PAEDS

PRESANTATION
A SHANZI AND S. MHANGO
YOU ARE WELCOME
HISTORY

 KENNEDY CHIRWA M CHILD OF15

MONTHS
 JOHN LENG SDA
 INFORMAT MOTHER
PRESENTING COMPLAINT

 YELLOWING OF EYES URINE

ANDPALMS OF HANDS 2/12
 CHANGE IN COLOUR OF STOOL 2/12

 ON AND OFF FEVER

 DISTENTION OF ABDOMEN
Hx OF PRESENTING
COMPLAINT
 WELL 2/12 AGO
 FIRST HAD RECCURING FEVERS AND
YELLOWING OF EYES TX AS MALARIA
AT LOCAL CLINIC.
 THEN NOTICED ABDOMINAL
DISTENTION AND A MASS IN CHILDS
ABDOMEN.
CONT.

 NO Hx OF JOINT SWELLING OR BUT CHILD

HAS ABDOMINAL PAIN .Hx OF ITCHING
SKIN
 NO HX OF BLOOD TRANSFUSIONS OR
TATOOS BEFORE ON SET OF SYMPTONS.
 NO SIBLING OR NEIGHBOUR WITH
YELLOWING OF EYES OR DIARRHOEA.
CONT.

 ABDOMINAL MASS ASSSOCIATED

WITH PAIN BUT HAS NO LOSS OF
APPETITE OR VOMITING. CHILD
PASSES FLATUS BUT CRIES WHEN
PASSING STOOL SOMETIMES.STOOL
IS DARK AND FOUL SMELLING.
 Hx OF TATOOS AFTER DISCOVERY OF
MASS.
SYSTEMIC REVIEW

 RS/CVS
 NO COUGH,NO DIFFICULTIES
BREATHING, NOSWELLING OF LIMBS
CNS .NO FITTING, BUT PATIENT NOT
ABLE TO WALK ANYMORE.
MEDICAL Hx

 NO PREVIOUS ADMISSIONS.
 NO TB,EPILEPSY
DRUG Hx

 FANSIDAH AND QUININE FOR

PREVIOUS MALARIA EPISODES
 NOW ON PANADOL AND FOLIC ACID.
BIRTH Hx

 BORN @9MTH SVD

 NO MATERNAL ILLNESS IN
PREGNANCY
 LABOUR UNEVETIFUL
IMMUNISATION &
NUTRITION
 CHILD UP TO DATE WITH IMMUNISATION
SCHEDULE
 STILL BREASTFEEDING AND HAS 3 MEALS
/DAY
 WEANED @ 6MTHS WITH SOYA PORRIAGE.
 EATS PORRIAGE FOR B/F. NSHIMA AND
WHAT EVER RELISH IS PRESENT
DEVELOPMENTAL Hx
 SMILED @3/12
 SAT @5/12
 CRAWLED @7/12
 STOOD @ 8/12
 WALKED @ 1YR 1MTH – BUT CAN NOT
WALK NOW
 SPEAKS AT LEAST 3 WORDS
 HAS 8 TEETH
 PLAYS WELL
FAMILY & SOCIAL Hx
 NO SIMILAR ILLNESS IN SIBLINGS OR
FAMILY
 NO TB, SCD, DM, HTN
 LAST BORN IN FAMILY OF 3
 LIVES IN A 1 ROOMED HOUSE WITH 4
OCCUPANTS
 FATHER DIED IN ROAD ACCIDENT
 MOTHER SELLS VEGETABLES &KAPENTA
AT HOME.
SUMMARY

 KENNEDY CHIRWA M/1YR 3MTNS

PRESENTED WITH RECURRENT
YELLOWING OF EYES,ABDOMINAL
MASS,FEVER, CHANGE IN COLOUR
OF STOOL AND ITCHING OF THE
SKIN.
DIFFERENTIALS

 LIVER PATHOLOGY- CHRONIC

HEPATITIS OR TUMOUR
 SICKLE CELL DISEASE
 LYMPHOMA
 NEPHROBLASTOMA
 NEUROBLASTOMA
EXAMINATION

 CHILD SITTING ON MOTHERS LAPS

 NOT IN RESP DISTRESS, NOT
WASTED,PALE, JAUNDICED, NO
BOSSING
 NO LN, PEDAL OEDEMA
VITALS & ANTHRO.

 PULSE – 115/MIN
 RR - 23/MIN
 TEMP -38.5C
 HEIGHT- 73CM
 HC -47CM
 MUAC -14CM
SYSTEMIC EXAM

 CVS & RS NORMAL

 P/A- DISTENDED, UMBILICAL HERNIA
 TATOOS ON RT SIDE OF ABD.
 NON TENDER
 MASS ON RT SIDE OR ADB.
EXTENDING 10CM BELOW RT
COSTAL MARGIN, NOT EXTENDING
BEYOND MIDLINE.
CONT.

 MASS FIRM, SMOOTH NOT ABLE TO

GET ABOVE IT, NOT BALLOTABLE.
 LT KIDNEY AND SPLEEN NOT
PALPABLE.
 NO ASCITES
 BOWEL SOUNDS PRESENT.
CNS

 CHILD FULLY CONCIOUS

 PUPILS EQUAL AND REACTING TO LIGHT.
 MOTOR: ABLE TO STAND BUT NOT WALK
 MUSCLE BULK EQUAL BIL.
 TONE NORMAL
 REFLEXES NORMAL
 GENITALS NORMAL
 URINALYSIS NOT DONE
SUMMARY

 EXAMINED CHILD WELL NORISHED,

PALE ,JAUNDICED WITH
HEPATOMEGALLY, ABLE TO STAND
BUT NOT WALK.
DIFFERENTIALS

 LIVER PATHOLOGY – TUMOURS

 NEPHROBLASTOMA
 NEUROBLASTOMA
 SICKLE CELL DISEASE AS A
COMORBID.
INVESTIGATIONS

 BLOOD: FBC, ESR,LFT, U/Es,

COAGULATION PROFILE, SICKLING
TEST, PERIPHERAL SMEAR
 RADIOLOGY: CXR, SKULL X-RAY,U/S,
IVP, BONE SCAN
 URINE: VMA. STOOL: OCCULT BLOOD
 BONE MARROW BIOPSY
 BIOPSY OF THE MASS
TREATMENT
 DEPENDS ON TYPE OF MASS
 NEUROBLASTOMA
LOCALISED DSE- SURGERY
METASTATIC DSE- 2ND LOOK SURGERY
RADIOTHERAPY FOR BULKY TUMOUR WITH
CHEMOTHERAPY.
DOXORUBICIN, CYCLOP, ETOPOSIDE &
CISPLASTIN
BONE MAROW TRANSPLANT AFTER CHEMO
CONT.

 NEPHROBLASTOMA
ALL PT SURGERY FOR STAGING &
REMOVAL OF MASS
RADIOTHERAPY FOR STAGE 3 DSE &
BONE METASTASIS
CHEMO- COMBINATION
1ST LINE- DOXO, ACTINOMYCIN D,
VINCRISTINE