More Related Content
Similar to CASE PRESENTATION BY DR SIRAJ AHMED CMC on SLE 2023pptx
Similar to CASE PRESENTATION BY DR SIRAJ AHMED CMC on SLE 2023pptx (20)
More from ZairaHussain6
Recently uploaded
Recently uploaded (20)
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
- 10. Not started yet
- 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.
- 12. Hx was not Significant
- 13. ANTIMALARIAL MULTIVITAMINS SYP: BRUFEN FOLIC ACID ORAL ANTIBIOTICS SYP: SILVER SYP: OSNATE-D SYP: DUPHALEC SYP: MUCAINE SYP: HIMALAYA
- 14. 50yr Healthy 22y 45yr Healthy 25y married 5th DOL due to fits 6th DOL due to fits 17y 14y Pt; 9y NO Hx of chronic illness in family NO Hx of JAUNDICE in FAMILY
- 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
- 29. CHRONIC LIVER DISEASE 2NDRY T0… 1) Viral hepatitis? 2) Wilson disease? 3) Autoimmune hepatitis? ABDOMINAL T.B? MALIGNANCY? HIV? SLE?
- 31. HB 5.2g/dl HCT 19.7% MCV 53.3fl WBC 4100/cmm PLT 203000/cmm MP-ICT… NEGATIVE SMEAR… Microcytic hypochromic anisocytosis poikilocytosis
- 32. T. BILLI 15.7mg/dl D. Billi 10.5mg/dl SGPT 390 U/L ALK PHO 479 U/L
- 33. Hepatosplenomegally PV diameter 5mm No free fluid seen
- 34. HB 6.2g/dl HCT 22.4% MCV 51.4fl WBC 3000/cmm PLT 91000/cmm S. BILLI : 2.8mg/dl DIRECT: 1.5mg/dl SGPT : 159 U/L ALK PHO: 604 U/L MP-ICT P. VIVAX SEEN
- 35. HB 6.3g/dl HCT 20.8% RBC 3.78 millions/cmm MCV 55.1fl WBC 3700/cmm PLT 70000/cmm MP-ICT… NEGATIVE
- 36. Anti-HIV N/R
- 37. T.Billi 2.0mg/dl D.Billi 1.0mg/dl SGPT 50U/L ALK PHO 218U/L PT 15sec INR 1.07 APTT 36sec
- 38. RBS 106mg/dl Urea 26mg/dl Cre 0.7mg/dl V/M NEGATIVE
- 39. Color.. Yellow Appearance.. clear pH.. 5.0 S gravity.. 1.015 Albumin.. nil Sugar.. nil Rbc.. Nil Puss cells.. Nil Epi cells 2-3/hpf
- 40. Coarse texture of liver Suggestive of CLD Mild Spleenomegally Moderate ascites PV diameter 10mm
- 41. Interpretation: WBC = 4700 HB = 7.2 g/dl HCT= 24.0 % RBC = 4.5 millions/dl MCV= 53.3 fl RDW= 32.1% MCHC= 30g/dl Plt=86000 SMEAR microcytic, hypochromic, anisocytosis and target cells RETICULOCYTES 1.0% NO blast
- 44. 0.19 g/l SLIGHTLY Below the reference range for age
- 45. ANA … POSITIVE PATTEREN… COARSE SPECKLED ASMA… NEGATIVE AMA… NEGATIVE
- 48. INJ: CEFOTAXIME 1g i/v x 8 hourly INJ: VIT:K 2mg diluted in 5cc i/v stat Syp: Ibuprofen 200mg 2tsp x TDS Syp: duphalec 30ml x HS Syp: vidalyn 1tsp x OD Syp: silver 1tsp x BD Tab: aldacton 50mg ¾ x OD Tab: inderal 10mg 1x OD
- 49. Tab: Deltacortil 5mg 4+0+3 Tab: HCQ 200mg 1xOD Tab: Folic acid 1xOD Tab: Aldacton 100mg ¾ x OD Tab: Inderal 10mg 1xOD Syp: Osnate-D 1+1 Syp: Mucaine 1xOD
- 50. natural history of disease Complications of disease Complications of drugs Prognosis of disease with and without treatment Avoid sun exposure Regular follow up
Editor's Notes
- unevenful