Monday, July 9, 2007

ITP with purpura and subconjuctival haemorrhage

ITP with pupura and subconjunctival Haemorrahge

A girl of 6 years presented with 5 days fever, subconjuctival haemoorage and skin rashes.
The patient was also giving the history of passage of stool mixed with altered or fresh blood and also passage of reddish urine.

On examination, the patient was alert and conscious, non toxic, the rashes were identified as purpura present all over the body. There was mild hepatomegaly. but no splenomegaly no lymophadenopathy and no bony tenderness.

Clinically we suspect the case as ITP or Dengue fever, or Laukaemia

Though at present, there is no epidemiological evidence for Dengue, we wanted to exclude the Dengue as the rainy season begins in our country. But though platelet count was 50000/cmm, But the PCV was 38% and antibodies against the Dengue were absent.

The other features of peripheral blood pictures are normal. We were preparing for bone marrow aspiration.

In the meantime , pt was start improving, her bleeding stops, there was no further crops of purpura, no epistaxis, no malean and no hematuria.

The fever may be a coinfection on ITP.


Tuesday, July 3, 2007

Acute Appendicitis with Ascites

A girl of 8 years presented with fever, abdominal pain and vomiting of one day. I have seen the patient in outdoor setting. The fever was high grade, pain was central, vomiting occurs once containing food particles which suggesting the case as food poisoning.

On examination, the patient was looking sick, abdomen was tender centrally with muscle guard. Macburney’s point was not definitely tender.

To exclude the appendicitis, we suggested investigation for blood R/E, Urine R/E and Ultrasonography.

Ultrasonography reveals Acute Appendicitis and Ascites.

The patient was admitted and operated.

Monday, July 2, 2007

Enteric fever with hepatitis and ASD

A 7 year old child from Sandvip, an Island west of Chittagong came to our hospital with fever for 22 days, jaundice and abdominal pain.

On examination, his jaundice was moderate, abdomen was tender on the epigastric, right lumber and Rt hypochondriac region. His liver was 5 cm enlarged, tender.

Ausculatation of the heart reveals a murmur which is systolic in nature at the left upper sternal border.

We thought it could be a) a case of Infective Endocarditis out of a noncyanotic congenital heart disease
b) Enteric fever with hepatitis
c) Hepatic abcess

We started treating the patient with Injection Ceftrixone and Inj penecillin.

In the meantime , the investigation reveals normal widal test, normal blood culture and X-ray shows mild cardiomegaly and Echocardiography suggests ASD.

The fever started to subside and sense of wellbeing improved on the 4th day and by 9th day, the patient become afebrile.

After review, we settled our final diagnosis as Enetric Fever with hepatitis and ASD.