Gen med case( 14 yr old boy)

           GENERAL MEDICINE 

12/11/22

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DATE OF ADMISSION : 9/11/22

A 14 year old boy ,  came to casuality with  chief complaints of

CHIEF COMPLAINTS : pain in the abdomen and noticed a swelling in the left side of the abdomen since the past 15- 16 days

HISTORY OF PRESENTING ILLNESS : 

Patient was apparently asymptomatic till 9 years of age , on August, 2016 -  his parents noticed neck swelling and he had difficulty in swallowing then they took him to ENT doctor ,later referred to endocrinologist ,where he was diagnosed with hyperthyroidism. USG showed diffuse enlargement of both lobes of thyroid gland . FNAC was done showing features suggestive of hyper plastic goitre. 

At 12 years of age patient had chicken pox ,resolved over 10 days.

Around late part of December 2021

He gave history of yellowish discoloration of eyes, One episode of bilious vomiting. yellow coloured urine, He was treated by a pediatrician for jaundice but as the bilirubin was on increasing trend he was referred to our hospital in the first week of January with the history of above said complaints of 7-10 days

PAST HISTORY 

▪︎Not a known case of Asthma , TB, epilepsy , type 1 diabetes 

PERSONAL HISTORY : 

Diet : mixed 

Appetite: normal 

Sleep: adequate 

Bowel and bladder movements : H/O 4 episodes of loose stools on 10/11/22

FAMILY HISTORY :

He is a 4th order child ,born out of grade 4 consanguinous marriage, He has 2 elder brothers and one elder sister - who expired at 5 years of age, His sister was the first child and she was assymoptomatic till 2 years of age ,then she had shortness of breath and was rushed to hospital,where here condition detiorated and got admitted .They were told that she had splenomegaly and Her blood counts were decreasing .She was given multiple blood transfusions every 25 days for one year inspite of that she remained anemic ,she also underwent bone marrow biopsy twice . According to parents she was given steriods also for one year before death .she never had jaundice or recurrent infections.

Elder brother is 19 year old and second brother is -16 years old . Second one had history of fever ,white coloured loose stools at the age of 5 years ,for which they went to near by hospital .He was given some medications and it got resolved .But he was said to have anemia ,and he recovered according to parents with some medications.There was no jaundice and no history of blood transfusion.

GENERAL EXAMINATION 

On Examination, the patient is conscious, coherent and cooperative 

▪︎Moderate built and nourishment

▪︎No signs of pallor, icterus ,cyanosis, clubbing, koilonychia, lymphadenopathy, edema of feet

VITAL SIGNS 

•BP :110/70 mmhg 

•Pulse:82 beats per min

•Respiratory rate:16 cycles per min 

. Temperature: 97.4F 

SYSTEMIC EXAMINATION 

CVS:

Cardiac sounds S1,S2 heard 

No Cardiac murmurs

 

RESPIRATORY SYSTEM :

No dyspnoea, wheezing 

Position of trachea-central

NVBS present 

PER ABDOMEN :

INSPECTION 

Shape of abdomen- scaphoid 

Umbilicus normal 

•No engorged veins, visible peristalsis,scars and sinuses

PALPATION 

. All inspectory findings are normal 

. No tenderness seen

. Palpable mass felt- massive splenomegaly 

CNS:

CLINICAL IMAGES 

PROVISIONAL DIAGNOSIS: 

INVESTIGATIONS 

                             Hemogram(10/11/22)

Urine examination(10/11/22) 

Blood UREA

Prothrombin time

APTT

Ultrasound abdomen 

2D ECHO

ECG

TREATMENT: