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3R SRGDWNLK 1DFLRQDOQHJD LQãWLWXWD ]D YDURYDQMH ]GUDYMDVRELOHOHWDEROH]QLNRVWQRPLãLþQHJD sistema pogost vzrok obiskov zdravnika na primar- QLUDYQLSRPRþMHLVNDORYHþNRWRWURNVWDULK GROHWLQYHþNRWRWURNVWDULK±OHW 9 VSUHMHPQL DPEXODQWL 3HGLDWULþQH NOLQLNH Y /MX- EOMDQLYVDNWHGHQYSRYSUHþMXSUHJOHGDPRWULRWUR- NH]RWHNOLQRDOLEROHþLQRYVNOHSXNLVRQDSRWHQL QDSUHJOHGVVWRSQMRQDSRWLWYHQXMQR2VWDOHRWURNH SUHJOHGDPRYUHYPDWRORãNLDPEXODQWL
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UDQMH3ULRWURFLKNLSULGHMRQDSUHJOHG]DUDGLSUL- zadetosti enega sklepa, pogosto odkrijemo, da je SUL]DGHWLK YHþ VNOHSRY 3RGDWHN R ãWHYLOX SUL]DGH- WLKVNOHSRYMH]HORSRPHPEHQSULRGORþDQMXJOHGH QDþUWRYDQLKSUHLVNDYLQQDGDOMQMHREUDYQDYH9 nadaljevanju predstavljamo diferencialno diagnozo artritisa pri otroku glede na ãWHYLOR prizadetih skle- SRYHGHQDOLYHþ
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Pri prizadetosti enega sklepa moramo najprej iz- NOMXþLWLSRãNRGER=DYHGDWLVHPRUDPRGD]ODVWL majhni otroci pogosto padejo in da podatek o padcu DOLXGDUFXãHQHSRWUMXMHGDMHWHåDYDVVNOHSRPGH- MDQVNRSRVOHGLFDSRãNRGEH9SUDNVLXJRWDYOMDPR GDVWDUãLSULMXYHQLOQHPLGLRSDWVNHPDUWULWLVX-,$
opazijo spremenjen sklep šele po padcu, ko sklep SUYLþSR]RUQRSUHJOHGDMR3ULSRãNRGEDKVHWHåDYH s sklepom navadno pojavijo nenadno in so precej izrazite, ne spremljajo pa jih povišana telesna tem- peratura ali povišane vrednosti vnetnih parametrov, UD]HQREVSUHPOMDMRþLRNXåEL2EUHPHQLWHYVNOHSD L]UD]LWR SRVODEãD WHåDYH V VNOHSRP 3RãNRGER GR- kazujemo s slikovnimi preiskavami: rentgenskim VOLNDQMHP 57* XOWUD]YRþQR SUHLVNDYR 8= LQ PDJQHWQRUHVRQDQþQLP VOLNDQMHP 05, ]ODVWL SUL SRãNRGEDK YH]L LQ KUXVWDQFD 2E SXQNWLUDQMX SR- škodovanega sklepa praviloma aspiriramo krvavka- VWR YVHELQR 3RãNRGRYDQ VNOHS UD]EUHPHQL- mo, bolnika pa pošljemo na pregled k travmatologu DOLRUWRSHGX
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Trn, drobec stekla ali druge oblike tujka lahko pov- ]URþLMRRNXåERVNOHSDDOLVWHULOQLVLQRYLWLV 3LRJHQLDUWULWLVLQRVWHRPLHOLWLV
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9OHWLK±VPRQD,QIHNFLMVNLNOLQLNLY/MX- EOMDQL REUDYQDYDOL RWURN ] RVWHRPLHOLWLVRP RWURNVVHSWLþQLPDUWULWLVRPWHURWURNVKNUDWQR RNXåERVNOHSDLQNRVWL7UHWMLQDRWURNMHELODDNWLY- nih športnikov ali otrok z anamnezo manjših po- ãNRGE3RY]URþLWHOMDRNXåEHVPRXJRWRYLOLYVNRUDM SRORYLFLSULPHURYLQVLFHUSRY]URþLWHOMH6WDSK\OR- FRFFXVDXUHXVRWURN6S\RJHQHVRWURN6 SQHXPRQLDHRWURN.LQJHOODNLQJDHRWURFLLQ 6DOPRQHOODRWURFL
Pri osteomielitisu moramo v diferencialni diagno- ]LYHGQRSRPLVOLWLWXGLQDNURQLþQLSRQDYOMDMRþLVH YHþåDULãþQLRVWHRPLHOLWLV±YQHWQREROH]HQNLSUL- ]DGHQHSUHGYVHPRWURNH±]]QDþLOQLPLSRQDYOMDMR- þLPL VH HSL]RGDPL RVWHRPLHOLWLVD 6WHULOQR NRVWQR YQHWMHVHNDåH]EROHþLQDPLYNRVWHKNLVRSRJRVWR KXMãHSRQRþLLQMLKODKNRVSUHPOMDSRYLãDQDWHOHVQD WHPSHUDWXUD0HVWREROHþLQHMHODKNRRWHNORLQWR- SOR 9 ODERUDWRULMVNLK L]YLGLK VR ODKNR SULVRWQH OH blage spremembe v vrednostih ESR, CRP in krv- QLVOLNL1DUHQWJHQVNHPSRVQHWNXSRJRVWRYLGLPR RVWHROLWLþQHVSUHPHPEHREGDQHVVNOHUR]RYHQGDU MHUHQWJHQVNLSRVQHWHNY]DþHWQLID]LEROH]QLODKNR QRUPDOHQ 1DMEROM REþXWOMLYD PHWRGD VOLNRYQHJD GLDJQRVWLFLUDQMD MH 05, VDM RPRJRþD RSUHGHOLWHY stopnje prizadetosti kosti in hkratne prizadetosti PHKNHJDWNLYD%LRSVLMRRSUDYLPRSUHGYVHP]DUDGL L]NOMXþLWYHPDOLJQHEROH]QL=GUDYLORSUYHL]ELUHVR QDYDGQR QHVWHURLGQL DQWLUHYPDWLNL 2E VXPX QDNURQLþQLSRQDYOMDMRþLVHYHþåDULãþQLRVWHRPLHOL- WLVPRUDPREROQLNDQDSRWLWLNUHYPDWRORJX /\PVNLDUWULWLV
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