Pemeriksaan Klinis Fisik pada Bedah Anak.pptx
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Alfi, a 10-year old boy, presented with sudden onset of severe pallor, dark colored urine, and jaundice. Examination found severe pallor, jaundice, splenomegaly, and otherwise normal vital signs. Initial workup showed features of hemolysis, positive direct Coombs test, and elevated bilirubin and LDH. The provisional diagnosis was autoimmune hemolytic anemia, which was confirmed. Treatment with steroids led to improvement in symptoms and laboratory values over subsequent follow ups.
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ABDOMINAL PAIN CASE HISTORY FOR DIAGNOSTIC SYNDROME SLIDESHARE
INTRODUCTION
Abdominal pain refers to discomfort that is felt between the chest and the groin.,which can be acute or chronic on presentation.
Categorised into 4 quadrant and 9 regions for analysis of underlying pathologies and their localization ,patient may also present with ;-Bloating, N/V, diarrhea or constipation, fever, visible swelling or tenderness.
It Can occur due to Gastrointestinal pathologies like peptic ulcer ,appendicitis, obstructions, cholecystitis etc or gynecologycal, vascular, peritoneal pathologies
EPIDEMIOLOGY
5 – 10% of all ED visits.
Among them, 14 – 40 % patients need surgical intervention
Most common diagnosis is Non specific
Males were more affected than females with male to female ratio of 1.14 : 1
Highest number of patients were in 15 – 24 years of life
Most common cause found to be acute appendicitis for acute abdomen in a range of 57.5 % of total admission.
CAUSES
Gastrointestinal
Gastrointestinal
Gastroduodenal
Peptic ulcer
Gastritis
Malignancy
Gastric volvulus
Intestinal
Appendicitis
Obstruction
Inverticulitis
Gastroenteritis
Mesentric adenitis
Strangulated hernia
Inflammatory bowel disease
Intussusception
Volvulus
TB
Case
History of Present Illness
A 26-year-old woman comes to the office because of a 3-day history of lower abdominal pain. She is 18 weeks pregnant by dates. The patient describes the pain as sharp, steady, and radiating across her lower abdomen bilaterally. Last night she developed new nausea and vomiting. She has not been able to keep down any food or drink this morning. She had a normal bowel movement yesterday. She says she felt cold and shivering this morning, followed by feeling warm; however, she did not check her temperature. She denies vaginal bleeding.
General: Patient feels generally weak and ill but was in her usual state of health until 3 days ago. She has gained approximately 5 lbs (2.3 kg) in the pregnancy so far.
Skin: She denies rash.
HEENT: Her mouth feels dry. No headache, nasal congestion, or sore throat.
Pulmonary: She denies cough or shortness of breath.
Cardiovascular: She denies chest pain or palpitations.
Gastrointestinal: She has had a decreased appetite for 1 day and has been unable to keep any food or drink down this morning due to nausea and vomiting. She has not had diarrhea or constipation.
Genitourinary: She reports a frequent urge to urinate and a sensation of incomplete bladder emptying for the past 3 days. No dysuria or hematuria. She is G1P0A0 and has been seeing an obstetrician for all routine visits and testing. No vaginal bleeding.
Musculoskeletal: She reports mild diffuse low back pain. No generalized muscle aches.
Neurologic: Noncontributory
Past Medical History
Medical history: Mild intermittent asthma diagnosed in childhood requiring only occasional rescue inhaler use, no hospitalizations for asthma. She is otherwise healthy.
Surgical history: Wisdom teeth removed at age 18.
Medications: Albuterol inhaler as needed, about once a month.
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1. The document describes two case presentations of pediatric patients seen in the emergency department with fever and abdominal pain.
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3. The second case involves a 14-year-old boy with 8 days of fever, 5 days of vomiting, and 3 days of right lower quadrant abdominal pain who undergoes an appendectomy for acute appendicitis and is later found to have Salmonella sepsis based on blood culture.
Newborn examination
Newborn screening involves a head-to-toe physical examination of a newborn to check for any abnormalities, as well as biochemical screening tests and special screenings to check for conditions like retinopathy of prematurity, hearing issues, and heart defects. The physical exam includes measurements, assessment of vital signs, and examination of features from head to toe to check growth and development. Biochemical screening checks for inborn errors of metabolism, while special screenings aim to identify conditions that require early intervention.
ABDOMINAL PAIN CASE HISTORY FOR DIAGNOSTIC SYNDROME SLIDESHARE
INTRODUCTION
Abdominal pain refers to discomfort that is felt between the chest and the groin.,which can be acute or chronic on presentation.
