Dr. KANTA HALDERResident (MD;Phase A),

General Pediatrics;BICH.

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.

Chief Complaints

Fever for 7 days.

Yellow coloration of skin, sclera and urine for 5 days.

Abdominal pain for same duration.

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.

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.

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.

Developmental History

Age appropriate.

Immunization History

She is immunized as per EPI schedule..

Feeding History

She is on family diet.

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.

General Examination

Appearance: Conscious.

Anaemia: Mild.

Jaundice: Mild.

Cyanosis:

Clubbing: Absent

Dehydration:

Edema:

Cont..

Ear:

Nose: Normal

Throat:

Skin: BCG mark present. No other skin manifestation.

Lymphnode: Not palpable.

Cont..

Vital Signs:

Pulse: 88/min.

Respiratory Rate: 20/min.

Temperature: 99°F.

Blood pressure: 90/60 mmHg.

Anthropometry:

Cont..

Weight: 25 kg.

Height: 130 cm.

BMI: - 1.6 (normal).

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.

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.

Cont.. Nervous system:

• Higher psychic function: Normal.

• Cranial nerves: Intact.

• Motor function: Normal.

• Sensory function: Normal.

• Gait: Normal.

Other Systemic examination:

No abnormality.

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.

Salient features (cont..)

There is tender hepatomegaly without ascites. Other systemic examination reveals normal finding.

Provisional Diagnosis

Acute viral hepatitis (Hepatitis A).

Differential Diagnosis

Acute viral hepatitis (Hepatitis E).

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%

Cont..

o RBC: Normocytic normochromic.

o WBC: Mature with above distribution.

o Platelet: Adequate.

• Platelet: 275,000/mm3.

• PBF:

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.

Final Diagnosis

Acute viral hepatitis (Hepatitis A).

Management

Counseling.

Supportive treatment:

• Bed rest.

• IV fluid.

• Antipyretics.

• Multivitamin Syrup.

• Syrup Ranitidine.

• Syrup lactulose.

Follow up.

Thank You