12 years female protruding abdomen pallor clubbing malnourished history of motion after every intake , chronic case , typically? ESR Mildly raised USG abdomen non specific mesentric lymphadenitis , cervical lymphadenopathy present , manteoux negative , chest x ray NAD , Investigation and diagnosis

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Plz r/o IBD Like Ulcerative colitis nd Crohn's disease Cirrhosis of liver Stool examination & LFT Lowe GI endoscopy & biopsy

Very correct coeliac disease suspect reports await
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CERVICAL LYMPHADENOPATHY + CERVICAL LYMPH NODE FOR EXCISION BIOPSY. MALNUTRITION, CLUBBING & PALLOR, MESENTERIC LYMPHADENOPATHY, STILL CAN BE POSSIBILITY OF ABDOMINAL KOCH'S. ONCE KOCH'S HAS BEEN RULED OUT, THEN ONE CAN THINK OF OTHER D/D.

Workup details required- CBC with PBF, LFT, RFT, thyroid profile... FNAC of cervical LN. Cardiac evaluation, anthropometry. Facies looks like bit hemolytic..

PBF microcytic hypochromic anaemia, TSH normal hypoproteinaemia , urea creat normal FNAC report awaiting TBferron and TTG IG A level awaited, Hb electrophoresis iron deff anaemia Hb A decreased others normal
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This girl pt. Needs to be admitted In hospital and investigated go in the history, past investigation take help of seniors. Start with food allergy,could be caeliac disease . Stool for worms. Biopsy for Whipple's disease.ulcerative collitis, Irritable bowel syndrome.

Rule out Lymphoma also...Do colonoscopy and lymph node biopsy for confirmation...

One of the easily accessed lymphnode biopsy. If Tb. Is thought examine other relatives. Us scan abd. Peripheral blood smear for cells.

R/o malabsorption disorder And crohns disease

Cervical LN+ Mesentric LN + ^ESR Protruding abdomen Suspect TB Start anti -TB drugs for 2 months with 4 drugs and watch and follow up response Then later start 2 drug for 4 months

Cealicdiease

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