT (DSD) ................................................................................... 71
5. DERMATOLOGIE ......................................................................................................................... 71
A. Luierdermatitis (DD ZEER BELANGRIJK) .................................................................................... 71
B. Molluscum contagiosua .......................................................................................................... 72
C. Scabies .................................................................................................................................. 72
D. Pediculosis (luizen) ................................................................................................................. 73
E. Huiduitslag bij systemische ziekte ............................................................................................ 73
6. GENETICA .................................................................................................................................. 74
A. Chromosomale afwijkingen ..................................................................................................... 74
B. Structurele afwijkingen ............................................................................................................ 74
C. Genetische mechanismen ...................................................................................................... 75
, D. Dysmorfologie ........................................................................................................................ 76
H7: LIVER DISORDERS & MUSCULOSKELETAL DISORDERS ............................................................77
LIVER DISORDERS ............................................................................................................................... 77
1. Belangrijke leverparameters (ZEER EXAMENGERICHT) .............................................................. 77
2. Neonatale icterus en cholestase .............................................................................................. 77
3. Verhoogde transaminasen (AST/ALT) ........................................................................................ 79
4. acuut leverfalen ...................................................................................................................... 83
5. Galactosemie ......................................................................................................................... 83
MUSCULOSKELETALE AANDOENINGEN .......................................................................................... 84
1. Growing pains ......................................................................................................................... 84
2. Osteomyelitis .......................................................................................................................... 84
3. Septische artritis (URGENT!) .................................................................................................... 85
4. lyme artritis ............................................................................................................................. 86
5. Transient synovitis ................................................................................................................... 86
5. Reactieve artritis ..................................................................................................................... 86
6. Juveniele idiopathische artritis (JIA) .......................................................................................... 87
H8: CARDIAC DISORDERS ............................................................................................................88
1. EPIDEMIOLOGIE ......................................................................................................................... 88
2. TRANSITIE FOETALE → NEONATALE CIRCULATIE ........................................................................... 88
3. NEONATALE PRESENTATIES ........................................................................................................ 89
4. NEONATALE SHOCK ................................................................................................................... 89
5. CYANOSE BIJ NEONAAT .............................................................................................................. 91
6. BELANGRIJKE CYANOTISCHE HARTAFWIJKINGEN ........................................................................ 92
6.1 Transpositie van de grote vaten (TGA) ..................................................................................... 92
6.2 Tetralogie van Fallot............................................................................................................... 93
7. BREATHLESS INFANT = LINKS-RECHTS SHUNT ............................................................................. 94
8. HARTGERUIS .............................................................................................................................. 95
9. HARTRITMESTOORNISSEN .......................................................................................................... 95
9.1 Congenitale complete AV-blok ............................................................................................... 95
9.2 Supraventriculaire tachycardie (SVT) ...................................................................................... 96
9.3 Long QT syndroom ................................................................................................................. 96
10. SYNCOPE ................................................................................................................................. 97
11. THORACALE PIJN BIJ KINDEREN ................................................................................................. 97
12. INFECTIEUZE CARDIALE AANDOENINGEN ................................................................................. 99
12.1 Infectieuze endocarditis ....................................................................................................... 99
13. KAWASAKI ZIEKTE ..................................................................................................................... 99
H9: KIDNEY AND URINARY TRACT AANDOENINGEN .................................................................... 100
1. OVERZICHT NIERPATHOLOGIE BIJ KINDEREN............................................................................. 100
2. ASSESSMENT VAN RENALE FUNCTIE ......................................................................................... 100
Anamnese ................................................................................................................................ 100
Klinisch onderzoek .................................................................................................................... 101
3. LABORATORIUMONDERZOEK.................................................................................................... 101
Plasma creatinine ..................................................................................................................... 101
eGFR ........................................................................................................................................ 101
Ureum ...................................................................................................................................... 102
andere ..................................................................................................................................... 102
Urineonderzoek ........................................................................................................................ 103
PROF. JAAN TOELEN
