5. PDA

Case Presentation SYED ARIFF AMIR SYED AWALY MUHAMMAD NIZAR MOHAMMAD YATIM FAIZUL HARIS MOHD HATTA

DEMOGRAPHIC DETAILS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CHIEF COMPLAINT ,[object Object]

HISTORY OF PRESENTING COMPLAINT ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

[object Object],SYSTEM COMPLAINTS General No fever, no irritability Cardiovascular No pedal edema, no sweating Respiratory Shortness of breath , cough, no haemoptesis Gastrointestinal Vomit , loss appetite , no abdominal pain, no haemetemesis and no alter bowel habits Genitourinary No polyuria, no dysuria and no haematuria Central Nervous System No loss of consciousness, no neck stiffness, no weakness ENT No runny nose, no ears discharge MSK no gross deformities

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BIRTH HISTORY ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

FAMILY HISTORY ,[object Object],[object Object],[object Object],[object Object],[object Object]

SOCIAL AND ENVIRONMENTAL HISTORY ,[object Object],[object Object],[object Object],[object Object],[object Object]

HISTORY OF CONTACT ,[object Object],[object Object],[object Object]

General Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Examination of face, head, neck and limbs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Developmental assessment ,[object Object],[object Object],[object Object],[object Object]

Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiovascular system ,[object Object],[object Object],[object Object]

Abdominal Examination ,[object Object],[object Object],[object Object],[object Object]

Central Nervous System Examination ,[object Object],[object Object],[object Object],[object Object]

CLINICAL SUMMARY ,[object Object],[object Object],[object Object],[object Object],[object Object]

PROVISIONAL DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DIFFERENTIAL DIAGNOSIS Differential diagnosis Support Against Bronchiolitis Breathlessness Signs of respiratory distress hyperinflated chest - No fever - No noisy breathing (wheezing) -Crepitations more prominent than rhonci Asthma Breathlessness No fever ,[object Object],[object Object],[object Object],Cardiac failure Breathlessness Signs of respiratory distress ,[object Object]

General Investigation Full Blood Count 18/12/2010 Normal Range Impression WBC 16.93 6.0-16.0 x 10 9 /L increase RBC 4.09 4.0-6.0 x 10 12 /L normal RBC Distribution 14.0% normal Hemaglobin 11.3 11.1-14.1 g/dL normal Hematocrit 38.6 37.0-45.0 % normal MCH 24.6 24-33 Pg normal MCV 77.1 77-95 fL Normal MCHC 31.6 31-40 pg/cell Normal Platelet 445 110-450 x 10 9 /L Normal

Automated Differential Renal Profile 18/12/2010 Normal Range Neutrophil (%) 57.8 40-75% Lymphocyte 50.0 20-45% Monocyte 5.6 2-10% Eosinophil 1.8 0-5% Basophil 0.1 0-0.2% 25/07/08 Normal Range Urea 3.3 2.5-8.0 mmol/L Sodium 139 133-145 mmol/L Potassium 3.9 3.5-6.0 mmol/L Creatinine 35.8 20-65 µmol/L

[object Object],Normal range Value Interpretation Total protein 64.0-83.0 g/L 74.0 Normal Albumin 35-50 g/L 35 Normal Globulin 20-35 g/L 33 Normal Albumin/Globulin Ratio 0.89 1 Normal Total bilirubin 3.4- 20.5 umol/L 3.4 Normal Alkaline phosphatase 40-150 U/L 145 Normal Alanine Aminotransferase 7-53 U/L 14 Normal

[object Object],[object Object],[object Object],C-Reactive Protein- 1.20mg/dl normal value < 1 mg/ dl increase

Chest x-ray Interpretation :hyperinflated lungs, hazziness in both lungs , cardiomegaly

Final diagnosis ,[object Object]

MANAGEMENTS (taken from Malaysian CPG and Paediatrics Protocols) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Problems… ,[object Object],[object Object],[object Object]

Complications of Preterm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ASD & PDA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Why recurrent chest infection?

Management of heart disease in the patient ,[object Object],[object Object],[object Object]

Definition ,[object Object],[object Object]

Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],Age Bacterial pathogens Newborns Group B streptococcus, E. coli, Klebsiella, Enterobacteriaceae 1-3months Chlamydia trachomatis Preschool Strp. pneumoniae, HiB, Staph. Aureus school Mycoplasma pneumoniae, Chlamydia pneumoniae

Microorganisms entry ,[object Object],[object Object],[object Object],[object Object]

Types ,[object Object],[object Object],[object Object],[object Object]

Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Viral vs Bacterial Characteristics Viral Bacterial Fever Low grade, acute High grade, gradual onset Mucosal congestion and inflammation of upper airway Suggestive Not suggestive FBC WBC normal or mildly elevated, lymphocytes predominance WBC elevated, neutrophils elevated X-ray Usually characteristics of bronchopneumonia Usually lobar consolidation

Macrolide antibiotic is used if Mycoplasma or Chlamydia are the causative agents. 1 st line Beta-lactam drugs Ampicillin , amoxycillin, benzylpenicillin 2 nd line Cephalosporins Cefotaxime, cefuroxime, ceftazidime 3 rd line Carbapenam Imipenam others aminoglycosides Gentamicin, amikacin

Supportive treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Others… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Take home message ,[object Object],[object Object],[object Object],[object Object]

5. PDA

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5. PDA