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Capitolul_1_p.(68-125)

Capitolul_1_p.(68-125)

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Published by: Red Forman on May 02, 2012
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(cubifidumbacterina),BAD-2(lisocim~ibifidumbacterina).Dietoterapiainhipotrofiecauzatadeceliachienecesitaexcludereaproduselorcereale(fulgideovaz,flinadegrausanamidon).ininsuficientalactazicaseexcludedinalimentatielaptele,seintroducamestecuricucontinutdelactozascazut(laptedesoie,nutrisoie,prosoealetc.)insindromuldemalabsorbtiedietoterapiavafiprecizatamaidetaliatincapitolulrespectiv.inmalnutritiileseverecrestehipovitaminozasipentrunonnalizareaproceselormetaboliceesterationalafolosirea
parenterala
avitaminelorhidrosolubileinprimeleetapedetratament:Vit.Bi,C,B
2,
cocarboxilaza,inetapaintermediaraseadaogaVitoB,~iacidnicotinic,Vit.B6,B
l2,
B
1S,
vitamineleliposolubileA~iE,potfiadministratecumarireasuficientaalipidelor,inscopdesubstitutie,pentruameliorareaprocesuluidedigestieseadministreazapepsinacuacidclorhidric,acidin-pepsins,suegastricnatural,pancreatina,panzinonn,digestal,mexaza,festal,pancurmen,mezim-forte,pepsidil.Prescriereapreparatelorfermentativese.facelasfarsitulperioadeialimentatieiminimale,atuncicandvolumulalimentarcorespundecu115dingreutatea
reala,
indecursde3-4saptamani.
Pentrunormalizarea
microfloreiintestinalese
recomanda
preparatebiologiceactive:bifidumbacterina(panalavarstade6luni),bificol~icoli-bacterina(dupa6luni),2-5dozede3-4oripezi,lactobacterinadela5-10mlpezilanoi-nascuti,panala50-100mIlacopiiidupa6luni.Durataadministrariipreparatelorbiologiceactive2saptamani-2luni.inhipotrofiemarcatadeetiologieinfectioasasaucuafectiuniasociateinfectioaseseindicaterapiaantibacteriala.Cuscopdestimulareafunctieitrofice~iameliorarea
68
proceselormetaboliceinhipotrofiadegr.ll,IIIserecomandaapilac,metacil,pentoxil,dibazol,eleuterococ,tincturaaralii,pantocrina,orotatdepotasiu,ATFetc.Aeestepreparateseadrninistreazanumaidupaameliorareastariicopilului~icrestereaponderala.inetapaderepaossialimentatieminimalapentruridieareaniveluluideprotectienespecificaserecornandagamaglobulina,albumins,rareoriplasma(risedehepatitaB,IDV).inunelecazuridehipotrofietorpidaserecomandaincludereaintratamentahonnonilorcuactiuneanabolica(retabolil,nerobolil)pentrustimulareacresteriiingreutate(inetapaaII-a).Concomitentsaudupareluarearecuperarii,anemiasecorecteazaprinadministrareapreparatelordefier.Rahitismulsetrateazaeudoze
corespunzatoare
deVit.D.DinetapaaII-aadietoterapieilacopiiicuhipotrofieseincludeintratamentmasajul,gimnastica,stimulareaneuropsihica.Inconcluzieconstatam
ca
tratamentulhipotrofiiloresteeomplicat,delungaduratasinuintoatecazurileeficient.
Prognosticul
informele
usoare
~imediiestesatisfacator,infonnelegravedehipotrofiiesterezervat.Ceamai
buna
metodade"tratament"esteprofilaxia.
Profilaxia
1.
Supraveghereamedicalaactivaacopiluluiinprimelelunideviatiipentrudepistareaprecoce~iinlaturarea
erorilor
inalimentatie,2.Mentinereaalimentatieinaturale.3.Alirnentatiacorectamixtasauartificialacuamestecuridelapteadaptate-umanizatesaupartialadaptate.4.Diversifieareacorectaaalimentatieipentruacoperireanecesitatilornutritivealeeopiilor,maialespanala4-6luni..5.Educatiaparintilorineeeaeeprivestenutritia
69
 
