Clinical meeting Paediatrics

1. Dr. KANTA HALDER
Resident (MD;Phase A),
General Pediatrics;
BICH.

2. Particulars of the patient
 Name: Neha.
 Age: 10 years.
 Sex: Female.
 Address: Shewrapara, Dhaka.
 Date of Admission: 09.10.2016.
 Date of Examination: 10.10.2016.

4. Chief Complaints
 Fever for 7 days.
 Yellow coloration of skin, sclera and
urine for 5 days.
 Abdominal pain for same duration.

5. History of present illness
According to the statement of the mother the
child was well 7 days back. Then she developed
fever which was low grade, intermittent in
nature, associated with anorexia, nausea and
occasional vomiting and subsided after taking
antipyretics. She also developed yellow
coloration of skin, sclera and urine for last 5
days. She also developed abdominal pain which
was not associated with feeding or bowel habit.

6. Cont..
On query, mother stated that her child used to
eat street food. She has no H/O previous
jaundice, blood transfusion or taking any
offending drugs or no family H/O of such type
of illness. With these complains they consulted
a local doctor who advised some investigations
and referred the child to Dhaka Shishu Hospital
for further evaluation & better management.

7. History of Past illness
She had no significant past illness.
Birth History
She was delivered normally at term with
average birth weight without any
perinatal complication.

8. Developmental History
Age appropriate.
Immunization History
She is immunized as per EPI schedule..
Feeding History
She is on family diet.

9. Family History
She is the 1st issue of her non-consanguineous
parents. There is no family H/O such type of
illness.
Socio-economic History
She belongs to a middle class family. They
live in 4 storied building and drink boiled
water.

10. General Examination
 Appearance: Conscious.
 Anaemia: Mild.
 Jaundice: Mild.
 Cyanosis:
 Clubbing: Absent
 Dehydration:
 Edema:

11. Cont..
Ear:
Nose: Normal
Throat:
Skin: BCG mark present. No other skin
manifestation.
Lymphnode: Not palpable.

12. Cont..
Vital Signs:
Pulse: 88/min.
Respiratory Rate: 20/min.
Temperature: 99°F.
 Blood pressure: 90/60 mmHg.

13. Anthropometry:
Cont..
Weight: 25 kg.
Height: 130 cm.
BMI: - 1.6 (normal).

14. Systemic Examination
 Alimentary System:
 Mouth and Oral Cavity: Normal
 Abdomen:
Inspection: Shape of the abdomen is normal,
flanks are not full, umbillicus is centraly
placed and inverted.

15. Palpation:
• Tenderness present over right hypochondriac
region.
• Liver is palpable, 3 cm from right costal margin
along right mid clavicular line which is tender,
surface is smooth, regular border. Upper
border of liver dullnes is present at right 5th
intercoastal space.
• Spleen: Not palpable.
• Fluid thill: Absent.
Percussion: Shifting dullness absent.
Auscultation: Bowel sound present.

16. Cont..
 Nervous system:
• Higher psychic function: Normal.
• Cranial nerves: Intact.
• Motor function: Normal.
• Sensory function: Normal.
• Gait: Normal.
Other Systemic examination:
No abnormality.

17. Salient features
Neha, 10 years old immunized girl admitted
with low grade intermittent fever associated
with anorexia, nausea and occasional vomiting
for 7 days, jaundice and abdominal pain for 5
days. She has history of taking street food. She
had no history of previous jaundice, blood
transfusion or taking any offending drugs or
such type of illness in her family. She is
conscious, afebrile, mildly pale, mildly icteric.
Her vitals are within normal limit.

18. Salient features (cont..)
There is tender hepatomegaly without
ascites. Other systemic examination reveals
normal finding.

19. Provisional Diagnosis
Acute viral hepatitis (Hepatitis A).

20. Differential Diagnosis
Acute viral hepatitis (Hepatitis E).

21. Investigations
Complete Blood Count :
• Hb: 12.7 gm/dl.
• WBC: Total count: 8,200/mm3.
Differential count:
o Neutrophil: 65%
o Lymphocyte: 30%
o Monocyte: 02%
o Eosinophil: 03%
o Basophil: 00%

22. Cont..
o RBC: Normocytic normochromic.
o WBC: Mature with above
distribution.
o Platelet: Adequate.
• Platelet: 275,000/mm3.
• PBF:

23. Cont..
 S. bilirubin:
Total: 9.71 mg/dL.
Direct: 4.01 mg/dL.
Indirect: 5.70 mg/dL.
 SGPT: 2262 U/L.
 Prothrombin time: 12 sec.
 S. albumin: 31.0 gm/L.
 Anti HAV IgM: Positive.

24. Final Diagnosis
Acute viral hepatitis (Hepatitis A).

25. Management
 Counseling.
 Supportive treatment:
• Bed rest.
• IV fluid.
• Antipyretics.
• Multivitamin Syrup.
• Syrup Ranitidine.
• Syrup lactulose.
 Follow up.

26. Thank You