education purposes

1. EDEN UNIVERSITY
PEADIATRICS SEMINAR

2. DEMOGRAPHICS
● E.N
● MALE
● 9YRS
● CHRISTIAN
● GARDEN HOUSE
● GRADE FOUR PUPIL AT BETHLEHEM
● DOA 22/01/25
● DOC 23/01/25
● MOTHER A.M

3. PRESENTING COMPAINT
● 4/7 ABDOMINAL PAIN
● 4/7 VOMITING
● 4/7 BODY HOTNESS

4. HISTORY OF PRESENTING COMPLIANT
● PATIENT WAS IN HIS USUAL STATE OF HEALTH UNTIL 4/7 AGO WHEN HE
STARTED EXPERIENCING SUDDEN SEVERE SHARP ABDOMINAL PAIN THAT
WAS PERSISTANT AND NON RADIADING. PAIN WOULD BE RELIEVED BY
BEING IN A CURLED POSITION.THERE WERE NO AGGREVATING THINGS
NOTED. H/O DARK STOOL.
● YELLOW VOMITUS FOR THE PAST 4/7 (2-3 TIMES/DAY ,NOT ASSOCIATED
WITH FOOD INTAKE),NON FORCEFUL ASSOCIATED WITH LOSS OF
APPETITE.
● THE CHILD ALSO DEVELOPED YELLOWING OF EYES , PALMS AND FEET.
NOT ASSOCIATED WITH ITCHINESS.

5. RESPIRATORY SYSTEM
● NO DYSPNEA
● NO COUGH
● NO WHEEZING
MUSCULOSKELETAL
● NO JOINT SWELLING
● NO JOINT PAIN
● NO RASHES
● GENERALIZED BODY WEAKNESS

6. HISTORY PRESENTING COMPLAINT CONT.
● ELEVATING HIGH GRADE FEVERS (RELIEVED BY TEPID SPONGING)
AND FRONTAL HEADACHE WITH SUDDEN ONSET WHICH WAS
THROBBING, NON RADIATING, USUALLY OCCURING IN THE EVENING.
NO CONVULSIONS , LOSS OF CONCIOUSNESS ,BLURRED VISION OR
DIZZINESS
● H/O PASSING DARK URINE (NON FOUL SMELLING WITH NO BLOOD OR
PAIN WHEN PASSING). SLIGHT WEIGHT LOSS WAS NOTED BY THE
MOTHER

7. REVIEW OF SYSTEMS
CARDIOVASCULAR
● PALPITATIONS +
● CHEST PAIN -
● DYSPNEA-
● PEDAL EDEMA OR ANKLE SWELLING-
● NO COLDNESS OF FEET

8. BIRTH HISTORY
● PREGNANCY DIAGNOSIS MADE BY GRAVINDEX TEST
● SHE ATTENDED ALL 8 ANTENATAL VISITS , WAS GIVEN FOLIC ACID IN
FIRST THREE MONTHS OF PREGNANCY , FANCIDA 3 TIMES AND
DEWORMING MEDICATION IN FOLLOWING MONTHS
● SHE IS RVD [NR] ,MOTHER STATES SHE NEVER HAD ANY UTI’S , SHE
WAS HYPERTENSIVE DURING HER PREGNANCY, SHE DELIVERED
THROUGH SPONTANEOUS VAGINAL DELIVERY AT NINE MONTHS WITH
NO COMPLICATIONS
● SHE WAS IN HOSPITAL POST DELIVERY JUST FOR A DAY

9. BIRTH HISTORY CONT
● CHILD HAD A BIRTH WEIGHT OF 3.8KG
● CRIED IMMEDIATELY AFTER BIRTH

10. IMMUNIZATION
● CHILD RECEIVED ALL VACCINATIONS
NUTRITION
● CHILD HAS AT LEAST FOUR MEALS A DAY
● BREAKFAST (PORRIGE WITH PEANUT OR BREAD WITH TEA)
● BREAD AND EGGS/POLONY (AT SCHOOL)
● LUNCH (POTATOES/PASTA WITH MINCE AND MIXED VEGTABLES)
● DINNER (NSHIMA WITH MEAT AND VEGTABLES)

