Common Diseases In Well Baby Clinic .pptx

undescended testis
umbilical hernia
DDH
umbilical granuloma

1. Common Diseases In Well Baby C linic Presented by Abdulaziz Bagasi November 2019

2. Case

3. What do you think ?

4. Pediatric Umbilical Hernia

5. What complications we are afraid of ?

6. complications - Incarceration. - Strangulation. - Perforation.

7. Physical Examination Look for a mass in the area of the fascial defect. The size of the fascial defect Generally asymptomatic , it may cause mild discomfort

8. When to suggest that the hernia is strangulated ?

9. acute incarcerated or strangulated hernias Painful, tender and irreducible Green, bile-stained vomit if obstruction present Discoloration of overlying skin

10. Risk factors Premature babies. In patients with Ehlers-Danlos Down syndrome may be present in up to 75% of infants weighing < 1,500 g

11. Clinical features -Asymptomatic. - Interfere with feeding if contain bowel wall .

12. Management (Infant) Observation and reassurance as these defects > 80% close by age 5 years . Rarely incarcerated.

13. Hawaa world based medicine

14. Management (In Adults) With increased abdominal pressure (such as with obesity, ascites, or pregnancy) More prone to incarceration and strangulation in an adult than in a child Adults who have symptoms should have a hernia repair

15. What are the indications for referral?

16. indications for referral 1-More than 1.5 cm defect. 2- Bowel incarceration or strangulation. 3- if persistant more than 5 years of age. 4-Children with large, proboscoid (large amount of redundant skin). 5-Signs of infection.

17. Proboscoid hernia warranting early repair

18. Case A 7-month-old male is brought in for a routine checkup. Only one testicle is palpable . The genital examination is otherwise within normal limits. Which one of the following would be most appropriate at this time?

19. Undescended testes (cryptorchidism)

20. Undescended testes 1- abdomen 2- inguinal canal 3-suprascrotal( prepubic ) . Ectopic testes 4-suprapubic (penile) 5-femoral region 6-perineal region 7- contralateral hemiscrotum

21. Bilateral suprascrotal undescended testes

22. Right ectopic testis palpable in the perineum.

23. Bilateral cryptorchidism

24. Risk factors Prematurity Small for gestational age at birth.

25. What complications we are afraid of ?

26. Complications Inguinal hernia : 90 percent of congenital undescended testes Testicular torsion : 10 times more common in undescended testis. Testicular trauma infertility Testicular cancer :   incidence is approximately 5.4 per 100,000

27. In physical examination The testicular examination in the infant and young child requires two hands. One hand is placed near the anterior superior iliac spine and the other on the scrotum The first hand is swept from the anterior iliac spine along the inguinal canal to gently express any retained testicular tissue into the scrotum

28. Management 4 Case Scenarios 1) Bilateral Palpable 2) Bilateral non- Palpable 3) Unilateral non-Palpable 4)Unilateral Palpable

29. What are the indications for referral?

30. Refer to a pediatric urologist 1- No spontaneous descent by age 6 months 2- Boys older than 6 months 3- Who presents with severe abdominal or groin pain , owing to increased risk of hernia strangulation or torsion

31. Refer to a pediatric urologist 4- for evaluation of congenital adrenal hyperplasia and disorder of sexual development(DSD) in :  All with bilateral nonpalpable testes All patients with unilateral nonpalpable testis with hypospadias or micropenis

32. Case A 7-month-old male is brought in for a routine checkup. Only one testicle is palpable . The genital examination is otherwise within normal limits. Which one of the following would be most appropriate at this time? A) Observation only, until 18 months of age B) Abdominal ultrasonography C) Urologic referral for surgical exploration D) HCG treatment for 3 months

33. Guideline statement Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making. (Grade B) In boys with retractile testes , providers should assess the position of the testes at least annually to monitor for secondary ascent. (Grade B) Normal testicular volume and function can be achieved if cryptorchidism is corrected before age 18 months 

34. In Bahra PHC 4 years old girl came with limping for 2 years

35. History

36. Seen by pediatric orthopedic

37. DDH Radiographic findings

38. DDH DDH Hilgenreiner line Perkin’s line

39. DEVELOPMENTAL DYSPLASIA OF THE HIP ( DDH )

40. Risk factors DDH breech position (The most significant) Oligohydramnios female sex incorrect lower-extremity swaddling positive family history of DDH

41. Swaddling DDH “ hip healthy swaddling of infants should allow enough room for hip and knee movement in the first few months of life to allow for optimal development of the infant hip “ POSNA, IHDI, AAOS

42. Physical Examination

43. Physical Examination Barlow and Ortolani sign Asymmetry Asymmetrical gluteal or thigh skin folds Positive Galeazzi sign Restricted or asymmetrical hip abduction

44. video

45. History

46. Diagnosis Hip ultrasound  is primary imaging technique for infants < 4 months old X-ray  may be used for infants ≥ 4 months old

47. Screening All neonates should undergo a clinical examination for hip instability. Infants with risk factors should receive more careful screening that includes at least an examination by an experienced examiner and possibly ultrasonography.

48. Screening with U/S Screening with ultrasonography remains controversial... American Academy of Orthopaedic Surgeons (AAOS) recommendations perform imaging study in infants < 6 months old with ≥ 1 risk factors of : Breech presentation Family history of DDH History of clinical hip instability

49. DDH Neonates treatment

50. DDH 6 -18 months ” Obtain reduction and maintain it without femoral head damage “ treatment

51. DDH > 18 months treatment

52. 2 month old baby came with this

53. Umbilical granulomas commonly during the first few weeks of life. Normally, the cord dries and separates in 7–14 days. persistence and hypertrophy of the normal granulation tissue present at the base of the umbilicus  Treatment : Cauterization with silver nitrate with repeated applications of isopropyl alcohol usually produces rapid healing of the granuloma .

54. If left untreated In some infants, secondary infection results in omphalitis Aggressive antibiotic therapy is necessary to prevent peritonitis and sepsis.

55. Cautery with Silver Nitrate video