SEMINAR.pptx ...

education purposes

1. EDEN UNIVERSITY PEADIATRICS SEMINAR

2. DEMOGRAPHICS E.N MALE 9YRS CHRISTIAN GARDEN HOUSE GRADE FOUR PUPIL AT BETHLEHEM DOA 22/01/25 DOC 23/01/25 MOTHER A.M

3. PRESENTING COMPAINT 4/7 ABDOMINAL PAIN 4/7 VOMITING 4/7 BODY HOTNESS

4. HISTORY OF PRESENTING COMPLIANT PATIENT WAS IN HIS USUAL STATE OF HEALTH UNTIL 4/7 AGO WHEN HE STARTED EXPERIENCING SUDDEN SEVERE SHARP ABDOMINAL PAIN THAT WAS PERSISTANT AND NON RADIADING. P AIN WOULD BE RELIEVED BY BEING IN A CURLED POSITION.THERE WERE NO AGGREVATING THINGS NOTED. H/O DARK STOOL. YELLOW VOMITUS FOR THE PAST 4/7 (2-3 TIMES/DAY ,NOT ASSOCIATED WITH FOOD INTAKE),NON FORCEFUL ASSOCIATED WITH LOSS OF APPETITE. THE CHILD ALSO DEVELOPED YELLOWING OF EYES , PALMS AND FEET. NOT ASSOCIATED WITH ITCHINESS.

5. RESPIRATORY SYSTEM NO DYSPNEA NO COUGH NO WHEEZING MUSCULOSKELETAL NO JOINT SWELLING NO JOINT PAIN NO RASHES GENERALIZED BODY WEAKNESS

6. HISTORY PRESENTING COMPLAINT CONT. ELEVATING HIGH GRADE FEVERS (RELIEVED BY TEPID SPONGING) AND FRONTAL HEADACHE WITH SUDDEN ONSET WHICH WAS THROBBING, NON RADIATING, USUALLY OCCURING IN THE EVENING. NO CONVULSIONS , LOSS OF CONCIOUSNESS ,BLURRED VISION OR DIZZINESS H/O PASSING DARK URINE (NON FOUL SMELLING WITH NO BLOOD OR PAIN WHEN PASSING). SLIGHT WEIGHT LOSS WAS NOTED BY THE MOTHER

7. REVIEW OF SYSTEMS CARDIOVASCULAR PALPITATIONS + CHEST PAIN - DYSPNEA- PEDAL EDEMA OR ANKLE SWELLING- NO COLDNESS OF FEET

8. BIRTH HISTORY PREGNANCY DIAGNOSIS MADE BY GRAVINDEX TEST SHE ATTENDED ALL 8 ANTENATAL VISITS , WAS GIVEN FOLIC ACID IN FIRST THREE MONTHS OF PREGNANCY , FANCIDA 3 TIMES AND DEWORMING MEDICATION IN FOLLOWING MONTHS SHE IS RVD [NR] ,MOTHER STATES SHE NEVER HAD ANY UTI’S , SHE WAS HYPERTENSIVE DURING HER PREGNANCY, SHE DELIVERED THROUGH SPONTANEOUS VAGINAL DELIVERY AT NINE MONTHS WITH NO COMPLICATIONS SHE WAS IN HOSPITAL POST DELIVERY JUST FOR A DAY

9. BIRTH HISTORY CONT CHILD HAD A BIRTH WEIGHT OF 3.8KG CRIED IMMEDIATELY AFTER BIRTH

10. IMMUNIZATION CHILD REC EI VED ALL VACCINATIONS NUTRITION CHILD HAS AT LEAST FOUR MEALS A DAY BREAKFAST (PORRIGE WITH PEANUT OR BREAD WITH TEA) BREAD AND EGGS/POLONY (AT SCHOOL) LUNCH (POTATOES/PASTA WITH MINCE AND MIXED VEGTABLES) DINNER (NSHIMA WITH MEAT AND VEGTABLES)

11. DEVELOPMENTAL MILESTONES GROSS MOTOR- SITTING AT 4 MONTH, CRAWLING AT 6 MONTHS, WALKING AT 9 MONTHS FINE MOTOR – MOTHER CAN NOT REMEMBER SOCIAL/COGNITIVE – SMILING AT 2 MONTHS, RECOGNIZING FACES AT 4 MONTHS, CHILD RELATES WELL WITH PEERS.

12. MEDICAL , SURGICAL AND DRUG HISTORY PATIENT HAS BEEN IN AND OUT OF THE HOSPITAL FOR 3/12 DUE TO ABDOMINAL PAIN , FEVER ,HEADACHES AND GENERALISED BODY WEAKNESS , DIARRHOEA AND CONSTIPATION WAS TREATED FOR MALARIA 4/52 BUT SYMPTOMS NEVER RESOLVED (FROM LOCAL CLINIC WITHOUT TESTS) HAS NO HISTORY OF DIABETES , EPILEPSY , ASTHMA, TUBERCULOSIS , HYPERTENTION AND SICKLE CELL HAS NO HISTORY OF SURGERY HAS BEEN RECEIVING PARACETAMOL, IBRUFEN, METRONIDAZOLE WAS NOT GIVEN ANY HERBAL MEDICATIONS HAS NO KNOWN ALLEGIES TO FOOD OR MEDICATION

13. FAMILY HISTORY FAMILY HAS NO HISTORY OF DIABETIS , EPILEPSY , ASTHMA,TUBERCULOSIS AND SICKLE CELL MATERNAL GRANDMOTHER HYPERTENSIVE NO HISTORY OF SIMILAR ILLNESS IN PARENTS AND SIBLINGS