Categorised into 4 quadrant and 9 regions for analysis of underlying pathologies and their localization ,patient may also present with ;-Bloating, N/V, diarrhea or constipation, fever, visible swelling or tenderness.
It Can occur due to Gastrointestinal pathologies like peptic ulcer ,appendicitis, obstructions, cholecystitis etc or gynecologycal, vascular, peritoneal pathologies
EPIDEMIOLOGY
5 – 10% of all ED visits.
Among them, 14 – 40 % patients need surgical intervention
Most common diagnosis is Non specific
Males were more affected than females with male to female ratio of 1.14 : 1
Highest number of patients were in 15 – 24 years of life
Most common cause found to be acute appendicitis for acute abdomen in a range of 57.5 % of total admission.
CAUSES
Gastrointestinal
Gastrointestinal
Gastroduodenal
Peptic ulcer
Gastritis
Malignancy
Gastric volvulus
Intestinal
Appendicitis
Obstruction
Inverticulitis
Gastroenteritis
Mesentric adenitis
Strangulated hernia
Inflammatory bowel disease
Intussusception
Volvulus
TB
Case
History of Present Illness
A 26-year-old woman comes to the office because of a 3-day history of lower abdominal pain. She is 18 weeks pregnant by dates. The patient describes the pain as sharp, steady, and radiating across her lower abdomen bilaterally. Last night she developed new nausea and vomiting. She has not been able to keep down any food or drink this morning. She had a normal bowel movement yesterday. She says she felt cold and shivering this morning, followed by feeling warm; however, she did not check her temperature. She denies vaginal bleeding.
General: Patient feels generally weak and ill but was in her usual state of health until 3 days ago. She has gained approximately 5 lbs (2.3 kg) in the pregnancy so far.
Skin: She denies rash.
HEENT: Her mouth feels dry. No headache, nasal congestion, or sore throat.
Pulmonary: She denies cough or shortness of breath.
Cardiovascular: She denies chest pain or palpitations.
Gastrointestinal: She has had a decreased appetite for 1 day and has been unable to keep any food or drink down this morning due to nausea and vomiting. She has not had diarrhea or constipation.
Genitourinary: She reports a frequent urge to urinate and a sensation of incomplete bladder emptying for the past 3 days. No dysuria or hematuria. She is G1P0A0 and has been seeing an obstetrician for all routine visits and testing. No vaginal bleeding.
Musculoskeletal: She reports mild diffuse low back pain. No generalized muscle aches.
Neurologic: Noncontributory
Past Medical History
Medical history: Mild intermittent asthma diagnosed in childhood requiring only occasional rescue inhaler use, no hospitalizations for asthma. She is otherwise healthy.
Surgical history: Wisdom teeth removed at age 18.
Medications: Albuterol inhaler as needed, about once a month.
sacrococcygeal teratoma dr. shafikul islam.pptx
A 1-month old female infant presented with a large hanging swelling on her lower back since birth. On examination, the swelling was found to be a 15x13 cm globular mass overlying the sacrococcygeal region with tense, shiny skin. An ultrasound and MRI confirmed it was a large teratoma. Laboratory tests found elevated AFP levels. The provisional diagnosis was a Type 1 sacrococcygeal teratoma. The planned treatment was excision of the tumor along with the coccyx.
Genitourinary Examination.pptx
This document provides guidance on performing a genitourinary assessment for both males and females. It outlines the steps to inspect and palpate the kidneys, ureters, bladder, penis, testes, and female external genitalia and perform a speculum and bimanual pelvic exam. The goal is to obtain a medical history and perform a physical exam to diagnose issues like urinary tract infections.
Thyroid gland
The examination of the thyroid gland involves inspection to observe the size, shape, and movement of the gland, palpation to evaluate the texture, mobility, and presence of nodules, and synthesizing the findings from inspection and palpation to characterize the condition of the gland. Symptoms of thyroid disorders vary depending on whether the gland is underactive, overactive, or cancerous and include changes in heart rate, weight, mood, and appearance of the eyes and skin. The sex, age, occupation, and place of residence of the patient provide clues about their risk for developing different thyroid conditions.
Tracheoesophageal fistula
A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality.
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TEF is an abnormal connection between the trachea and the oesophagus
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2) Evaluating vital signs like blood pressure, heart rate, and respiratory rate and comparing arm and leg blood pressure.
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Hypospadias & epispadiasis
Hypospadias is a birth defect where the opening of the urethra is on the underside of the penis rather than at the tip. It is usually detected at birth and can be corrected with surgery. While it does not affect urination or development in infants, surgery is typically recommended to allow for normal urination and reproduction later in life. Risk factors may include family history or maternal age over 35, though the cause is often unknown. With successful treatment, most males can have normal urinary and reproductive functions.
