Concluded Case

Abdominal Distension with tenderness/Peritonitis with abdominal koch

PBC 20082020 3.5 yr old male 12 kg arrived with c/o distended abdomen with irritability with fever,,, O/E I°P°Ln°Cy°Cl° P/A distended with garding ,,stool greeninsh with mucus Urine passed SpO2 99% off O2 PR 150 bpm RR 40 BPM Neck rigidity mild (no h/o seizure alterd sensorium ect) Temp 101 degree No family h/o active or after treatment TB patients Inj Xone,Oflox,metro,with prebiotics and zinc and multivitamin are going on Inj lasix SOS,,neotonic anema SOS My ddx AGE/abdominal koch/meningitis 1.Does Abdominal distension with guarding assosiated with neck rigidity? 2.Kindly add your valuable opinion

(Edited)

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Advised to continue the treatment but attendent refused to it so pt was DAMA

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Is there altered sensorium. Howzz the gcs. Its hard to elicit neck rigidity in children. This case seems to b a case of emerging peritonitis. Can think of tuberculosis if theres any contact history. Cbc crp serum electrolytes. Keep npo upgrade antibiotics to inj piperacillin inj Mikacin n inj metrogyl iv fluids.

No alterd sensorium,,V4E4M6 GCS,,
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Can be a case of acute liver failure or peritonitis / sepsis, which can cause irritability and neck rigidity indirectly

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How was the onset? If acute, then more likely typhoid with peritonitis. Weight of child doesn't point towards chronic illness like TB. Lymphadenopathy on CT is not significant, dont get fooled by the report. Check LFT, Blood count, typhoid antigen, malaria parasite, kft, electrolytes, CRP, Blood culture. Stop inj lasix. Keep Nil by mouth, put NG tube in on free drainage. Continue Ceftriaxone, metronidazole- if more than 48 hours without improvement then consider upgrade. Check blood pressure, pulses, child needs fluid boluses and maybe inotropes as Pulse rate is high- maybe due to shock like state. Chest and abdominal xrays. Monitor in ICU. Needs surgical review if increasing distension, bilious vomiting or aspirates, xray with free gas under diaphragm. Please keep us all updated.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

? Peritonitis ? Abd tuberculosis Upgrade antibiotics to meropenam+ Amika, NPO, IV FLUIDS

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Advised to continue the treatment but attendent refused to it so pt was DAMA

Kochs abfomen

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Koch,s

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