Posted On :
27 May 2017
A 8year old male child born of a consanguineous marriage of degree 2nd without significant past history presented with fever since 1 and ½ to 2 months,Yellowish discoloration of eyes since 1 months,Pain in the abdomen since 10 -15 days.Oedema of feet since 7 days,No h, o altered sensorium, No h, o haematemesis.,No h, o bleeding per rectum,No h, o contact with jaundice person,No h, o Tuberculosis or contact with Tuberculosis person,No h, o blood transfusion in the past,No h, o chronic intake of medication.
On examination-Child is conscious, well oriented, having icteric look, oedema of feet.
Vitals- stable,Temperature-99.8 degree F.BP- 110, 58mmHg.
Systemic examination-
PA Examination- Abdomen distended, umbilicus transversely stretched, fullness of flank.no dilated vein.
Hepatomegaly- rt lobe about 4cm ,left lobe about 6cm,Tender, firm in consistency, surface is smooth, no nodularity detected, Liver span- 13 cm.Splenomegaly- about 6 cm, tender,Free fluid in the abdomen is present.
RS examination-Air entery bilaterally equal , clear, no foreighn sound heard.
CVS examination-Both S1 and S2 heard , systolic murmer heard over the mitral area, grade III, not radiating to back or axillary area.
CNS examination- NO Singns of focal neurological deficit.
Investigations in the past
CBC{24, 03, 10}- Hb- 9.3gm percent, Total WBC- 10,100 cells, Cumm, N-63.1, percent L-29.7 percent, Platelets- 3.02L, Cumm.
Malarial parasite{24, 03, 10}- Negative. SGPT{ 24, 03, 10}- 343 IU, L. Urine routine- normal.Brucella tube method {17, 95, 10}- Negative. Serum CERULOPLASMIN {26, 03, 10}- 0.27 { Reference range- 0.25- 0.46}.USG Abdomen {24, 03, 10}- hepatosplenomegaly with focal lesion.No evidence of portal hypertension
Recent Investigations-
CBC- {2, 06, 10} Hb- 7.9gm percent, Total WBC- 5,800 cells, Cumm, N-56.8, percent L-38.7.0 percent, Platelets- 2.02L, Cumm.
HBsAG { 2, 06, 10}- Negative.Serum Bilirubin-{2, 06, 10}-Total Bilirubin- 3.7mg percent.Direct-1.5mg percent.Indirect- 2.2mg percent.SGPT {2, 06, 10}- 255 IU, L.HIV TEST- negative.ESR {2, 06, 10}- 40 mm.WIDAL Tube method- negative.USG abdomen { 7, 06, 10}-Hepatosplenomegaly, ascites plus, no evidence of portal hypertension.
2D ECHO- Dilated cardiac chambers, Coronary origination not confirmed.
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