7 year male child come to opd today with . c/o -Pain in abdomen at periumbilical region, -Fever -Nause - Vomiting. . O/e Tender abdomen, Dehydrated. . USG report attached , please guide next.

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A case of viral hepatitis with secondary paralytic ileus or adynamic obstruction. Or non obstructive intestinal obstruction. Viral hepatitis can present like this Get an X- ray abdomen standing A CBC, L.FT , HBsAg, hepatitis C , S.Electrolytes as associated hypokaemia can present like this. Start N.PO RT aspiration IV fluids and correction of dehydration and electrolytes with R.L Parenteral antibiotics preferably cetriaxone as it is not hepatotoxic Addition of 10 % Dextrose, MVI and vitamin. K is advisable. Once bilirubin level comes down A CECT abdomen may be desirable if obstruction is not relieved

Since the USG suggests liver parenchymal involvement. Adv. CBC, LFT , URINE FOR ROUTINE AND MICROSCOPIC EXAM., X-RAY OF ABDOMEN IN ERECT POSTURE, ESR, CRP AND TREAT ACCORDINGLY DEPENDING ON REPORTS. Meanwhile hospitalise the pt. Start higher parenteral antibiotics Rehydration. Close watch on vitals.

X Ray abdomen erect and supine. Counts, LFT Hydrate the Patient Antibiotics Ryles tube Aspiration Possibility of Meckel's diverticulitis Acute Appendicitis Food bolus obstruction SEPSIS

As per USG report it is cirrhosis with Intestinal obstruction... Better to do CECT abdomen...

Any viral hepatitis can cause such presentation with acute abdomen like presentation .if u clinically suspecting abd obstruction then refer to surgeon .but I think it is paralytic ileus

Given the symptoms and USG report, you should go for CECT abdomen to find the exact problem. Blood inv.and conservative approch, as outlined above should be started without delay. Once CT clinches the Dx, further management accordingly. Patient is 7 yr.old, so avoiding any risk is important

Appears to be a case of either acute appendicitis or Meckels diverticulitis. X-ray abdomen errect, LFT, electrolytes to be investigated. He may need exploration

Clinical decision........1. Viral hepatitis 2.Ileus 3.in v/o persistent vomiting r/o hypokalemia.

Its a case of viral hepatitis.

First keep nbm.put Rt.give iv fluids.give isolate.p,iv kesol