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SABRINA TAMILMANY
012011100237
• NAME : JACKSON TEA JIA SHENG
• AGE : 6 YEARS 4 MONTHS
• GENDER : MALE
• RACE : CHINESE
• ADDRESS : SETIAALAM
• DATE OFAD...
 Jackson, aged 6 years 4 months old, chinese
boy was admitted to HTAR ( KLANG ) due
to vomiting and diarrhea for the past...
 This little boy was apparently well until 2 days ago when he
started to have fever. It was a sudden onset, low grade and...
• VOMITING
 Had 6 episodes of vomiting for the past 2 days.
 vommits soon after taking meal and was projectile
 vomitus...
 Had chest discomfort but Patient was still eager to drink water and
taking orally well.
 became less active, lethargic ...
 Had neonatal jaundice and was admitted in HTAR for 3 days.
 Had heart disease.
 found 2 months after birth and had und...
 Had heart surgery before 5 years, when the
child was 9 month old.
 There was no any complication due to the
surgery.
 ...
 ANTENATAL :
 Attended regular antenatal check-ups.
 Had gestational diabetes mellitus, found during third trimester
an...
 NATAL :
 Delivery was through a nomal vaginal delivery.
 Artificial rupture of membrane was done.
 There was spinal a...
 No exclusive breast feeding. He was breastfed for 2
months only because the mother was pregnant after that
period. He wa...
• His mother was satisfied with her child’s growth.
 Physical growth and development
- normal physical growth
- had start...
 Emotional and social development
 according to the mother, child is very active in school and
home.
 does well in educ...
 His mother claimed that her child’s immunization was
up-to-date and followed the schedule.
 He had received all BCG, He...
• There is not consanguinity marriage in the family.
• No one among the family members have this kind of medical
problem.
...
 Patient lives with his family in an double storey house in Setia Alam, and
adequate electricity and water supply.
 His ...
 my patient, Jackson who is 6 year
4 months old chinese boy
presented with vomiting
and diarrhea for past 2 days.
It was ...
AZLINAH BINTI MOHAMED IQBAL
012011100190
 General inspection
 Patient was comfortably lying supine, alert and
conscious.
 Interacting well with his mother.
 Di...
 General examination
 Head
 Anterior fontanel was normal
 Eye
 Conjuctiva was not pallor and no icterus
 Mouth
 Goo...
 Nose
 No any discharge or bleeding
 Ear
 No any discharge or bleeding
 Hand
 Cold, moist and pink
 no clubbing, no...
- Neck
 no enlargement of lymph nodes
 no stiffness of neck
- Throat
 no tonsillitis
- Axillary
 no lymph nodes enlarg...
- Skin
 light pinkish color tone
 no rashes
 no pigmentation
 Temperature: 37°c ( reading taken at
axillary)
 Pulse Rate: 86 bpm
- rhythm : regular
- volume : normal
 Respiratory R...
 Anthropometry
 Weight: 20 kg
 Length : 119 cm
 BMI : 14.1 kg/m²
 RESPIRATORY SYSTEM
 inspection: shape of the chest was normal,
chest move with respiration bilaterally
 palpation: che...
 CARDIOVASCULAR SYSTEM
 inspection: no chest deformities, there was well
healed midline scar on chest, apex beat was vis...
 GASTROINTESTINAL SYSTEM
 inspection: no abdomen discomfort , no
pigmentation, umbilicus centrally located and
inverted
...
 On examination, patient was well hydrated and
doesn’t show any significant sign and symptoms.
Furthermore, capillary ref...
C.K.SURENTHIRAN
012010090079
POINTS FAVOURING
1. Vomiting
2. Diarrhea
3. Fever
4. Fatigue
1. Food Poisoning
POINTS FAVOURING POINTS AGAINST
-Vomiting
-Fever
-Diarrhea
-Fatigue
-Consumption of outside
food
-No abd...
2. Giardasis
POINTS FAVOURING POINTS AGAINST
-Diarrhea
-Vomiting
-Fever
-No general malaise and
weakness
-No abdominal dis...
3. URINARY TRACT INFECTION (UTI)
POINTS FAVOURING POINTS AGAINST
-Fever
-Vomiting
-No flank/abdominal pain
-No urinary sym...
ABISHAG A/P KALI
012011100113
2. BUSE
-electrolyte imbalance and dehydration
3. Urine Analysis
-rule out urinary tract infection
4. Stool Examination
-c...