Te kennen: wat er op de slides staat en wat er in de lessen verteld wordt + semeiologie (foto’s) uit
klinische lessen
Tekstboek: niet verplicht
Casusgebaseerde integratieweek: handig om de MCQ te leren oplossen
INHOUDSOPGAVE
H1: THE CHILD IN SOCIETY – CHILD PROTECTION .......................................................................... 6
1. WAAROM “THE CHILD IN SOCIETY” BELANGRIJK IS ......................................................................................6
2. THE CHILD’S WORLD: MEER DAN DE CONSULTATIE .....................................................................................6
3. ONMIDDELLIJKE EN BREDERE OMGEVING .................................................................................................6
4. PREVENTIEVE GEZONDHEIDSZORG VOOR KINDEREN IN VLAANDEREN ..............................................................7
5. BESCHERMENDE STRUCTUREN BIJ RISICO ................................................................................................8
5.1 Vertrouwenscentra Kindermishandeling (VK) .............................................................................8
5.2 Comité Bijzondere Jeugdzorg (CBJ) ...........................................................................................8
5.3 Jeugdrechtbank .......................................................................................................................8
6. MEDICOLEGALE ASPECTEN IN PEDIATRIE..................................................................................................9
7. WET PATIËNTENRECHTEN (WPR) – BELGIË ..............................................................................................9
8. MINDERJARIGEN EN BESLISSINGSRECHT ..................................................................................................9
9. TYPISCHE CASUSSEN (EXAMENGERICHT) ............................................................................................... 11
10. KINDERMISHANDELING EN VERWAARLOZING ........................................................................................ 11
11. KLINISCHE TEKENEN VAN MISHANDELING............................................................................................. 12
11.1 Hematomen (meest frequent) .............................................................................................. 12
11.2 Brandwonden ...................................................................................................................... 12
11.3 Fracturen (hoog specifieke!) ................................................................................................. 12
11.4 Niet-accidenteel hoofdtrauma ............................................................................................. 12
12. SEKSUEEL GEWELD ........................................................................................................................ 13
13. GLOBAL CHILD HEALTH .................................................................................................................. 13
14. TAKE HOME MESSAGES (EXAMEN) .................................................................................................... 13
H2: PERINATAL MEDICINE ............................................................................................................14
1. PRE-PREGNANCY CARE .............................................................................................................. 14
2. ANTENATALE DIAGNOSE ............................................................................................................. 15
3. OBSTETRISCHE AANDOENINGEN MET FOETALE IMPACT .............................................................. 15
4. MATERNALE AANDOENINGEN MET FOETALE IMPACT ................................................................... 15
4.1 Diabetes mellitus .................................................................................................................. 15
4.2 Hyperthyroïdie (Graves) ......................................................................................................... 16
4.3 Systemische lupus ................................................................................................................ 17
, 4.4 Rh iso-immunisatie ................................................................................................................ 17
4.5 Auto-immune TTP .................................................................................................................. 17
5. MATERNALE DRUGS DIE DE FOETUS BEÏNVLOEDEN .............................................................................. 18
6. CONGENITALE INFECTIES ........................................................................................................... 18
6.1 Rubella ................................................................................................................................. 18
6.2 CMV ..................................................................................................................................... 19
6.3 Toxoplasmose ....................................................................................................................... 19
6.4 Varicella zoster ..................................................................................................................... 20
7. ADAPTATIE NA GEBOORTE .......................................................................................................... 20
7.1 Longen.................................................................................................................................. 20
7.2 Circulatie .............................................................................................................................. 21
7.3 Glucosehomeostase ............................................................................................................. 21
7.4 Temperatuur ......................................................................................................................... 21
7.5. de lever ................................................................................................................................ 21
8. NEONATALE RESUSCITATIE ......................................................................................................... 22
9. SIZE AT BIRTH ............................................................................................................................. 22
10. ROUTINE POSTNATALE ZORG .................................................................................................... 23
11. NEONATALE SCREENING .......................................................................................................... 23
H3: NEONATAL MEDICINE ............................................................................................................25
1. HYPOXIC-ISCHEMIC ENCEPHALOPATHY (HIE) ............................................................................. 25
1.1 Pathofysiologie ...................................................................................................................... 25
1.2 Klinische ernst....................................................................................................................... 25
1.3 Behandeling .......................................................................................................................... 26
2. GEBOORTELETSELS .................................................................................................................... 26
2.3 Fracturen .............................................................................................................................. 27
3. PREMATUUR INFANT ................................................................................................................... 28
3.1 Respiratory Distress Syndrome (RDS) ..................................................................................... 28