corectatV_J)erioadapre-~ipostnatala.6.Depistareaprecocesitratamentulcorectalinfectiilor
-".
'
enteral~.§iparaenterale.7.Iluminareasanitarainprofilaxiahipotrofiilorlaradiou,televiziune,Inpresa.
Dispensarizarea
l.Intocmireaplanuluiderecuperareacopiilordepistaticuhipotrofie.-2.IntemareacopiilorInstationar,lacares-adepistathipotrofiade
gr.
II-III.3.Executarearecomandatiilordetratamentladomiciliudupaextemareadinspital.4.Controlulponderallacopiiidingrupaderisco5.Patronajinfiecarelunaladomiciliu.6.Lucruleducativ~ideiluminaresanitaraladomiciliu.
1.5.Anemiilenutritionale(deficitarelacopii)
Definitie:
Anemiaeste
0.
starepatologicacaracterizata(hematologic)prinscadereadehemoglobins(Hb),amaseiglobularetotalesubvalorilenormalepentruvarsta~isexuIrespectiv~iclinic-prinpaliditatea(paloarea)tegumentelor~imucoaselor.Crit~riulesentialdediagnosticramaneconcentratiadehemoglobinatehnicusordeterrninata,Intrucatdeterminareamaseieritrocitaretotaleesteincomoda,fiindunprocesdelaboratorvoluminos.
Clasificareaanemiilor
estevariata,dupadiferitecriteriiavandavantajesidezavantaje.Secunoaste:1.Clasificareapecriteriifunctionale.2.Clasificareamorfologica.
3.
Clasificareapatologica.O.altaclasificareesteceaetiologica:
70
1.Anemiinutritionale(defectareadupa
V.
Caliniceva)maifrecventintalniteinpracticalacopiidevarsta
frageda:
.feriprive;.proteinoprive;.anemiimetaloblasticeprindeficitdeacidfolic;.defectVit.B12;.defectalaciduluiascorbic;6hipocrome;.mixte.2.Anemiideterminatedescadereaproductieieritrocitare(aplasticesauhipoplastice)..
3.
Anemiiprincrestereadistrugeriieritrocitare(postholitice)imunologice(autoimune,izoimune),agresiunetoxica,anomaliidemembranaeritrocitara(sferocitoza,aIptocitoza),anemiideenzimeeritrocitare(deficitG-6PO),piruvatchinaza,hemoglobinopatii(drepanocitozaetc.),hemoglobinurileparoxisticanoctuma,hemolizaindusademedicamente.4.Anemiiprinpierderiexcesivedeeritrocite(post
hemoragice).
Anemiiledeficitare(nutritionale)ocupaunlocimportantinproblemelehematologieiprinvastalorraspandire~iseriozitateaafectariiorganismului,evoluanddereglarideadoptare,scadereaposibilitatiideactivitate~icrestereamaladiilor
infectioase,
Unitateastructuralaaeritronuluiestehemoglobina(Hb),careestecompusadinhem~iglobina.Larandulsau,hemulsedescompuneinFe++~i
porfirina,
In
asamoda~§mii1edeficitaresunt:1-feriprive;2-proteinedeficitare;3-dereglareametabolismuluideporfirine.Lacopiiidevarstafragedamaifrecventseintalnescanemiileferiprive,caresuntdescriseincontinuare.
71
 
Anemiileferiprive(sideropenice,prindeficit
de
fier)
Deflnitie.
Anemiaferiprivaeste
0
starepatologicadetulburare-ahemoglobinosintezeisuccesivascaderiicanw.tiigloQ~edefieraorganismuluiexprimatadinpunetdevederehematologicprinanemiehipocromicaeuHbmaijosde110
gil-
sub5
ani,
peste5ani-120gil,iareritrocitelesub4,0x10
12
11.
Epidemiologie:
Anemiaferiprivaesteunadincelemaifrecventemaladiialecopiilordevarstafrageda(V.Bisearina-36,9%,Gusunova-73%),subvarstade.landezile.Formalatentaadeficituluidefiersedepisteazalafiecarealtreileacopilinvarstadepanala3ani.DupaOMScirca
60%
copiidepeglobsuferadeanemii._Anemiaferiprivaeste
0
boalacuimplicatiisocialeintalnitelatoatevarstele
~i
In
toata
lumea.---
Etiopatogenie
sifizlepatologie
-CantitateanecesaradefierzilnicIncopilarieeste
de.la
0..1.:1mg/kgcuexceptiaprimelor4-6lunide
viata.-
Fierul,fiindcomponentalhernoglobinei,transportsoxigenuIin'celule
~i
esteasiguratprinaportexogenalimentar.LanivelulintestinuluisubtireFeseabsoarbecircala
10010;
(in-
anemiigrave~imaimult-18%).PrinintermediulapoferitineiFeestetransferatsubformadeFe/ericsprepolulvascularalceluleiepitelialeintestinale.CuajutorultransferineiFeestetransportatmaidepartespreeritroblasti
~i
inorganelededepozitie.--CarentaFesievolutiaanemieifieriprivedepinde:denecesitateacrescutaaFeinprocesuldecrestere;deaportulredusdeFeprinalimentatialactatasaulactofainoasa.PierdereaFezilnicestede1-1,5mg.CantitateaFeinorganismestestranslegataellgreutateacopiluluilanastere.Uncopilnou-nascutcugreutateanormalaarecirca250-300mgFe(175mgfierheminic,30-50mgdeFede
72-
rezerva,fiertisular-15mg
~i
4~gdeFeserie).-Schema-
nr.3
Metabolismul--Fe
in
organism
ApQ,nAl~n!ar
q_e..F~+++
(lQ-20mg/zi).SuegastricPJfacid.
Gastroferina
Acidascorbic
\.,~
Aminoacizi
V
e(OH)J
~StQrn~9
Apoferitina
Fe++
f--
FeritinaFeB
Oxalati,
Hipoxie,Anemie
Fitati,
Fo§~tiDeficitdeFe,
..
Lactat,Piruvat
..
Fructoza,Cisteina
.,
..
I
POOLdeFeplasmatic.Fe+++ransferina
l
~t
FiertisularFeritina
HemoglobinaHemosiderina
~
PierderedeFeprinscaun
4
(8-18mg/zi)inmajoritateacazurilor,aportuldeFe200-250mgestedeprovenientamaterna,fiindtr~attransplacentarzilnicinultimele3luni,sinumai50mgFeprovinedinhemoliza
73

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