 ORS plan A (200cc)
 Give extra fluid(IV/drinking water)
 Iron tablets
 Antibiotics
 Encourage orally
 Monitor patie...
MATHILASHINI RETNAM
012011100178
 Drinking well water
 Eating undercooked food, especially seafood
 Improperly stored food
 Travel to high risk areas
...
 Viruses (∼70%)
 Rotaviruses
 Noroviruses (Norwalk-like
viruses)
 Enteric adenoviruses
 Calciviruses
 Astroviruses
...
 Vomiting
 Watery diarrhea, sometimes
bloody mucus
 Abdominal pain, loss of
appetite
 Dizziness, headache
 Flu - like...
 Medical history and physical examination.
 Tests that may be used to evaluate gastroenteritis
 Stool culture
 Complet...
 A stool culture can detect:
 Cholera
 Shigella infection
 Campylobacter enteritis
 Cryptosporidium enterocolitis
 G...
 Oral rehydration solution
 The treatment of choice for children with mild to moderate
gastroenteritis,
 Agents used in...
 Dehydration
 Metabolic acidosis
 Electrolyte disturbance (hypernatraemia,
hyponatraemia, hypokalaemia)
 Carbohydrate ...
 http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1764079/
 http://www.freemd.com/gastroenteritis
THANK YOU
acute gastroenteritis, case presentation < sabrina >
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acute gastroenteritis, case presentation < sabrina >

  1. 1. SABRINA TAMILMANY 012011100237
  2. 2. • NAME : JACKSON TEA JIA SHENG • AGE : 6 YEARS 4 MONTHS • GENDER : MALE • RACE : CHINESE • ADDRESS : SETIAALAM • DATE OFADMISSIO : 17TH MARCH 2014 @ 12 AM • DATE OF CLERKING : 18TH MARCH 2014 • INFORMER : MOTHER (RELIABLE & ADEQUATE)
  3. 3.  Jackson, aged 6 years 4 months old, chinese boy was admitted to HTAR ( KLANG ) due to vomiting and diarrhea for the past 2 days since 15th march 2014.
  4. 4.  This little boy was apparently well until 2 days ago when he started to have fever. It was a sudden onset, low grade and intermittent fever but no rigor. But, the fever was resolved on that day itself when the mother gave him some of his previous medicines and vitamins at home. Soon after the fever resolved, he had vomiting and continued with diarrhea.
  5. 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. 6.  Had chest discomfort but Patient was still eager to drink water and taking orally well.  became less active, lethargic and weak.  Urine output was normal.  Patient had outside food the day before but none of the family members had similar symptoms.  Apart from that, he had no cough, no shortness of breath, no bloody vomiting or bloody diarrhea, no dark or bloody urination. He also did not have abdominal pain or distention, no anal redness, no rashes and no seizures. Had no history of travelling.
  7. 7.  Had neonatal jaundice and was admitted in HTAR for 3 days.  Had heart disease.  found 2 months after birth and had undergone follow up and surgery in IJN.  resolved after surgery when the child was 9 months old and still on follow up once every year.  the last follow up was on 12th march 2014, and according to the doctor patient was completely fine.  Had no any other medical illness.  Not any medication due to this medical illness.
  8. 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. 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. 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. 11.  No exclusive breast feeding. He was breastfed for 2 months only because the mother was pregnant after that period. He was bottle-fed since then till now. • He was given ANMUM formulae until he was 3 years. • he was introduced with porridge and home cooked adult food after 2 years, in small quantity.
  12. 12. • His mother was satisfied with her child’s growth.  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. 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. 14.  His mother claimed that her child’s immunization was up-to-date and followed the schedule.  He had received all BCG, Hep B, DTeP, Hib and IPV injection. TREATMENT / ALLERGIC HISTORY  Patient had No known allergy to food or medication
  15. 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. 16.  Patient lives with his family in an double storey house in Setia Alam, and adequate electricity and water supply.  His mother works as a clerk in a company at Subang Jaya. His father works as an executive manager at Petaling Jaya.  Patient stays in day care with his sister after school and there are few other kids living with them and no history of similar illness from the other kids.  His parents are non-smoker and both of them do not consume alcohol.  They came from a moderate socioeconomic class with an average monthly income of RM 4000.00 combined.
  17. 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. 18. AZLINAH BINTI MOHAMED IQBAL 012011100190
  19. 19.  General inspection  Patient was comfortably lying supine, alert and conscious.  Interacting well with his mother.  Did not look in pain or distress.  Nutritional and hydration status was normal.  BCG scar was seen on his left deltoid muscle.
