acute gastroenteritis, case presentation < sabrina >
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SABRINA TAMILMANY012011100237
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• NAME : JACKSON TEA JIA SHENG
• AGE : 6 YEARS 4 MONTHS
• GENDER : MALE
• RACE : CHINESE
• ADDRESS : SETIA ALAM
• DATE OF ADMISSIO : 17TH MARCH 2014 @ 12 AM
• DATE OF CLERKING : 18TH MARCH 2014
• INFORMER : MOTHER (RELIABLE & ADEQUATE)
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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.
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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.
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• 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.
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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.
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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.
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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.
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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.
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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.
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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.
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• 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.
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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.
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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
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• 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.
36363636 3232
8 years old8 years old( schooling )( schooling )
7 years old7 years old( schooling )( schooling )
5 years old5 years old( schooling )( schooling )
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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.
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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.
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AZLINAH BINTI MOHAMED IQBAL012011100190
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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.
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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
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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.
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- 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
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- Skin light pinkish color tone no rashes no pigmentation
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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)
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Anthropometry
Weight : 20 kg
Length : 119 cm
BMI : 14.1 kg/m²
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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
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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)
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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
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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.
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C.K.SURENTHIRAN012010090079
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POINTS FAVOURING
1. Vomiting
2. Diarrhea
3. Fever
4. Fatigue
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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
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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
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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
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ABISHAG A/P KALI012011100113
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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
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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
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MATHILASHINI RETNAM
012011100178
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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:DiabetesOrgan transplantChemotherapyAIDS
Living around poor sanitation
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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 producingE coli Salmonella typhi and S
paratyphi Vibrio cholerae
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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
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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.
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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
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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
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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
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079/
http://www.freemd.com/gastroenteritis
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THANK YOU