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PEDIATRIE > NN PATOLOGIC > Flashcards

NN PATOLOGIC Flashcards

1
Q

ce este boala membranelor hialine?

A

sd de dtresa resp

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2
Q

ce este sd detresa resp?

A

insuf resp det de def de surfactant la prematuri

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3
Q

pe cine afecteaza sd detresa resp?

A

exclusiv prematuri (<=36 sapt) si rar cei la termen (37-42 sapt)

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4
Q

cand scade incidenta de sd detresa resp?

A

la nn >34 sapt cu 5%

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5
Q

care este tulburarea de baza in sd de detresa resp?

A

sinteza insuf de catre pneumocitele de tip 2 a surfactantului

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6
Q

din ce este alcatuit surfactantul?

A

lecitina adica dipalmitoil fosfatidil colina

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7
Q

care este consecinta deficitului de surfactant in SDR?

A

atelectazia pulm - alveole neventilate - hipoxie si hipercapnie

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8
Q

pot fi compensate prin POLIPNEE hipoxia si hipercapnia in SDR?

A

NU!!!

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9
Q

SDR - primele 24 ore

A

formarea membranei hialine care captuseste canalele alveolare si alveolele si este fibrin acidofila

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10
Q

SDR - dupa 36 ore

A

apare infiltrat inflam in mb hialina alc din macrofage si histiocite care fagociteaza mb

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11
Q

SDR in 7-10 zile

A

dispar leziunile histologice

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12
Q

ce insemna CARACTERUL AUTOLIMITAT al SDR?

A

disparitia lez histo in 7-10 zile

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13
Q

cat timp trebuie sa supravietuiasca NN in SDR ca sa scape cu bine?

A

7 ZILE!!!

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14
Q

cand incepe SDR?

A

primele 4-6 ore CU CAT MAI REPEDE CU ATAT MAI GRAV!!!

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15
Q

Semne clinice SDR -4

A
  1. stare generala alterata
  2. insuf resp
  3. edeme mb
  4. hTA
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16
Q

Semne insuf resp in SDR - 7

A
  1. cianoza
  2. polipnee
  3. geamat expirator
  4. batai aripi nazale
  5. tiraj = retractii sternale + spatii intercostale
  6. balans toraco-abdominal = in inspir, apar retractia toracelui si bombarea abd
  7. mv diminuat
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17
Q

SDR in evolutie - 5

A
  1. criza apnee - det de hemoragii intraventriculare
  2. hemoragie pulm
  3. hipotermie
  4. stare de soc
  5. deces in cateva ore sau ameliorare in 4-5 zile
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18
Q

ce investigatii se fac in SDR?

A

RX

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19
Q

ce prezinta RX in SDR?

A

voalare difuza si reticulogranulara = atelectazie generalizata
- asem hemoragiei pulm
- apare acidoza metab +/- respiratorie

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20
Q

tratament profilactic in SDR - 3

A

1,. tocolitice = salbutamol
2. glucocorticoizi = betametazona
3. surfactant

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21
Q

tratament curativ SDR - 5

A
  1. Ventilatie cu preziune pozitiva de O2 continua CPAP si intermitenta PIP - impiedica producerea atelectaziilor
  2. surfactant pe sonda de intubatie
  3. bicarbonat de sodiu
  4. termoreglare = confort termic in incubator
  5. alim parenterala - intial glc 10% apoi K, Ca, aa, lipide, vit
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22
Q

cand este prognosticul mai bun in adm de surfactant in SDR?

A

cu cat e administrat mai devreme

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23
Q

care este r adv la surfactant in sdr?

A

hemoragia intraalveolara intinsa

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24
Q

tipuri surfactant natural in SDR

A

bovin = SURVANTA si porcin = CUROSURF

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25
Q

tipuri surfactant sintetic in SDR

A

uman = EXOSURF si lucinactant = SURFAXIN

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26
Q

ce rol are tratamentul cu bicarbonat de sodiu in sdr?

A

pt reechilibrarea acidobazica

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27
Q

in functie de ce se adm bicarbonatul de sodiu in SDR?

A

fct de scor ASTRUP

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28
Q

ce risc are adm de bicarbonat de studiu in sdr daca acidoza metab nu rasp la tratam corect aplicat?

A

hipercapnie secundara

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29
Q

reactie adverse ale administrarii de ventilatie cu presiune pozitiva O2 in conc crescuta? - 3

A
  1. retinopatia de prematuritate
  2. hipertensiune pulmonara persistenta
  3. displazia bronhopulm
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30
Q

ce este displazia bronhopulm?

