Keeping Your Bones Healthy – A Comprehensive Guide.
CASE PRESENTATION BY DR SIRAJ AHMED CMC on SLE 2023pptx
2. DR. SIRAJ AHMED SARKI
FCPS-II TRAINEE
@ PAEDS UNIT III
CHILDREN HOSPITAL LRK
3. A 12 ½ year old female
child named IQRA D/O
AMANULLAH , resident of
JACOBABAD admitted via
ER in pediatrics unit iii
children hospital larkana
on 18/03/2023 with
complaints of…
Fever for 7 days
Abdominal distension
for 6 days
4. My historian was patient herself According to her
She was relatively better 7 days back then she
developed Fever that was subjectively low grade,
intermittent in pattern and relieved by taking
antipyratics with No special time of occurrence.
Associated with headache (generalized mild in
intensity) However, fever was Not associated with
shivering, cough, rashes, ear pain, ear discharge,
sore throat, joint pain, Burning micturation,
diarrhea, night sweats, and bleeding from any site.
5. ABDOMINAL DISTENSION
on 2nd day of fever she noticed abdominal
distension that was gradual in onset started at
left upper abdomen than progress to involve
whole abdomen, associated with abdominal pain
(that was generalized, gradual in onset, aching in
nature, mild in intensity, no radiation, referral or
shift, no aggravating or relieving factors) not
associated with vomiting, constipation, diarrhea,
bleeding per rectum and SOB
6. GENERAL : decreased appetite but no h/o weight loss no
sleep disturbance
CNS: No convulsion, ALOC, blurred vision or weakness of any
part of body.
CVS: no palpitation, no chest pain No cyanosis and edema of
feet
Res: No respiratory distress, no hemoptysis
GI : Jaundice is present in eyes for 7-8 months
GUS: No dysuria, oligouria and Hematuria, color was yellow
ENDO: no neck swelling, cold or heat intolerance, polydipsia
or polyuria
MSK: No muscle/bone/joint pain,swelling, stiffness,
skeletal deformity, or restriction of movement
SKIN: no rashes, itching or colored spot, hair loss
7. There has been only ONE Hospital admission for 1 day in july
2022 with complaints of FEVER, YELLOWISH DISCOLORATION ,
AND PALLOR some investigations (CBC, LFTs, MP, HBsAg and
U/S ABDOMEN) done and PCV was transfused at that time,
after that she has hx of multiple OPD VISITS from July to
December 2022 with persistent complaint of fever, yellowish
discoloration, abdominal pain and she was treated as case of
ACUTE HEPATITS, after that she remains relatively alright then
she develops presenting complaints and went to GP, and he
counseled the attendants for tertiary care hospital
SURGICAL Hx was not significant except ears
piercing by her aunty (new needle)
8. Birth hx unremarkable .
She is vaccinated according to National
EPI schedule.
Acheived normal developmental
milestones.
9. Total amount of calories required according to
weight at the 12 ½ years of age 1780
k.calories/day.
Current intake about 1350 k.calories/last 24 hours.
2 cup tea 60k.cal
biscuit 8, 280k.cal
1 of chapatti two time/day 200k/cal
sabzi two times 300k/cal
1 glass milk given/day (120 k.calories)
boiled egg 80k.cal
boiled rice1 200k.cal
1 banana 110 k.cal Def:
430kcal/Day
11. 1 time PCV transfusion
Hb 5.2 g/dl.
blood group O+ve.
blood was arranged from private laboratory.
Donor was cousin
blood transfused after proper blood grouping
screening and cross match
No reaction was noted.
15. No any addiction or habit
Normal bowel habits
No any psychosocial problem
Student of class five
Home and school surroundings are
satisfactory
16. 7 family members
Living in well built house
Father is uneducated laborer by
occupation earn 25-30k/month
Source of water from hand pump
water
NO Domestic animal at home.
17. patient daily activities have disturbed
she is not able to continue his education,
previously she has good education record
parents are disturbed financially and
psychologically and worried about disease of
his child because of repetitive opd visits.