  20. 20.  General examination  Head  Anterior fontanel was normal  Eye  Conjuctiva was not pallor and no icterus  Mouth  Good oral hygiene  No bluish discoloration of lips  No dehydration of lips
  21. 21.  Nose  No any discharge or bleeding  Ear  No any discharge or bleeding  Hand  Cold, moist and pink  no clubbing, no peripheral cyanosis  pulse rate were 86 beats per minute with regular rhythm, good volume and normal character.
  22. 22. - Neck  no enlargement of lymph nodes  no stiffness of neck - Throat  no tonsillitis - Axillary  no lymph nodes enlargement - Lower limb  no deformities  no muscle wasting  no pitting edema
  23. 23. - Skin  light pinkish color tone  no rashes  no pigmentation
  24. 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 brachiocephalic during supine position)
  25. 25.  Anthropometry  Weight: 20 kg  Length : 119 cm  BMI : 14.1 kg/m²
  26. 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 rhonchi sound
  27. 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. 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. 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 organomegaly and bowel sound were present.
  30. 30. C.K.SURENTHIRAN 012010090079
  31. 31. POINTS FAVOURING 1. Vomiting 2. Diarrhea 3. Fever 4. Fatigue
  32. 32. 1. Food Poisoning POINTS FAVOURING POINTS AGAINST -Vomiting -Fever -Diarrhea -Fatigue -Consumption of outside food -No abdominal pain -No headache -No aching limbs -No muscle weakness -Other family members do not present similar symptoms
  33. 33. 2. Giardasis POINTS FAVOURING POINTS AGAINST -Diarrhea -Vomiting -Fever -No general malaise and weakness -No abdominal distension -No weight loss -No passing of greasy stools
  34. 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. 35. ABISHAG A/P KALI 012011100113
  36. 36. 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
  37. 37.  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
  38. 38. MATHILASHINI RETNAM 012011100178
  39. 39.  Drinking well water  Eating undercooked food, especially seafood  Improperly stored food  Travel to high risk areas  Any condition that causes a weakening of the immune system such as:  Diabetes  Organ transplant  Chemotherapy  AIDS  Living around poor sanitation
  40. 40.  Viruses (∼70%)  Rotaviruses  Noroviruses (Norwalk-like viruses)  Enteric adenoviruses  Calciviruses  Astroviruses  Enteroviruses  Protozoa (<10%)  Cryptosporidium  Giardia lamblia  Entamoeba histolytica  Bacteria (10-20%)  Campylobacter jejuni  Non- typhoid Salmonella spp  Enteropathogenic Escherichia coli  Shigella spp  Yersinia enterocolitica  Shiga toxin producing E coli  Salmonella typhi and S paratyphi  Vibrio cholerae
  41. 41.  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 of skin elasticity  Infants:  Depressed fontanelle  Weak sucking reflex  Reduced blinking eyelids  Very low urine production
  42. 42.  Medical history and physical examination.  Tests that 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 with E. coli O157 infection require specialist advice on monitoring for haemolytic uraemic syndrome.
  43. 43.  A stool culture can detect:  Cholera  Shigella infection  Campylobacter enteritis  Cryptosporidium enterocolitis  Giardiasis  Pseudomembranous colitis:  Clostridium difficile  Salmonella gastroenteritis  Traveler's diarrhea due to bacterial infection  E. coli
  44. 44.  Oral rehydration solution  The treatment of choice for children with mild to moderate gastroenteritis,  Agents used in the treatment and prevention of acute pediatric gastroenteritis includes:  Probiotics - used in the treatment and prevention of acute diarrhea  Zinc – used to treat diarrhea  Metronidazole - In patients infected with C.difficile and Giardia  Tetracycline and doxycycline - For cholera  Vaccine - In February 2006, the US Food and Drug Administration (FDA) approved the RotaTeq vaccine for prevention of rotavirus gastroenteritis
  45. 45.  Dehydration  Metabolic acidosis  Electrolyte disturbance (hypernatraemia, hyponatraemia, hypokalaemia)  Carbohydrate (lactose, glucose) intolerance  Susceptibility to reinfection  Development of food (cow's milk, soy protein) intolerance  Haemolytic uraemic syndrome  Iatrogenic complications (due to inappropriate composition or amount of intravenous fluids)  Death
  46. 46.  http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1764079/  http://www.freemd.com/gastroenteritis
  47. 47. THANK YOU

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