Samenvatting Kind & Ontwikkeling 1

​ amenvatting​
S
​Kind & ontwikkeling​

,​Anamnese​​en​​Lichamelijk​​Onderzoek​​.......................................................................................​​7​
​Het​​geval​​..................................................................................................................................​​7​
​Landschap​​het​​geval​​................................................................................................................​​8​
​LO​​anorexie,​​rash,​​hoest​​........................................................................................................​​11​
​Erg​​ziek​​of​​niet​​ILL​​of​​ABCD​​..................................................................................................​​15​
​Hersenen​​&​​ontwikkeling​​..........................................................................................................​​22​
​Ontwikkeling​​van​​het​​brein​​.....................................................................................................​​22​
​Ontwikkelingsdomeinen​​.........................................................................................................​​28​
​Alarmsignalen​​........................................................................................................................​​33​
​Conclusie​​...............................................................................................................................​​35​
​QUIZ​​......................................................................................................................................​​36​
​Adaptatie​​na​​de​​geboorte:​​van​​foetus​​naar​​neonaat​​..............................................................​​46​
​Inleiding​​.................................................................................................................................​​46​
​Casus​​.....................................................................................................................................​​47​
​De​​geboorte​​komt​​op​​gang…..​​...............................................................................................​​50​
​Transitie​​.................................................................................................................................​​53​
​Respiratoire​​transitie​​..............................................................................................................​​53​
​Wrap​​up​​deel​​1​......................................................................................................................​​56​
​Circulatoire​​transitie​​...............................................................................................................​​56​
​Metabole​​transitie​​..................................................................................................................​​61​
​TAKE​​HOME​​MESSAGES​​.....................................................................................................​​63​
​GI​​kinderchirurgie,​​de​​embryologie​​en​​zijn​​gevolgen​​............................................................​​64​
​Embryologie​​van​​het​​GI​​stelsel​​in​​een​​notendop​​...................................................................​​64​
​Nog​​buikwand​​defecten..​​.......................................................................................................​​67​
​Indeling​​pathologieën​​.............................................................................................................​​69​
​Embryologie​​van​​de​​slokdarm​​...............................................................................................​​70​
​Embryologie​​van​​duodenum​​..................................................................................................​​74​
​Embryologie​​van​​de​​anus​​......................................................................................................​​82​
​Semiologie​​gastro-intestinaalstelsel​​neonaat​​en​​het​​gebruik​​van​​Rx​​abdomen​​overzicht​​​87​
​Gastro-intestinale​​symptomen​​neonaat​​.................................................................................​​87​
​Braken​​...................................................................................................................................​​88​
​Bloed​​in​​ontlasting​​bij​​neonaat​​...............................................................................................​​92​
​Geen​​stoelgang​​in​​de​​eerste​​dagen​​.......................................................................................​​93​
​Opdracht​​congenitale​​afwijkingen​​urogenitale​​tractus​​en​​zindelijkheid​​..............................​​99​
​Casus​​.....................................................................................................................................​​99​
​Embryologie​​en​​functionele​​ontwikkeling​​van​​de​​urogenitale​​tractus​​(ZS​​1)​​....................​​101​
​Congenitale​​afwijkingen​​van​​de​​nieren​​en​​urinewegen​​.......................................................​​106​
​Ontwikkeling​​vd​​nierfunctie​​in​​1e​​levensjaar​​(ZS​​2)​​.............................................................​​114​
​De​​organisatie​​van​​het​​urogenitaal​​systeem:​​een​​korte​​herhaling​​.......................................​​114​
​Ontwikkeling​​van​​renale​​functies​​bij​​pasgeborene​​en​​zuigeling​​...........................................​​114​
​Ontwikkeling​​van​​de​​renale​​tubuli​​........................................................................................​​118​