11. DEVELOPMENTAL MILESTONES
● GROSS MOTOR- SITTING AT 4 MONTH, CRAWLING AT 6 MONTHS,
WALKING AT 9 MONTHS
● FINE MOTOR – MOTHER CAN NOT REMEMBER
● SOCIAL/COGNITIVE – SMILING AT 2 MONTHS, RECOGNIZING FACES AT
4 MONTHS, CHILD RELATES WELL WITH PEERS.

12. MEDICAL , SURGICAL AND DRUG HISTORY
● PATIENT HAS BEEN IN AND OUT OF THE HOSPITAL FOR 3/12 DUE TO
ABDOMINAL PAIN , FEVER ,HEADACHES AND GENERALISED BODY
WEAKNESS , DIARRHOEA AND CONSTIPATION
● WAS TREATED FOR MALARIA 4/52 BUT SYMPTOMS NEVER RESOLVED
(FROM LOCAL CLINIC WITHOUT TESTS)
● HAS NO HISTORY OF DIABETES , EPILEPSY , ASTHMA, TUBERCULOSIS ,
HYPERTENTION AND SICKLE CELL
● HAS NO HISTORY OF SURGERY
● HAS BEEN RECEIVING PARACETAMOL, IBRUFEN, METRONIDAZOLE
● WAS NOT GIVEN ANY HERBAL MEDICATIONS
● HAS NO KNOWN ALLEGIES TO FOOD OR MEDICATION

13. FAMILY HISTORY
● FAMILY HAS NO HISTORY OF DIABETIS , EPILEPSY ,
ASTHMA,TUBERCULOSIS AND SICKLE CELL
● MATERNAL GRANDMOTHER HYPERTENSIVE
● NO HISTORY OF SIMILAR ILLNESS IN PARENTS AND SIBLINGS

14. SOCIAL HISTORY
● 4TH
CHILD OUT OF 5
● THERE ARE 7 RESIDENCE IN THEIR 8 ROOMED HOUSE WITH
5BEDROOMS , WITH LARGE WINDOWS , TWO FLASHABLE TOILETS
AND BOREHOLE WATER
● THEY DRINK MINERAL WATER
● FATHER IS A TRUCK DRIVER (CROSS BOARDER)
● MOTHER RUNS A POUTRY AT THE SAME RESIDENTIAL ADDRESS
● CHILD HAS NO H/O TRAVEL

15. SUMMARY
E.N , MALE 9 YEARS OF GARDEN HOUSE, PRESENTED WITH 4/7 SEVERE
ABDOMINAL PAIN , VOMITING , PERSISTANT FEVER , FRONTAL HEADACHE,
JAUNDICE WITH LOSS OF APPETITE ..PT HAD DARK URINE AND STOOL.
HOWEVER PT HAD NO CONVULSIONS, NO NAUSEA OR DIARRHEA, NO
PRURITIS.

16. IMPRESSION AND DIFFERENTIALS
IMP: ENTERIC FEVER
DIFFERENTIALS:
● CHOLECYSTISIS
● S. MALARIA
● YELLOW FEVER

17. EXAMINATION
● AFTER OBTAINING CONSENT
● WE EXAMINED STANDING AT THE FOOT END OF THE BED A MALE
CHILD LAYING IN SUPINE
● PATIENT WAS ILL LOOKING BUT ALERT AND NOT IN OBVIOUS
RESPIRATORY DISTRESS
● PT WAS CANNULATED ON THE RIGHT HAND BUT NO RUNNING FLUIDS
OR DRUGS
● NO MEDICAL ADJUNCTS ATTACHED TO PATIENT
● PATIENT HAD SCLERAL JAUNDICE

