acute gastroenteritis, case presentation < sabrina >

1. SABRINA TAMILMANY
012011100237

2. •NAME :JACKSONTEAJIASHENG
•AGE :6YEARS4MONTHS
•GENDER :MALE
•RACE :CHINESE
•ADDRESS :SETIAALAM
•DATEOFADMISSIO :17
TH
MARCH2014@12AM
•DATEOFCLERKING :18
TH
MARCH2014
•INFORMER :MOTHER(RELIABLE&ADEQUATE)

3. Jackson,aged6years4monthsold,chinese
boywasadmittedtoHTAR(KLANG)due
tovomitinganddiarrheaforthepast2days
since15
th
march2014.

4. Thislittleboywasapparentlywelluntil2daysagowhenhe
startedtohavefever.Itwasasuddenonset,lowgradeand
intermittentfeverbutnorigor.But,thefeverwasresolvedon
thatdayitselfwhenthemothergavehimsomeofhisprevious
medicinesandvitaminsathome.Soonafterthefever
resolved,hehadvomitingandcontinuedwithdiarrhea.

5. •VOMITING
Had 6 episodes of vomiting for the past 2 days.
vommits soon after taking meal and was projectile
vomitus contained food particles, no blood or bile content.
•DIARRHEA
8 episodes for the past 2 days
Was watery stool and yellowish
no blood or mucus content.
was small amount each time pass motion.

6. HadchestdiscomfortbutPatientwasstilleagertodrinkwaterand
takingorallywell.
becamelessactive,lethargicandweak.
Urineoutputwasnormal.
Patienthadoutsidefoodthedaybeforebutnoneofthefamily
membershadsimilarsymptoms.
Apartfromthat,hehadnocough,noshortnessofbreath,nobloody
vomitingorbloodydiarrhea,nodarkorbloodyurination.Healso
didnothaveabdominalpainordistention,noanalredness,norashes
andnoseizures.Hadnohistoryoftravelling.

7. HadneonataljaundiceandwasadmittedinHTARfor3days.
Hadheartdisease.
found2monthsafterbirthandhadundergonefollowupandsurgery
inIJN.
resolvedaftersurgerywhenthechildwas9monthsoldandstillon
followuponceeveryyear.
thelastfollowupwason12
th
march2014,andaccordingtothedoctor
patientwascompletelyfine.
Hadnoanyothermedicalillness.
Notanymedicationduetothismedicalillness.

8. Had heart surgery before 5 years, when the
child was 9 month old.
There was no any complication due to the
surgery.
Surgery done at IJN, in Kuala Lumpur.

9. ANTENATAL:
Attended regular antenatal check-ups.
Had gestational diabetes mellitus, found during third trimester
and was on diet. No any medications.
No hypertension.
No seizure attacks and no fever with rash ( No
TORCH infection), No urinary tract infection.
Only took vitamin, iron and folic acid
supplements. No any other drugs or medication taken.
took anti-tetanus toxoid vaccine.
No exposure of radiation and no ante-partum-
hemorrhage.

10. NATAL:
Delivery was through a nomal vaginal delivery.
Artificial rupture of membrane was done.
There was spinal anesthesia given to the mother during labor.
It was full term delivery. Birth weight was 3.6 kg.
POSTNATAL
Baby cried vigorously soon after birth.
Within a few days after birth, baby had neonatal jaundice.
undergone phototherapy 3 times within a month.

11. Noexclusivebreastfeeding.Hewasbreastfedfor2
monthsonlybecausethemotherwaspregnantafterthat
period.Hewasbottle-fedsincethentillnow.
•HewasgivenANMUMformulaeuntilhewas3years.
•hewasintroducedwithporridgeandhomecookedadult
foodafter2years,insmallquantity.

12. •Hismotherwassatisfiedwithherchild’sgrowth.
Physical growth and development
-normal physical growth
-had started to lose teeth.
Thinking and reasoning (cognitive development)
-able to communicate and respond well.
-could express himself well through words.
-could understand and write.

13. Emotional and social development
according to the mother, child is very active in school and
home.
does well in education.
Language development
could describe a favorite television show, movie, story, or
other activity.
could Speak with correct grammar
could write his name and spell simple words.
Sensory and motor development
All senses and motor reflexes is normal.
( could perform normal activities like other normal kids.