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The document provides guidance on performing a detailed newborn examination, including assessing measurements, gestational age, skin appearance, neurological reflexes, and examining each body system such as head/neck, chest, heart, abdomen, genitals, extremities, and skeletal structure. Key steps are to record height, weight and head circumference, assess for prematurity using the Ballard score, and perform a full external and neurological exam.
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This document provides an overview of how to perform an abdominal examination. It discusses examining the abdomen by inspection, palpation, percussion and auscultation in a systematic manner. Key points covered include examining the abdomen in four quadrants, assessing for masses, tenderness, organomegaly and ascites. Common clinical tests discussed are Murphy's sign, McBurney's point and shifting dullness.
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Examination of newborn.
This document provides guidance on performing a newborn examination. It begins by classifying newborns by gestational age and birth weight. It then describes how to assess vital signs, growth measurements, and the different body systems. Key parts of the examination are classified including the skin, head, eyes, chest, heart, abdomen, genitals and nervous system. Important reflexes are outlined to assess neurological development. The document emphasizes the importance of estimating gestational age and recognizing normal and abnormal findings during the newborn examination.
Assesment of the newborn baby kuliah
This document provides guidelines for assessing newborns. It describes performing a comprehensive history and physical examination at birth and within 24 hours. The examination includes evaluating vital signs, appearance, gestational age, and screening for abnormalities of various body systems. The physical examination involves inspection, palpation, auscultation and measurement of things like temperature, heart rate, abdominal organs and limbs. The goals are to ensure healthy transition after birth, detect any malformations, and establish breastfeeding.
9 hernia
1. The document discusses different types of hernias, including inguinal, femoral, umbilical, incisional, and rare types.
2. It provides details on examining patients for hernias, such as observing for visible lumps, checking for cough impulse, and performing reducibility tests.
3. Key factors are described for differentiating between direct and indirect inguinal hernias, as well as differentiating inguinal from femoral hernias based on location and examination findings.
Newborn examination
This document provides guidance on performing a newborn examination. It discusses examining the baby's history, vital signs, appearance, major body systems and reflexes. The examination is conducted in a warm, well-lit room and includes assessing temperature, heart rate, respiratory rate, blood pressure, color, muscle tone, reflexes, measurements and a full physical exam from head to toe. The exam evaluates the skin, fontanelles, eyes, ears, heart, lungs, abdomen, genitals, limbs and neurological function through assessing tone and primitive reflexes. The goal is to identify any abnormalities and ensure healthy development.
一比一原版布里斯托大学毕业证(Bristol毕业证书)学历如何办理
补办文凭【微信号:176555708】【(Bristol毕业证书)】【微信号:176555708】《成绩单、外壳、offer、真实留信官方学历认证（永久存档/真实可查）》采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
【我们承诺采用的是学校原版纸张（纸质、底色、纹路）我们拥有全套进口原装设备，特殊工艺都是采用不同机器制作，仿真度基本可以达到100%，所有工艺效果都可提前给客户展示，不满意可以根据客户要求进行调整，直到满意为止！】
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份就读学校的毕业证【微信号:176555708】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信号:176555708】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
留信网服务项目：
1、留学生专业人才库服务（留信分析）
2、国（境）学习人员提供就业推荐信服务
3、留学人员区块链存储服务
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
选择实体注册公司办理，更放心，更安全！我们的承诺：客户在留信官方认证查询网站查询到认证通过结果后付款，不成功不收费！
PPT on Embryological and fetal development
Embryological development and fetal development
Factors influencing fetal development
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一比一原版布里斯托大学毕业证(Bristol毕业证书)学历如何办理
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"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
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Example of Market Research working
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Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
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4. Select Research Methodology and Tools
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Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