3.2 Pneumothorax....................................................................................................................... 29
3.3 Apneu, bradycardie en desaturatie van prematuriteit ............................................................... 30
3.4 Necrotiserende enterocolitis (NEC) ........................................................................................ 30
3.5 Bronchopulmonale dysplasie ............................................................................................ 31
4. ICTERUS ..................................................................................................................................... 32
5. RDS BIJ TERME INFANT ................................................................................................................ 33
6. NEONATALE INFECTIES ............................................................................................................... 34
7. HYPOGLYCEMIE ......................................................................................................................... 35
8. CRANIOFACIALE AFWIJKINGEN ................................................................................................... 35
9. GASTRO-INTESTINALE AANDOENINGEN ...................................................................................... 35
9.1 Oesofagusatresie .................................................................................................................. 35
9.2 Dunne darmobstructie ........................................................................................................... 36
9.3 dikke darm obstructie ............................................................................................................ 36
9.4 Omfalocoele vs gastroschisis ................................................................................................. 36
H4: PEDIATRIC EMERGENCIES & ACCIDENTS AND POISONING .....................................................37
1. DE ERNSTIG ZIEKE KINDERPATIENT .............................................................................................. 37
1.1 Eerste beoordeling = ABCDE .................................................................................................. 37
1.2 Shock bij kinderen ................................................................................................................. 39
2. ANAFYLAXIE ............................................................................................................................... 41
3. EPILEPSIE / NEUROLOGISCHE URGENTIES .................................................................................. 41
4. SIDS / ALTE / SUDI ....................................................................................................................... 42
, 5. REANIMATIE (BLS) ....................................................................................................................... 43
6. CHOKING (ASPIRATIE) ................................................................................................................. 44
7. FOREIGN BODY INGESTION......................................................................................................... 45
8. HOOFDTRAUMA ......................................................................................................................... 45
9. BRANDWONDEN ........................................................................................................................ 46
10. INTOXICATIE – PARACETAMOL ................................................................................................... 47
11. POISONING ALGEMEEN ............................................................................................................ 48
12. DROWNING .............................................................................................................................. 48
H5: GROWTH & PUBERTY .............................................................................................................49
GROEI ............................................................................................................................................. 49
1. NORMALE GROEI .................................................................................................................... 49
2. METINGEN VAN GROEI ............................................................................................................ 49
3. ABNORMALE HOOFDGROEI .................................................................................................... 49
4. BIOMETRIE TIJDENS KINDERLEEFTIJD ...................................................................................... 53
5. KLEINE GESTALTE (SHORT STATURE)........................................................................................ 53
6. GROTE GESTALTE (TALL STATURE) ........................................................................................... 56
groeicurves................................................................................................................................. 56
PUBERTEIT ........................................................................................................................................ 57
1. Definitie .................................................................................................................................. 57
3. HORMONALE REGULATIE ........................................................................................................ 57
3. TANNER SCORE ...................................................................................................................... 58
4. PUBERTEIT BIJ MEISJES............................................................................................................ 59
5. PUBERTEIT BIJ JONGENS ......................................................................................................... 60
6. PREMATURE PUBERTEIT .......................................................................................................... 60
7. VERTRAAGDE PUBERTEIT ........................................................................................................ 61
8. BEHANDELING ........................................................................................................................ 62
H6: DIABETES, ENDOCRINOLOGIE, DERMATOLOGIE EN GENETICA ................................................63
1. DIABETES MELLITUS TYPE 1 ......................................................................................................... 63
Pathofysiologie ........................................................................................................................... 63
Klinische presentatie................................................................................................................... 63
Diabetische ketoacidose (DKA) .................................................................................................... 64
2. SCHILDKLIER.............................................................................................................................. 67
Congenitale hypothyreoïdie ......................................................................................................... 67
3. BIJNIEREN................................................................................................................................... 67
A. Congenitale adrenale hyperplasie (CAH) .................................................................................. 67
B. Primaire verworven bijnierinsufficiëntie .................................................................................... 69
C. Cushing syndroom .................................................................................................................. 70
