acute gastroenteritis, case presentation < sabrina >

SABRINA TAMILMANY012011100237

• 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)

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.

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.

• 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.

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.

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.

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.

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.

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.

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.

• 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.

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.

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

• 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 )

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.

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.

AZLINAH BINTI MOHAMED IQBAL012011100190

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.

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

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.

- 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

- Skin light pinkish color tone no rashes no pigmentation

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)

Anthropometry

Weight : 20 kg

Length : 119 cm

BMI : 14.1 kg/m²

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

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)

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

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.

C.K.SURENTHIRAN012010090079

POINTS FAVOURING

1. Vomiting

2. Diarrhea

3. Fever

4. Fatigue

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

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

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

ABISHAG A/P KALI012011100113

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

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

MATHILASHINI RETNAM

012011100178

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

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

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

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.

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 

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

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079/

http://www.freemd.com/gastroenteritis

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