Concluded Case

SEVERE ABDOMINAL PAIN

A 4 years old boy, complaining č severe pain abdo. with continuing vomiting. Rectal bleeding č fever č xerostomia. O/E Temperature 103° Pulse 110 bpm R/R 28 bpm Spo2 84% Chest B/L clear

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Concluded answer

Child having high temperature pain abdomen vomiting, bleeding rectal with severe dehydration USG reveal no significant finding It seem from the clinical picture the child is having some infection leading to septicaemic shock with tachycardia tachypnoea with low O2saturation. May be due to A. Haemohhhagic gengue or malaria or typhoid B. Intussception C Meckel's diverticulitis Blood examination to see features related to dengue particularly platelet count, and other coagulation factor CT abdomen may be helpful .

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IT'S A..CASE OF.. ? INTESTINAL PATHOLOGY.. ? MESENTERIC LYMPHADENITIS.. ? IBS.. ? ENTERITIS.. NEED'S.. * CTCE STUDY.. * COLONOSCOPY..

Tnx Dr Shivraj Agarwal sir
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Mesentric lymphadenitis R/o Abdominal tuberculosis Ad CBNAAT Endoscopic guided FNAC lymphnode of mesentric

Fever, abdominal pain , vomiting, rectal bleeding, low SpO2 , mesenteric adinitis, ascitis . Suggest CBC and dengue profile to rule out dengue DD Severe systemic sepsis Blood culture sigmoidoscopy, CT abdomen

Thank you, Doctor
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Sonography has not contributed significantly in this case However, Tachycardia, tachypnoea, fall in Saturation suggest a severe metabolic derangement High grade fever indicate infection Kindly do testing for malaria, Dengue, typhoid and leptospirosis check CRP, Procalcitonin, liver function test, renal function test and coagulation parameters in view of bleeding PR CT abdomen and pelvis may help in further diagnosis CT

Mesentric Lymphadenitis???? Rule out the cause: Tuberculosis & Malingnacy

Treat it as a case of dysentary . U have ruled out intussuception by doing usg already. Common cuses shigella salmonella campylobacter jejuni enterohemorrhagic e.coli . Do serum electrolytes cbc crp . Treat with iv fluids preferabely ringer lactate inj ceftriaxone at a dose of 75 mg /kg/day inj levofloxacin inj metrogyl inj ondasetron inj ranitidine inj diclofenac.

Role of levofloxacin ?
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Nonspecific mesenteric lymphadenopathy H/o bleeding p/a and hypoxic as spo2 is 84% with tachycardia D/d 1 malignancy r/o leukemia 2 koch's abdomen

Thanx dr Kute Ankush
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Mesenteric Lymphadenitis How will you take FNAC sample?

INJ. XONE 250MG ING. MIKACIN 100 10MG INF. METROGYL INJ. DILONA NILL ORALLY

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