4. DISORDERS OF SEX DEVELOPMENT (DSD) ................................................................................... 71
5. DERMATOLOGIE ......................................................................................................................... 71
A. Luierdermatitis (DD ZEER BELANGRIJK) .................................................................................... 71
B. Molluscum contagiosua .......................................................................................................... 72
C. Scabies .................................................................................................................................. 72
D. Pediculosis (luizen) ................................................................................................................. 73
E. Huiduitslag bij systemische ziekte ............................................................................................ 73
6. GENETICA .................................................................................................................................. 74
A. Chromosomale afwijkingen ..................................................................................................... 74
B. Structurele afwijkingen ............................................................................................................ 74
C. Genetische mechanismen ...................................................................................................... 75
, D. Dysmorfologie ........................................................................................................................ 76
H7: LIVER DISORDERS & MUSCULOSKELETAL DISORDERS ............................................................77
LIVER DISORDERS ............................................................................................................................... 77
1. Belangrijke leverparameters (ZEER EXAMENGERICHT) .............................................................. 77
2. Neonatale icterus en cholestase .............................................................................................. 77
3. Verhoogde transaminasen (AST/ALT) ........................................................................................ 79
4. acuut leverfalen ...................................................................................................................... 83
5. Galactosemie ......................................................................................................................... 83
MUSCULOSKELETALE AANDOENINGEN .......................................................................................... 84
1. Growing pains ......................................................................................................................... 84
2. Osteomyelitis .......................................................................................................................... 84
3. Septische artritis (URGENT!) .................................................................................................... 85
4. lyme artritis ............................................................................................................................. 86
5. Transient synovitis ................................................................................................................... 86
5. Reactieve artritis ..................................................................................................................... 86
6. Juveniele idiopathische artritis (JIA) .......................................................................................... 87
H8: CARDIAC DISORDERS ............................................................................................................88
1. EPIDEMIOLOGIE ......................................................................................................................... 88
2. TRANSITIE FOETALE → NEONATALE CIRCULATIE ........................................................................... 88
3. NEONATALE PRESENTATIES ........................................................................................................ 89
4. NEONATALE SHOCK ................................................................................................................... 89
5. CYANOSE BIJ NEONAAT .............................................................................................................. 91
6. BELANGRIJKE CYANOTISCHE HARTAFWIJKINGEN ........................................................................ 92
6.1 Transpositie van de grote vaten (TGA) ..................................................................................... 92
6.2 Tetralogie van Fallot............................................................................................................... 93
7. BREATHLESS INFANT = LINKS-RECHTS SHUNT ............................................................................. 94
8. HARTGERUIS .............................................................................................................................. 95
9. HARTRITMESTOORNISSEN .......................................................................................................... 95
9.1 Congenitale complete AV-blok ............................................................................................... 95
9.2 Supraventriculaire tachycardie (SVT) ...................................................................................... 96
9.3 Long QT syndroom ................................................................................................................. 96
10. SYNCOPE ................................................................................................................................. 97
11. THORACALE PIJN BIJ KINDEREN ................................................................................................. 97
12. INFECTIEUZE CARDIALE AANDOENINGEN ................................................................................. 99
12.1 Infectieuze endocarditis ....................................................................................................... 99
13. KAWASAKI ZIEKTE ..................................................................................................................... 99
H9: KIDNEY AND URINARY TRACT AANDOENINGEN .................................................................... 100
1. OVERZICHT NIERPATHOLOGIE BIJ KINDEREN............................................................................. 100
2. ASSESSMENT VAN RENALE FUNCTIE ......................................................................................... 100
Anamnese ................................................................................................................................ 100
Klinisch onderzoek .................................................................................................................... 101
3. LABORATORIUMONDERZOEK.................................................................................................... 101
Plasma creatinine ..................................................................................................................... 101
eGFR ........................................................................................................................................ 101
Ureum ...................................................................................................................................... 102
andere ..................................................................................................................................... 102
Urineonderzoek ........................................................................................................................ 103