14. SOCIAL HISTORY 4 TH CHILD OUT OF 5 THERE ARE 7 RESIDENCE IN THEIR 8 ROOMED HOUSE WITH 5BEDROOMS , WITH LARGE WINDOWS , TWO FLASHABLE TOILETS AND BOREHOLE WATER THEY DRINK MINERAL WATER FATHER IS A TRUCK DRIVER (CROSS BOARDER) MOTHER RUNS A POUTRY AT THE SAME RESIDENTIAL ADDRESS CHILD HAS NO H/O TRAVEL

15. SUMMARY E.N , MALE 9 YEARS OF GARDEN HOUSE, PRESENTED WITH 4/7 SEVERE ABDOMINAL PAIN , VOMITING , PERSISTANT FEVER , FRONTAL HEADACHE, JAUNDICE WITH LOSS OF APPETITE ..PT HAD DARK URINE AND STOOL. HOWEVER PT HAD NO CONVULSIONS, NO NAUSEA OR DIARRHEA, NO PRURITIS.

16. IMPRESSION AND DIFFERENTIALS IMP: ENTERIC FEVER DIFFERENTIALS: CHOLECYSTISIS S. MALARIA YELLOW FEVER

17. EXAMINATION AFTER OBTAINING CONSENT WE EXAMINED STANDING AT THE FOOT END OF THE BED A MALE CHILD LAYING IN SUPINE PATIENT WAS ILL LOOKING BUT ALERT AND NOT IN OBVIOUS RESPIRATORY DISTRESS PT WAS CANNULATED ON THE RIGHT HAND BUT NO RUNNING FLUIDS OR DRUGS NO MEDICAL ADJUNCTS ATTACHED TO PATIENT PATIENT HAD SCLERAL JAUNDICE

18. STANDING AT RIGHT SIDE OF THE BED PATIENT NO HAD KOILONYCHIA NO LEUKONYCHIA NO FINGER CLUBBING NO PERIFERAL CYANOSIS NO PALMA ERYTHEMA PATIENTS PALMS WERE WARM TO TOUCH CAPILLARY REFILL TIME WAS LESS THAN 2SEC

19. VITALS BP 92/70MMHG (97/57-115/76) RES 30BPM (18-25) PULSE 110BPM (75-118) O2 SAT. 95% ON ROOM AIR TEMP: 37.1C (TEMPORAL) RBS: 5.4MMOL

20. HEAD HAIR COLOR WAS NORMAL AND EVENLY DISTRIBUTED SCLERAL JAUNDICE NO CONJUCTIVAL PALLOR NO NASAL FLARRING OR POLYPS NO CENTRAL CYANOSIS NO SIGNS OF ORAL THRASH NO EAR DISCHARGE

21. NECK NO VISIBLE MASSES NO JUGULAR VEIN DISTENTION NO NECK STIFFNESS NO PALPABLE CERVICAL,MANDIBULAR NOR SUPRACLAVICULAR LYMP NODES RESPIRATORY NO SURGICAL SCARS OR TRADITION TATOOS NORMAL SHAPE AND SYMETRY SYMETRICAL CHEST MOVEMENTS CENTRAL TRACHEA NORMAL AIR ENTRY, NO ADDED SOUNDS

22. CVS NO PRECORDIAL SCARS APEX BEAT IN THE 5 TH IC,MIDCLAV. LINE REGULAR HEART SOUNDS, NO ADDED SOUNDS ABDOMEN NO SURGICAL SCARS UMBILICUS WAS CENTRAL AND INVERTED NO CAPUT MEDUSA OR SPIDER NIVEA MOVING WITH RESP. NO DISTENTION

23. CONT… NO PALPABLE MASS AND SKIN WAS WARM TO TOUCH POSITIVE MURPHY SIGN ABDOMINAL TENDERNESS IN RUQ NO ORGANOMEGALLY BOWEL SOUNDS 6 IN ONE MIN

24. SUMMARY E.N MIDDLE CHILDHOOD MALE , EXAMINED LYING IN SUPINE,ON GENERAL INSPECTION HE WAS ILL LOOKING AND JAUNDICED, NOT IN R.D. NO ABDOMINAL DISTENTION, CAPUT MEDUSA,SPIDER NIVEA OR PETECHIA. ON PALPATION, THERE WAS TENDERNESS IN RUQ. POSITIVE MURPHYS SIGN. HOWEVER THERE WAS NO REBOUND TENDERNESS OR ORGANOMEGALLY. ON AUSCULTAION BOWEL SOUNDS WERE HEARD : 6/MIN

25. IMPRESSION:CHOLECYSTITIS DIFFERENTIALS: ENTERIC FEVER CHOLELITHIASIS S. MALARIA MIRIZZI SYNDROME

26. INVESTIGATIONS LABS FBC RDT/MPS (-VE) HEP B S Ag TEST (-VE) NOT DONE (widal test,bone marrow culture, blood culture, LFT,KFT) IMAGING ABD U/S SCAN NOT DONE (CT SCAN, ERCP) CHEST X RAY

27. DIAGNOSIS – ACUTE ACALCULOUS CHOLECYSTITIS

28. TREATMENT PATIENT WAS PLACED ON CIPROFLOXACIN 500MG BD IV METRONIDAZOLE 500MG TDS IV PARACETAMOL 500MG QID PO IVF N/S 1.5L IN 24HRS

29. THANK YOU THE END