18. Parents have poor knowledge about disease
they only know she has liver problem
19. A 12 ½ year old female child 5th issue of
consanguineous marriage birth hx is unremarkable
vaccinated developmentally normal admitted with c/o
fever for 7days and abdominal distension for 6days
associated with headache & fatigue and jaundice since
july 2022. she has hx of hospital admission in July 2022
for 1 day with complaints of fever jaundice and pallor,
transfused with PCV once at that time, and having
multiple OPD visits b/c of fever jaundice and abd pain.
Death of two siblings in family in neonatal age with FITS
No h/o cough, glandular swelling, night sweats,rash,
ear discharge, sore throat, joint pain, Burning
micturation, diarrhea constipation, and bleeding from
any site.
21. My patient is well looking, conscious and
cooperative sitting on bed having obvious
pallor with no obvious signs of respiratory
distress and dysmorphic features having…
height 143 cm (at 75th percentile)
and
weight 34kg (above 25th percentile)
22. VITALS:
R/R: 20 Br/Min
H/R 104 Bt/Min
TEMP 98.8f
BP: 110/70 mmHg (systolic at 50th and diastolic below 50th
percentile)
SEVERE ANEEMIA and JAUNDICE are present
NO koilonychia, Cyanosis, Clubbing, palmar
erythema, nodes, Dehydration, bruises,
petechie, discoloration, Pedal edema and
Lymphadenopathy
Oral hygiene is satisfactory, ears, nose and
eyes are normal there is no neck swelling,
BCG SCAR was PRESENT
24. Inspection
Slightly Distended, moves with respiration, umbilicus is
centrally placed with inverted margins, no visible
marks/scars/pulsation/veins
Palpation
There was no tenderness
Spleen = palpable 6cm below left costal margin with regular
margins, smooth surfaces firm in consistency directed to RIF.
LIVER, KIDNEYS, BLADDER OR ANY MASS WAS NOT PALPABLE
Abdominal Girth: 60cm
Percussion
Percussion note was dull on LUQ and in flanks regions,
NO Fluid thrill but Shifting dullness was positive
TOTAL LIVER SPAN WAS 8cm (upper border in 5th ICS)
Auscultation
Bowel sounds audible
25. CNS is grossly intact,Hearing and vision
intact,spine is normal.
Lung= Are clear Bilaterally
CVS: Apex beat is in 4th ICS, and JVP is not
raised, S1 and S2 audible no added sound
MSK: no tenderness, swelling, discoloration,
stiffness, or joint pain on passive movements
SMR: stage II
26. A 12 ½ year old female child 5th issue of
consanguineous marriage birth hx is unremarkable
vaccinated developmentally normal admitted with c/o
fever for 7days and abdominal distension for 6days
associated with headache, fatigue and jaundice. she has
hx of hospital admission in july 2022 for 1 day with
complaints of fever jaundice and pallor, transfused
with PCV once at that time, and having multiple opd
visits b/c of fever jaundice and abd pain.
Death of two siblings in family in neonatal age with FITS
27. O/E
well looking female child with average built and height,
conscious and cooperative sitting on bed comfortably, vitally
stable she looks pale and jaundiced NO koilonychia Cyanosis,
Clubbing, palmar erythema, nodes, Dehydration, bruises,
petechie, and Pedal edema and Lymphadenopathy.
BCG SCAR WAS PRESENT
Abdominal ex: slightly distended, non tender Spleen is palpable
6cm below left costal margin with regular margins, smooth
surfaces firm in consistency directed towards RIF.
LIVER, KIDNEYS, BLADDER OR ANY MASS WAS NOT PALPABLE
Percussion note was dull on LUQ and in flanks regions, Shifting
dullness is positive TLS is 8cm. bowels sounds audible
Rest of systemic Ex: including CVS, CNS, CHEST AND MSK was
UNREMARKABLE
SMR: stage-II
50. natural history of disease
Complications of disease
Complications of drugs
Prognosis of disease with and without
treatment
Avoid sun exposure
Regular follow up