​2​

, ​Ontwikkeling van de blaasreservoirfunctie en de blaaslediging: zindelijkheidsproblemen​
(​ HC​​3)​​........................................................................................................................................​​126​
​Functie​​van​​de​​blaas​​............................................................................................................​​126​
​Zindelijkheidsproblemen​​(incontinentia)​​bij​​kinderen​​...........................................................​​130​
​Urinary​​tract​​infections​​.........................................................................................................​​134​
​Bedplassen​​(Bedwetting:​​Bladder,​​Kidney​​or​​Brain?)​​..........................................................​​140​
​Conclusies​​...........................................................................................................................​​142​
​Inleiding​​tot​​de​​farmacodynamiek​​bij​​het​​kind​​......................................................................​​143​
​A.​​Farmacokinetiek…​​..........................................................................................................​​143​
​B.​​Farmacodynamie​​.............................................................................................................​​152​
​Besluit​​..................................................................................................................................​​157​
​Vaccinatie​​geneeskunde:​​kliniek​​van​​te​​voorkomen​​ziekten,​​exantheemziekten​​..............​​158​
​Overview​​..............................................................................................................................​​159​
​Diseases​​preventable​​by​​current​​vaccines​​..........................................................................​​160​
​Exanthematous​​diseases​​.....................................................................................................​​164​
​Typical​​exanthemas​​.............................................................................................................​​165​
​Atypical​​exanthemas:​​enteroviruses​​....................................................................................​​174​
​Circulatoire​​veranderingen​​bij​​de​​geboorte​​en​​congenitale​​hartaandoeningen​​................​​178​
​Etiologie​​...............................................................................................................................​​178​
​Embryologie​​.........................................................................................................................​​179​
​Timing​​cardiale​​problemen​​...................................................................................................​​181​
​CHD:​​presentatie​​.................................................................................................................​​182​
​Voornaamste​​hartafwijkingen​​...............................................................................................​​186​
​Rechts​​links​​shunts​​-​​Cyanogene​​afwijkingen​​.....................................................................​​190​
​Common​​mixing​​AVSD​​........................................................................................................​​195​
​Outflow​​obstruction​​..............................................................................................................​​196​
​CHD​​conclusies​​...................................................................................................................​​199​
​Icterus​​vd​​pasgeborene:​​een​​fysiologisch​​vb​​van​​aanpassing​​ah​​extrauteriene​​leven​​(ZS)​​..​
​200​
​Bilirubine​​..............................................................................................................................​​200​
​Indirecte​​Hyperbilirubinemie​​................................................................................................​​201​
​Indirecte​​hyperbilirubiemie​​...................................................................................................​​206​
​Directe​​Hyperbilirubinemie​​-​​Oorzaken​​................................................................................​​206​
​Alarmsignalen​​bij​​Icterus​​Neonatorum​​!​...............................................................................​​208​
​Labo​​Investigaties​​................................................................................................................​​208​
​Conclusie​​.............................................................................................................................​​210​
​Algoritme​​voor​​de​​evaluatie​​van​​Icterus​​Neonatorum​​..........................................................​​210​
​Evaluatie​​van​​ontwikkeling​​(ZS)​​.............................................................................................​​212​
​Evaluatie​​van​​ontwikkeling​​...................................................................................................​​212​
​Screening​​.............................................................................................................................​​213​
​Formele​​ontwikkelingstesting​​=​​assessment​​.......................................................................​​215​



​3​

,​Wat​​als​​het​​misloopt?​​(ZS)​​......................................................................................................​​218​
​Overzicht​​..............................................................................................................................​​218​
​Benadering​​van​​kind​​met​​ontwikkelingsvertraging​​...............................................................​​219​
​Cognitie​​-​​verstandelijke​​beperking​​......................................................................................​​225​
​Motorische​​ontwikkeling​​.......................................................................................................​​226​
​Taalontwikkeling​​...................................................................................................................​​230​
​Sociaal-emotionele​​ontwikkeling​​&​​gedrag​​..........................................................................​​230​
​Schoolse​​vaardigheden​​.......................................................................................................​​233​
​Borstvoeding​​............................................................................................................................​​234​
​Anatomie​​van​​de​​borst​​.........................................................................................................​​234​
​Fysiologie​​van​​de​​lactatie​​....................................................................................................​​235​
​Het​​zuigen​​aan​​de​​borst​​.......................................................................................................​​235​
​Begeleiding​​bij​​borstvoeding​​................................................................................................​​236​
​Problemen​​met​​de​​borstvoeding​​..........................................................................................​​237​
​Voordelen​​van​​borstvoeding​​geven​​.....................................................................................​​240​
​Onderzoek​​...........................................................................................................................​​241​
​Contra-indicatie​​borstvoeding​​..............................................................................................​​241​
​Overige​​aspecten​​.................................................................................................................​​242​
​Vocht​​-​​dehydratie​​-​​gastroenteritis​​.......................................................................................​​245​
​Water​​in​​lichaam​​..................................................................................................................​​245​
​Dehydratie​​...........................................................................................................................​​246​
​Acute​​gastro-enteritis​​...........................................................................................................​​248​
​Klinische​​Aanpak​​van​​Persisterende​​Diarree​​bij​​Jonge​​Kinderen​​......................................​​252​
​Aanpak​​van​​Persisterende​​Diarree​​......................................................................................​​253​
​Samenvatting​​Aanpak​​Persisterende​​Diarree​​......................................................................​​255​
​Voeding​​van​​het​​gezonde​​kind​​...............................................................................................​​256​
​Inhoud​​..................................................................................................................................​​256​
​Zuigeling​​..............................................................................................................................​​256​
​Borstvoeding​​........................................................................................................................​​258​
​Flesvoeding​​.........................................................................................................................​​259​
​Diversificatie​​........................................................................................................................​​262​
​Voeding​​bij​​peuters​​&​​kleuters​​.............................................................................................​​266​
​Peuterdiarree​​.......................................................................................................................​​268​
​Voeding​​bij​​lagere​​schoolkinderen​​.......................................................................................​​269​
​Voeding​​bij​​adolescenten​​.....................................................................................................​​270​
​Moeilijke​​etertjes​​..................................................................................................................​​271​
​Inleiding tot dysmorfologie: anamnese en klinisch onderzoek van het kind met​
​aangeboren​​afwijkingen​​..........................................................................................................​​273​
​Wat​​doet​​een​​klinisch​​geneticus?​​........................................................................................​​273​
​Tijdspad​​van​​een​​genetische​​counseling​​.............................................................................​​274​
​Aangeboren​​afwijkingen:​​diverse​​indelingen​​.......................................................................​​275​