18. STANDING AT RIGHT SIDE OF THE BED
● PATIENT NO HAD KOILONYCHIA
● NO LEUKONYCHIA
● NO FINGER CLUBBING
● NO PERIFERAL CYANOSIS
● NO PALMA ERYTHEMA
● PATIENTS PALMS WERE WARM TO TOUCH
● CAPILLARY REFILL TIME WAS LESS THAN 2SEC

19. VITALS
● BP 92/70MMHG (97/57-115/76)
● RES 30BPM (18-25)
● PULSE 110BPM (75-118)
● O2 SAT. 95% ON ROOM AIR
● TEMP: 37.1C (TEMPORAL)
● RBS: 5.4MMOL

20. HEAD
● HAIR COLOR WAS NORMAL AND EVENLY DISTRIBUTED
● SCLERAL JAUNDICE
● NO CONJUCTIVAL PALLOR
● NO NASAL FLARRING OR POLYPS
● NO CENTRAL CYANOSIS
● NO SIGNS OF ORAL THRASH
● NO EAR DISCHARGE

21. NECK
● NO VISIBLE MASSES
● NO JUGULAR VEIN DISTENTION
● NO NECK STIFFNESS
● NO PALPABLE CERVICAL,MANDIBULAR NOR SUPRACLAVICULAR LYMP
NODES
RESPIRATORY
● NO SURGICAL SCARS OR TRADITION TATOOS
● NORMAL SHAPE AND SYMETRY
● SYMETRICAL CHEST MOVEMENTS
● CENTRAL TRACHEA
● NORMAL AIR ENTRY, NO ADDED SOUNDS

22. CVS
● NO PRECORDIAL SCARS
● APEX BEAT IN THE 5TH
IC,MIDCLAV. LINE
● REGULAR HEART SOUNDS, NO ADDED SOUNDS
ABDOMEN
● NO SURGICAL SCARS
● UMBILICUS WAS CENTRAL AND INVERTED
● NO CAPUT MEDUSA OR SPIDER NIVEA
● MOVING WITH RESP.
● NO DISTENTION

23. CONT…
● NO PALPABLE MASS AND SKIN WAS WARM TO TOUCH
● POSITIVE MURPHY SIGN
● ABDOMINAL TENDERNESS IN RUQ
● NO ORGANOMEGALLY
● BOWEL SOUNDS 6 IN ONE MIN

24. SUMMARY
E.N MIDDLE CHILDHOOD MALE , EXAMINED LYING IN SUPINE,ON GENERAL
INSPECTION HE WAS ILL LOOKING AND JAUNDICED, NOT IN R.D. NO
ABDOMINAL DISTENTION, CAPUT MEDUSA,SPIDER NIVEA OR PETECHIA.
ON PALPATION, THERE WAS TENDERNESS IN RUQ. POSITIVE MURPHYS
SIGN. HOWEVER THERE WAS NO REBOUND TENDERNESS OR
ORGANOMEGALLY.
ON AUSCULTAION BOWEL SOUNDS WERE HEARD : 6/MIN

25. ● IMPRESSION:CHOLECYSTITIS
DIFFERENTIALS:
● ENTERIC FEVER
● CHOLELITHIASIS
● S. MALARIA
● MIRIZZI SYNDROME

26. INVESTIGATIONS
LABS
● FBC
● RDT/MPS (-VE)
● HEP B S Ag TEST (-VE)
● NOT DONE (widal test,bone marrow culture, blood culture, LFT,KFT)
IMAGING
● ABD U/S SCAN
● NOT DONE (CT SCAN, ERCP)
● CHEST X RAY

30. ● DIAGNOSIS – ACUTE ACALCULOUS CHOLECYSTITIS

31. TREATMENT
● PATIENT WAS PLACED ON
CIPROFLOXACIN 500MG BD IV
METRONIDAZOLE 500MG TDS IV
PARACETAMOL 500MG QID PO
IVF N/S 1.5L IN 24HRS

32. THANK YOU
THE END