14. Hismotherclaimedthatherchild’simmunizationwas
up-to-dateandfollowedtheschedule.
HehadreceivedallBCG,HepB,DTeP,HibandIPV
injection.
TREATMENT / ALLERGIC HISTORY
PatienthadNoknownallergytofoodormedication

15. •There is not consanguinity marriage in the family.
•No one among the family members have this kind of medical
problem.
•No one in the family suffers from asthma, epilepsy and any other
gene related or chromosomal diseases.
•No abortion or miscarriage had taken place before.
36
36 32
8 years old
( schooling )
7 years old
( schooling )
5 years old
( schooling )

16. PatientliveswithhisfamilyinandoublestoreyhouseinSetiaAlam,and
adequateelectricityandwatersupply.
HismotherworksasaclerkinacompanyatSubangJaya.Hisfather
worksasanexecutivemanageratPetalingJaya.
Patientstaysindaycarewithhissisterafterschoolandtherearefew
otherkidslivingwiththemandnohistoryofsimilarillnessfromthe
otherkids.
Hisparentsarenon-smokerandbothofthemdonotconsumealcohol.
Theycamefromamoderatesocioeconomicclasswithanaverage
monthlyincomeofRM4000.00combined.

17. my patient, Jackson who is 6 year
4 months old chinese boy
presented with vomiting
and diarrhea for past 2 days.
It was associated with chest
discomfort and there is no
any other associated symptoms.

18. AZLINAH BINTI MOHAMED IQBAL
012011100190

19. Generalinspection
Patientwascomfortablylyingsupine,alertand
conscious.
Interactingwellwithhismother.
Didnotlookinpainordistress.
Nutritionalandhydrationstatuswasnormal.
BCGscarwasseenonhisleftdeltoidmuscle.

20. Generalexamination
Head
Anteriorfontanelwasnormal
Eye
Conjuctivawasnotpallorandnoicterus
Mouth
Goodoralhygiene
Nobluishdiscolorationoflips
Nodehydrationoflips

21. Nose
Noanydischargeorbleeding
Ear
Noanydischargeorbleeding
Hand
Cold,moistandpink
noclubbing,noperipheralcyanosis
pulseratewere86beatsperminutewithregular
rhythm,goodvolumeandnormalcharacter.

22. -Neck
noenlargementoflymphnodes
nostiffnessofneck
-Throat
notonsillitis
-Axillary
nolymphnodesenlargement
-Lowerlimb
nodeformities
nomusclewasting
nopittingedema

23. -Skin
light pinkish color tone
no rashes
no pigmentation

24. Temperature: 37°c ( reading taken at
axillary)
Pulse Rate: 86 bpm
-rhythm : regular
-volume : normal
Respiratory Rate : 24/minute
Blood Pressure : 100 /56 mmHg (taken by
brachiocephalicduring supine position)

25. Anthropometry
Weight:20kg
Length:119cm
BMI:14.1kg/m²

26. RESPIRATORY SYSTEM
inspection: shape of the chest was normal,
chest move with respiration bilaterally
palpation: chest expansion was normal
percussion: chest sound at upper & lower
zones, anterior & posterior was resonant
auscultation: normal vesicular sound was
heard , no crackles or rhonchisound

27. CARDIOVASCULAR SYSTEM
inspection: no chest deformities, there was well
healed midline scar on chest, apex beat was visible
and no visible pulsations
palpation: no collapsing pulse, no radio-radial
delay
auscultation: heart sound was normal without any
added sound (murmurs)

28. GASTROINTESTINAL SYSTEM
inspection: no abdomen discomfort , no
pigmentation, umbilicus centrally located and
inverted
palpation: spleen and liver was not palpable, no
palpable mass felt
percussion: dull sound heard, shifting dullness
present
auscultation: normal bowel sound heard

29. On examination, patient was well hydrated and
doesn’t show any significant sign and symptoms.
Furthermore, capillary refill time was not prolonged
and he was not anaemic.
On systemic examination, the abdomen appeared
normal, there was no organomegalyand bowel
sound were present.