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Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
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Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
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Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
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Pemeriksaan Klinis Fisik pada Bedah Anak.pptx
- 2. PE in Pediatric Surgery ▣ Build an acquaintanceship ▣ Take complete history from both parents and child ▣ Don’t be influenced by “other stated diagnosis” ▣ Inquire detailed history of mother’s pregnancy and delivery (for younger children) 2
- 3. ‘’ ▣ Difference with adult : Use various trick Children: □ Enjoy being the center of attention □ Distractable □ Sometimes uncooperative 3
- 4. Appearance One must observe : Reaction 4
- 5. 1. Skin 5
- 6. Inspection of skin □ Hemangioma □ Pigmented spot on palm and mucous membrane ( peutz jeghers syndr.) □ Henoch schonlein’s purpura (with abdominal pain) □ Hyperaemia of abdominal skin (peritonitis) □ Decrease turgor Sign of dehidration 6
- 8. Head and Neck ▣ Head asymmetry : torticolis ▣ Bulging fontanelle: high intracranial pressure ▣ Low set ear : chromosomal defect ▣ Absence of iris : Wilms tumor ▣ Telecanthus,protruding tongue flat occiput : Down Syndrome ▣ Branchial cleft remnants ▣ Thyroid nodule 8
- 9. Lymph Nodes ▣ Small, discrete nontender, 3-5 mm at cervical, axillary, epitrochlear, inguinal and occipital are normal ▣ Until the age 12 yrs up to 1 cm still normal ▣ Abnormal : larger,isolated ,indurated,fixed or reddened. 9
- 10. 3. Thorax 10
- 11. Chest ▣ Breast enlargement in boys and girls a months or two after birth is normal This must not be biopsied !!! ▣ Rapid shallow resp : peritonitis or dehidration ▣ Look for : retraction,asymmetry, paradoxal movement , etc. ▣ Auscultation: look for any deviation from normal 11
- 12. 4. Abdomen 12
- 13. Abdomen Inspection: ▣ Abnormal venous pattern ▣ Umbilical drainage ▣ Distention vs Schaphoid ▣ Peristaltic waves ▣ Etc. 13
- 15. Abdomen ▣ Palpation “Is an art that requires patience and practice” □ Warm and gentle palpation □ Start palpate well away from suspected area □ Awaken from sleep when the sore spot is touched : little doubt about the finding □ No need for rebound tendernes test Suspected Intussusception: Banana and dance sign 15
- 16. Invagination = Intussusception ▣ Pseudokidney mass/ banana like mass ▣ Dance sign
- 17. Dance Sign
- 18. Abdomen ▣ Auscultation: □ Performed before palpation □ Total absence intestinal sound: peritonitis/gangrene □ Frequent high pitch sound : early obstruction infrequent low pitch : overdistended 18
- 19. 5. Inguinal 19
- 20. Inguinal and genitalia Look for ▣ Inguinal hernia, hidrocele or scrotal mass ▣ Absence testicle in the scrotum (UDT) ▣ Abnormality of genitalia 20
- 21. Inguinal / Scrotal Mass
- 22. Hernia Inguinalis Lateralis vs Hidrokel ▣ Gargling sound ▣ More Soft in palpation ▣ Bowel sound ▣ GS (-) ▣ More tension,cystic in palpation ▣ Transilumination
- 24. Look for : ▣ Skin tag : Anal fissure ▣ Mass, rectal prolapse, prolaps intussusception, or rectal polyp DRE ▣ 5TH finger or index finger ▣ Check for Sphincter tone, presacral tumors, fecal impaction 26
- 26. HIRSCHSPRUNG’S DISEASE •Temperature (+/-) •Dehidration(+/-) •Abd. Distention •Visible bowel contour/perist. •DRE: tight anal sphincter, explosive watery fecal matter
- 27. Peritonitis •Increasing Temperature •Hyperemia •Distension •Decreasing/negative bowel sound •Abdominal wall edema •Papable mass(+/-)
- 28. THANK YOU
Editor's Notes
- Observasi appearance dan reaksi psn sangat bermanfaat. Anak yg tersenyum selagi diperiksa abdomen sgt kecil kemungkinan menderita acut abd. Sebaliknya anak yg stoic dan mengaku tidk nyeri ttp sedikit mengernyit bisa menderirta peritonitis Cuci tangan sbl pemeriksaan bukan hanya mencegah inf nosokomial ttp jg menghangatkan tangan shg membuat nyaman si anak. Pd anak besar mgk bisa dilakukan pem head to toe, ttp pd anak yg lbh kecil dan tdk kooperatif hrs diambil kesempatan memeriksa daerah yang diperbolehkan si anak. Botol susu kdg2 dpt membuat si anak lebih kalem
- Torikolis – umur 1 bulan,benjolan di leher, otot sternocleidomastoideus Konsul ke ikfr
- Nothing is tobe gained by testing for rebound tendernes coz normal child will wince at a suddent change of pressure.
- So the child will be accustomed/terbiasa to a light touch Paralitik, muntah hijau, karena peritonitis
- Massa di inguinal : hernia Hidrokel : lebioh bulat, lebih tense
- Anus robek : jam 12, skin tage, anal fissure yg sembuh, scar saja
- Omphalocele : umbilicus , puncak Gasto : seblah kanan umbilikusnya