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عبد الوهاب السعدنى حالة 56

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عبد الوهاب السعدنى حالة 56

  1. 1. Case 167 MD Pediatrics PhD ped study children special need
  2. 2. ‫ر‬‫دكتو‬ ‫محمد‬ ‫الوهاب‬ ‫عبد‬‫السعدني‬ ‫أطفال‬ ‫طب‬ ‫دكتوراه‬‫ـ‬‫الزقازيق‬ ‫طب‬ ‫الخاصة‬ ‫االحتياجات‬ ‫ذوى‬ ‫دكتوراه‬‫وتغذيه‬ ‫صحة‬ ‫األطفال‬ ‫شمس‬ ‫عين‬ ‫طب‬ ‫ـ‬ ‫وعالج‬ ‫تشخيص‬ ‫في‬ ‫الدكتوراه‬‫الحميات‬ ‫أمراض‬
  3. 3. Name :…… Age; 65 years Sex: female Residence: meat Ali Occupation :house wife Mariatal state married Social state High Diabetic 20 years ago hypertensive 15 years ag Personal history
  4. 4. Complaint Fever for 3 months not responding to treatment Headache , anorexia …easily tired sweating and occ palpitation Sense of abdominal discomfort and fullness……………….
  5. 5. Present history Started 3 months ago by sudden onset of febrile illness with generalized boneache , headache, sweeting easily tired sense of abdominal fulness indigestion and anorexia
  6. 6. Fever increased at night with shivering sweating and shortness of breath with palpitation
  7. 7. diagnosed as Enterica Patien asked many Med advices and all shared diagnosis of Typhoid fever Treated 10 days with Ciprofloxacin twice daily with minimal improvement Of some Symptoms
  8. 8. Patint reevaluated Pyogenic sinsuits by ENT consultant based on xRay nasal sinuses Received home medication Augmentin Two weeks Minimal improvement of fever and headache
  9. 9. Patient by lab and positive lab for Malta fever Given treatment for brucellosis for 8 weeks with no response Asked medical advice by fever specialist
  10. 10. Refered to hospital with the above symptoms No response
  11. 11. Through history and repeated physical examination revealed
  12. 12. General examination Alert,conscious,active ,non toxic T 39 c RR 22/mِ HR 92/m ,B P 145/95 Chest: BEAE CVS: S1-S2-O GIT: soft no visceromegaly CNS: NAD L L minimal pertibial edema
  13. 13. LAB Results
  14. 14. CBC: TLC:9.6 RBCs: 3.64 HB: 10 PLAT: 296 ESR: 110 ASO: -VE CPR: 12 FU SUGAR :404
  15. 15. URINE ANALYSIS PUS: 5-7 GLUCOSE ++ PROTEIN: ++
  16. 16. Widal 1l160 H:-ve Brucella:-ve S.creatinine: 1
  17. 17. Liver enzymes: normal ِKideny Function Normal
  18. 18. RADIOLOGICAL STUDY CXR ABD U S ABDOMINIAL COPUTARIZED CT ABD MRI
  19. 19. Chest x ray : free Abdominal U/S Multiple focal lesions for C/T liver
  20. 20. CT ABDOMEN: Mildly enlarged liver with multiple variable sized marginally enhanced cystic lesions are seen scattered in both liver lobes and caudate lobe . the largest measures about 3.5 cm in diameter and located in medial segment of the left liver lobe…… signs cobe with multiple liver granulomas Normal enhancement of the main portal vein and its two main branches. No dilated intra-hepatic biliary
  21. 21. 19-3-2012 Refered for guided CT liver aspiration and drainage for Histopathology and microbiological study
  22. 22. BIOPSY under guide CT Slowly growing gram +ve bacteria : actinomyces israeli
  23. 23. LIVER BIOPSY
  24. 24. Monday 23-4-2012 Resolution of all hepatic absceses and largest one resoled with half cm in diameter Pateient will continue ttt at hospital for further two weeks under tttt by………………………………………… ……….
  25. 25. Abstract Femal ward 65ys diabetic hypertensive hepatic actinomycosis Acombination of surgrgical radiological dranage and antibiotic proved to lead to complet cure ‫للجميع‬ ‫شكرا‬
  26. 26. discussion Actinomycosis liver abscess is comonly assoc with nonspecific clinical and lab signs of infection Immagine usualy review aspace occuping lesion suggest either hepatic tumor or pseeudotumor or inflamatory Adefinitive diagnosis is histopathology tests on sample obtained under screen Adefinitive diagnosis is histopathology tests on sample obtained under screen Felekouras et al (92) report hepatic lobectomy in ‫؛‬
  27. 27. Felekouras et al (92) report hepatic lobectomy in‫؛‬ case of isolated hepatic actinomycosis(case report) ‫؛‬Ped R health sci J 11:19-21 Samuel 1999 Post g Med j liver acinomycosis as C/o diverticulosis liver acinomycosis as liver mass by Vargas 92 medicine 21 111-115 ٍsugano etal in Japan hapatic actinomycosis in japan case report J gastroentro 9732;;672;6 Ali et al 97 hepatic inv in diss actinomycosis Panc sur 3 ;337;9 Bown etal 2011 report acase presenting solely as hapatic mass co actinomycosis {
  28. 28. Actinomycosis Actinomyces Slow growing gram +ve bacteria , it is a part of the oral flora in humans, flamentous structure gives them fungal like appearance
  29. 29. discussion case of isolated hepatic actinomycosis(case report) ‫؛‬Ped R health sci J 11:19-21 Samuel 1999 Post g Med j liver acinomycosis as C/o diverticulosis liver acinomycosis as liver mass by Vargas 92 medicine 21 111-115
  30. 30. Actinomycosis IActinomycosis is infection is infection caused by actinomyces bacteria Characterized by characteristic granulomatous suppurative disease characterized by peripheral spread with formation of draining sinus affect cervicofacial,thoracic,abdominal,pelvi
  31. 31. Actinomyces in clinical specimen sputum .crust purulent exudate surgical nacropsy ,rinsed stain reveal organisms with classic silver granules
  32. 32. c/s brain,heart infection agar 37 c 95% nitrogen 5 % co2 incubate aenerobically organism within 24h israile filaments spiderlike growth
  33. 33. epidemiology worldwide without relation to age ,sex,race,season or occupation review 85% case youngest one 28day etiology human flora increased in patient with steroid leukemia renal cong imm def.HIV
  34. 34. pathogenesis chronic suppurartive scaring inflammatory process with dense cellular infiltrate with suppuration forming many connecting abscess with sinus tracts site involves,lung.abdomen,orofaci al
  35. 35. c/p of abdominal and pelvic after disruption of mucosa of GIT hepatic affection 15% as solitary or multiple liver abscesses chills fever night sweets weight loss similar to TB
  36. 36. diagnosis microscopic examination with appropriate stain c/s of purulent discharge actinomyces irregular non spore forming non acid fast non moblle gram +ve bacillus c/s aerobic non aerobic
  37. 37. abdominal CT a contrast enhancing multicystic lesions that can be approached by CT guided needle biopsy and C/S
  38. 38. Treatment prolonged antibiotic therapy and drainaage Penicillin 250mg/kg/24h q4h Tetracycilin clendimycin chloramephenicol injection 2-6 weeks Oral3-12 months
  39. 39. THANK YOU

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