30. C.K.SURENTHIRAN
012010090079

31. POINTS FAVOURING
1. Vomiting
2. Diarrhea
3. Fever
4.Fatigue

32. 1.Food Poisoning
POINTSFAVOURING POINTSAGAINST
-Vomiting
-Fever
-Diarrhea
-Fatigue
-Consumption of outside
food
-No abdominal pain
-No headache
-No aching limbs
-No muscle weakness
-Otherfamily members do
not present
similar symptoms

33. 2. Giardasis
POINTS FAVOURING POINTS AGAINST
-Diarrhea
-Vomiting
-Fever
-No general malaise and
weakness
-No abdominal distension
-No weight loss
-No passing ofgreasy stools

34. 3. URINARY TRACT INFECTION (UTI)
POINTS FAVOURING POINTS AGAINST
-Fever
-Vomiting
-No flank/abdominal pain
-No urinary symptoms
(dysuria,urgency,frequency)
-No history of incontinence

35. ABISHAG A/P KALI
012011100113

37. 2. BUSE
-electrolyte imbalance and dehydration
3. Urine Analysis
-rule out urinary tract infection
4. Stool Examination
-culture and sensitivity
5. Arterial Blood Gas (ABG)
6. Acid-Base Balance
7. Random Blood Glucose
-rule out lactose intolerance/hypoglycemia

38. ORS plan A (200cc)
Give extra fluid(IV/drinking water)
Iron tablets
Antibiotics
Encourage orally
Monitor patient’s vital signs
Monitor plasma electrolytes
Continue observation
Return when there is poor oral intake, fever and
bloody stool

39. MATHILASHINI RETNAM
012011100178

40. Drinkingwell water
Eatingundercooked food, especially seafood
Improperlystoredfood
Travel tohigh riskareas
Any condition thatcausesaweakening of the
immune systemsuch as:
Diabetes
Organ transplant
Chemotherapy
AIDS
Living around poor sanitation

41. Viruses (∼70%)
Rotaviruses
Noroviruses(Norwalk-like
viruses)
Enteric adenoviruses
Calciviruses
Astroviruses
Enteroviruses
Protozoa (<10%)
Cryptosporidium
Giardialamblia
Entamoebahistolytica
Bacteria (10-20%)
Campylobacter jejuni
Non-typhoidSalmonella
spp
Enteropathogenic
Escherichia coli
Shigellaspp
Yersiniaenterocolitica
Shiga toxin producing
E coli
Salmonella typhiandS
paratyphi
Vibriocholerae

42. Vomiting
Watery diarrhea, sometimes
bloody mucus
Abdominal pain,loss of
appetite
Dizziness,headache
Flu -like symptoms (fever,
chills)
Signs of dehydration :
Urine scanty
Rapid pulse
Weight loss
Loss ofskin elasticity
Infants:
Depressedfontanelle
Weak sucking reflex
Reducedblinkingeyelids
Very low urine production

43. Medical historyand physical examination.
Teststhat may be used to evaluate gastroenteritis
Stool culture
Complete blood count
Coagulation profile
Liver profile
Kidney profile
Perform a blood culture if giving antibiotic therapy.
Children withE. coliO157 infection require specialist
advice on monitoring for haemolyticuraemic
syndrome.

44. Astool culturecan detect:
Cholera
Shigella infection
Campylobacter enteritis
Cryptosporidium enterocolitis
Giardiasis
Pseudomembranous colitis:
Clostridium difficile
Salmonella gastroenteritis
Traveler's diarrheadue tobacterial infection
E. coli

45. Oral rehydration solution
The treatment of choice for children with mild to moderate
gastroenteritis,
Agents used in thetreatmentand prevention of acute
pediatric gastroenteritis includes:
Probiotics-used in the treatment andpreventionof acute
diarrhea
Zinc –used to treat diarrhea
Metronidazole-In patients infected
withC.difficileandGiardia
Tetracycline and doxycycline-For cholera
Vaccine -In February 2006, the US Food and Drug
Administration (FDA) approved the RotaTeqvaccine for
prevention of rotavirus gastroenteritis

46. Dehydration
Metabolic acidosis
Electrolyte disturbance (hypernatraemia,
hyponatraemia, hypokalaemia)
Carbohydrate (lactose, glucose) intolerance
Susceptibility to reinfection
Development of food (cow's milk, soy protein)
intolerance
Haemolyticuraemicsyndrome
Iatrogenic complications (due to inappropriate
composition or amount of intravenous fluids)
Death

47. http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1764079/
http://www.freemd.com/gastroenteritis

48. THANK YOU