​4​

, ​ ysmorfologisch​​onderzoek​​................................................................................................​​278​
D
​Erfelijk​​vs​​niet​​erfelijk​​...........................................................................................................​​284​
​Take​​home​​message​​............................................................................................................​​289​
​Groei​​en​​puberteit​​....................................................................................................................​​290​
​Groeistadia:​​PRENATAAL​​....................................................................................................​​290​
​Groeistadia:​​POSTNATAAL​​.................................................................................................​​293​
​EVALUATIE​​VAN​​DE​​GROEI​​...............................................................................................​​298​
​Oorzaken​​klein​​gestalte​​.......................................................................................................​​300​
​Grote​​gestalte:​​oorzaken​​.....................................................................................................​​306​
​Puberteit​​(ZS)​​...........................................................................................................................​​309​
​Definitie​​................................................................................................................................​​309​
​Variabiliteit​​in​​timing​​en​​tempo​​.............................................................................................​​309​
​Fysiologie:​​hypothalamo-hypofysaire-gonadale​​as​​..............................................................​​310​
​Puberteitsstadia,​​klinische​​score​​.........................................................................................​​313​
​Pubertas​​praecox​​.................................................................................................................​​314​
​Pubertas​​tarda​​.....................................................................................................................​​317​
​Hielprikscreening​​....................................................................................................................​​319​
​Algemene​​inleiding​​..............................................................................................................​​319​
​Hielprikscreening​​.................................................................................................................​​319​
​Hielprikscreening:​​algemeen​​(!)​​...........................................................................................​​320​
​Voor-​​en​​nadelen​​van​​neonatale​​screening​​.........................................................................​​336​
​Toekomstperspectieven​​.......................................................................................................​​337​
​Take​​home​​messages​​en​​toekomstperspectieven​​...............................................................​​337​
​Chirurgische​​aanpak​​van​​congenitale​​afwijkingen​​van​​de​​Uro-Genitale​​tractus​​..............​​338​
​Undescended​​Testis​​(cryptorchidie)​​.....................................................................................​​338​
​Disorders​​of​​sexual​​differentiation​​.......................................................................................​​342​
​Inguinal​​pathology​​................................................................................................................​​342​
​Foreskin​​pathology​​..............................................................................................................​​343​
​Hypospadias​​........................................................................................................................​​347​
​Exstrophy​​–​​Epispadias​​complex​​(niet​​kennen)​​...................................................................​​348​
​(Congenital)​​Hydro(uretero)nephrosis​​.................................................................................​​349​
​Duplex​​Systems​​...................................................................................................................​​356​
​Difficult​​Case​​........................................................................................................................​​356​
​Varicocele​​(FYI,​​to​​study​​Ma1,​​Urology;​​niet​​overlopen)​​......................................................​​357​
​Slaap​​bij​​kinderen:​​Slaapstoornissen​​(ZS)​​............................................................................​​358​
​Artikel​​Slaapstoornissen​​bij​​kinderen​​...................................................................................​​358​
​Slaap-waakpatroon​​kinderen​​(RC)​​.........................................................................................​​364​
​Inleiding​​...............................................................................................................................​​364​
​Slaapstoornissen​​-​​casuistiek​​..............................................................................................​​365​
​Pathogenesis​​of​​acute​​cough​​in​​pediatrics​​(ZS)​​...................................................................​​374​
​Doelen​​.................................................................................................................................​​374​


​5​

, I​ntroductie​​............................................................................................................................​​375​
​Upper​​respiratory​​tract​​infection​​(URTI)​​...............................................................................​​377​
​Laryngeal​​and​​tracheal​​infections​​-​​STRIDOR​​.....................................................................​​383​
​Lower​​respiratory​​tract​​infections​​–​​ACUTE​​WHEEZE​​........................................................​​387​
​Lower​​respiratory​​tract​​infections​​–​​ACUTE​​cough​​..............................................................​​389​
​Pathogenesis​​of​​acute​​cough​​in​​pediatrics​​(RC)​​..................................................................​​392​
​Doelen​​.................................................................................................................................​​392​




​6​