A

este o reactie adversa, o b pulm cronica aparuta prin vent artific conventionala cu conc crescuta de O2 mai mult de 5-6 zile

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31
Q

cand se da surfactantul in SDR?

A

in sala - la toti pramaturii<28 sapt si profilactic la toti preamturii <32 s intubati

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32
Q

Cum se mai numeste tahipneea tranzitorie a NN?

A

detresa respiratorie

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33
Q

care sunt factorii de risc pt TTN? 5

A
  1. prematuritatea
  2. hipoxia fetala severa
  3. sedarea materna
  4. astmul in antecedente matern
  5. adm betadrenergice la mama
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34
Q

ce incidenta are TTN?

A

11:1000 nascuti vii mai ales NASCUTI LA TERMEN

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35
Q

cand incepe TTN?

A

primele 6 ore de la nastere

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36
Q

cand se remit semnele in TTN?

A

24-48 ore

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37
Q

care sunt semnele clinice in TTN?

A
  1. insuf resp
  2. crepitante
  3. cianoza UNEORI
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38
Q

unde e mai grava insuf resp? SDR sau TTN?

A

SDR

39
Q

ce scor Apgar au NN cu TTN?

A

4-7

40
Q

cat tip persista tahipneea TRANZITORIE in TTN?

A

minimum 12 ore

41
Q

apare MEREU cianoza in TTN?

A

NU, UNEORI

42
Q

ce metode de investigatie avem in TTN?

A

rx plaman si cord si eco pulm

43
Q

ce se vede la rx plaman in ttn?

A
  • atelectazii semnetare/lobare
  • acc desen perihilar
  • hiperinflatie pulm
44
Q

ce se vede la rx cord in ttn?

A

cardiomegalie usoara

45
Q

ce se vede la eco plaman in ttn?

A

sd de plaman interstitial=
1. aspect de plaman ALB
2. ingrosarea liniilor pleurale neclare

46
Q

ce este TTN?

A

producerea de surfactant DEZORGANIZAT, def CALITATIV
CUM? intarzierea resorbtiei lichidului alveolar
CAND? hipoxia intrauterina/ extragere prin op cezariana

47
Q

ce tratament necesita TTN?

A
  1. mentinerea oxigenarii
  2. atb spectru larg
48
Q

e tratamentul din TTN specific?

A

NU

49
Q

ce este sd aspiratiei e meconiu?

A

meconiu in trahee, sub corzile vocale

50
Q

incidentasd asp meconiu?

A

4% nascuti vii

51
Q

in ce cazuri apare sd asp meconiu? 2

A
  1. hipoxemie intrauterina - APROAPE NICIODATA INAINTE DE S.38(NU PREMATUR)
  2. in travaliu
52
Q

cum se produce sd asp meconiu? 2

A

meconiul aj in lich amniotic si obstr cai resp fat

53
Q

ce consecinte are sd asp meconiu?

A

scaderea compl pulm si lez parench - atelectazii LOCALIZATE - hipoxemie - acidoza

54
Q

ce fel de atelectazii se produc in sd asp meconiu?

A

localizate

55
Q

ce fel de atelectazii se prod in ttn?

A

segmentare sau lobare

56
Q

ce fel de atelectazii se prod in sdr?

A

generalizate

57
Q

ce apare la cei cu HIPOXEMIE SEVERA in sd asp meconiu?

A

HTP cu sunt dr stg

58
Q

ce se intampla molecular la niv alveolar in sd asp meconiu?

A

meconiul se comporta ca un corp strain care det aparita MACROFACE + HISTIOCITE care dev CEL GIGANT si DISTRUG SURFACTANTUL - PNEUMONIE CHIMICA

59
Q

cum se manif clinic sd asp meconiu?

A

detresa resp variab usoara - severa
HIPERINFLATIE PULM sau ATELECTAZII LOCALIZATE si DECES

60
Q

Trat profilactic sd asp mec?

A

aspiratie orofar si apoi trahee

61
Q

trat curativ sd asp mec? 4

A
  1. corectie hipoxemie si acidoza
  2. trat tulb asoc
  3. surfactant
  4. ECMO = oxigenare transmb extracorporeala - F GRAVE
62
Q

CE trat se fol pt forme grave de sd asp meconiu?

A

ECMO - oxigenare transmb extracorporeala

63
Q

ce este boala hemoragica a nn?

A

def de f coag dep de vit K (2, 7, 9, 10) tranzitoriu = prima sapt de viata si scad la mai putin de 20% din vn

64
Q

cauze BHN - 3

A
  1. incap tranzit ficat sinteza factori din complex protrombinic
  2. def vit K
  3. adm materna in sarcina de anticonvulsivante si anticoagulante
65
Q

incidenta f precoce bhn?

