MMW Fortschritte der Medizin
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Acute dyspnea is one of the most frequent pediatric emergencies in the medical practice. The severity of the condition ranges from mild and self-limiting to severe and life threatening. The primary care physician must recognize the clinical symptoms of impending respiratory distress in a child and, especially, in an infant or very young child who is not yet able to communicate verbally, so that the appropriate therapy can be initiated as quickly as possible and, therefore, to fundamentally influence the development of the condition. The most important clinical causes of dyspnea are croup, epiglottitis, foreign body aspiration, and bronchial obstruction.
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Acute abdominal pain in children occurs often and requires rapid clarification. Hints as to the condition are often given by the first impression and the case history of the patient. When the clinical examination and laboratory results do not lead to a clear finding, imaging methods such as a sonography can clarify the case. ⋯ Additional diagnoses are abdominal hernia, malrotation, hypertrophic pyloric stenosis, invagination or gastroesophageal reflux. In school-age children, the classic finding is "appendicitis". This should be differentiated from constipation, gastritis, pancreatitis, sigmoid volvulus, bowel and intestinal obstruction or, perhaps, gallstone trouble.
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Both generalized and localized edema needs to be submitted to a differential diagnostic investigation. In the case of edema affecting the lower extremities, in particular the Stemmer sign which is the inability to tent the skin at the dorsum of the toes is a useful distinguishing aid. ⋯ Chronic bilateral leg edema is usually due to a venous flowoff obstruction (stasis edema). Less commonly, lipedema or a primary lymphedema may be responsible for the swelling.