A

1% din cei ce nu au primit profilaxie cu vit K

66
Q

incidenta f tardiva bhn?

A

a scazut sub jumatate dupa ce s a introdus profix cu vit K

67
Q

cand apar manif hemoragipare in forma precoce in bhn?

A

la nastere sau in primele 3 zile de viata

68
Q

cand apar manif hemoragipare in forma tardiva in bhn?

A

de la peste 3 zile pana la 1-3-6 luni

69
Q

la care nn este frecventa forma precoce de bhn?

A

cei ai caror mame au luat in sarcina anticoag sau anticonvulsivante

70
Q

la care nn este frecventa forma tardiva de bhn?

A

la sugari alim nat si cei ce nu au primit profilactic vit K

71
Q

ce manif hemoragipare se intalnesc in f precoce in bhn? - 5

A
  1. digestive
  2. ombilicale
  3. cutanate izolate
  4. meningo-cerebrale
  5. retiniene
72
Q

care sunt manif digestive ale h digestive in f precoce a bhn? - 3

A
  1. hematemeza si sau melena BRUSC
  2. distensie abd
  3. soc hemoragic
73
Q

cum se manif socul hemoragic din hemoragia digestiva a formei precoce a bhn? - 4

A
  1. paloare
  2. tenta cenusie teg
  3. extr reci
  4. puls filiform
74
Q

cand apare hemoragia ombilicala a formei precoce de bhn?

A

la 2 zile sau la 7-10 zile cand cade bontul ombilical

75
Q

prin ce se manif h cutanate izolate din f precoce a bhn si ce conditie trebuie indeplinita ? - 3

A

trebuie sa se asocieze si TROMBOCITOPENIE
1. echimoze
2. hematoame
3. purpura

76
Q

care este CEA MAI GRAVA si CEA MAI FRECVENTA manifestare hemoragipara a formei precoce a bhn?

A

meningocerebrala

77
Q

ce este specific h meningocerebrale din f precoce de bhn?

A

poate sa apara fara ca mama sa fi luat anticonv sau anticoag

78
Q

ce riscuri prezinta h meningocerebrala a frecoce din bhn?

A

deces si sechele neuropsihice severe

79
Q

cum pot aparea h retiniene din f precoce a bhn?

A

izolate sau asoc h cerebrale

80
Q

ce manif hemoragipare prez f tardiva de bhn? - 3

A
  1. intracraniana acuta
  2. digestiva sau cutaneomucoasa
  3. urogenitala sau ORL
81
Q

tratament profilactic in bhn?

A

vit K1 adica FITOMENADIONA

82
Q

Trat curativ in bhn? - 5

A
  1. sg integral proaspat
  2. fitomenadiona 0,5 mg im
  3. confort termic
  4. glc
  5. reech acidobazica
83
Q

pt ce forma se da fitomenadiona curativ im?

A

F PRECOCE

84
Q

ce prognostic are h pulm?

A

f sever - mortalitate 75-90%

85
Q

ce afecteaza h pulmonara la niv de plaman?

A

interstitiu si alveola

86
Q

ce a declansat h pulmonara? - 4

A
  1. insuf circ ac
  2. hipoxia
  3. hipercapnia
  4. acidoza
    rupere perete capilar
    extravazare el figurate
87
Q

cum se traduce de fapt hemoragia pulm?

A

EDEM PULM HEMORAGIC

88
Q

f favorizanti ai hemoragiei pulm? - 13

A
  1. hipoxie intrauterina severa
  2. prematuritate
  3. infectii
  4. hipotermie
  5. aspirare de cont gastric sau sange matern
    6.edem cerebral
  6. icter nuclear
  7. izoimunizare severa sist rh
    9.adm o2 in sdr
  8. tulb hemoragipare - sdr
  9. malf card congen
  10. viroze materne in sarcina - cmv, herpes
  11. surfactant - risc mic sau contestat
89
Q

cum si cand este anuntata hemoragia pulm ?

A

prin alterarea st gen in 1 sapt de viata

90
Q

rx pt hemoragia pulm?

A

infiltrare/opacifiere cp pulm

91
Q

clinic hem pulm? -3

A
  1. insuf resp grava pana la edem pulm
  2. BK
    3.crize apnee si evol repede spre deces
92
Q

trat prof hem pulm - 1

A

prev hipoxiei la nn cu f fav la nastere

93
Q

trat curativ h pulm - 5

A

se corecteaza
1. hipoxemia
2. volemie si hematocrit
3. hipotens si acidoza
4. tulb coag
5. ic

94
Q
A

PEDIATRIE (7 decks)

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