Short cases in Abdomen: in paediatrics-final MBBS

Abdomen short cases Possible cases Hepatosplenomegaly Ascites Renal lump You found a massive hepatosplenomagaly (ﬁrm spleen). What this could be due to? Transfusion dependant anemia e.g. β thalessmia major aplastic anemia Gaucher’s Dx, osteopetrosis, pure red cell aplasia, HS Why β thalessmia major? Because it is common Do you think this child is adequately transfused? Inadequate transfusion result in Growth failure Bony deformities Splenomegaly or early splenectomy Pallor is indicative of this episode But still need to know pre-transfusion Hb level 9.5-10g/dl Inadequate chelation results in 1. Pigmentation 2. Complications 1. Cardiac: auscultate chest for murmurs 2. Hepatic 3. Endocrine- i. Gonads - Tanner stage ii. Thyroid- T4 iii. DM But still need to know trend of serum ferritin level: 100-200 normal 1000-1500 adequate Adherent to chelation regime Why do you say this is spleen? 1. Has its shape & notch 2. Can not feel the upper border 3. Not ballotable 4. No band of resonance 5. Direction of enlargement towards RIF Could this be leukemia? 1. Ill looking 2. Bone tenderness 3. Pallor 4. LNE 5. Splenomegaly 6. FBC→ abnormal cells 7. Needs BM biopsy to exclude

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Transcript of Short cases in Abdomen: in paediatrics-final MBBS

Page 1: Short cases in Abdomen: in paediatrics-final MBBS

Abdomen short casesPossible cases

Hepatosplenomegaly Ascites Renal lump

You found a massive hepatosplenomagaly (firm spleen). What this could be due to?Transfusion dependant anemiae.g. β thalessmia majoraplastic anemiaGaucher’s Dx, osteopetrosis, pure red cell aplasia, HSWhy β thalessmia major?Because it is common

Do you think this child is adequately transfused? Inadequate transfusion result in

Growth failure Bony deformities Splenomegaly or early splenectomy Pallor is indicative of this episode But still need to know pre-transfusion

Hb level 9.5-10g/dl

Inadequate chelation results in1. Pigmentation 2. Complications

1. Cardiac: auscultate chest for murmurs

2. Hepatic 3. Endocrine-

i. Gonads - Tanner stage

ii. Thyroid- T4iii. DM

But still need to know trend of serum ferritin level: 100-200 normal 1000-1500 adequateAdherent to chelation regime

Why do you say this is spleen?1. Has its shape & notch2. Can not feel the upper border3. Not ballotable4. No band of resonance5. Direction of enlargement towards RIF

Could this be leukemia?1. Ill looking2. Bone tenderness

3. Pallor4. LNE5. Splenomegaly6. FBC→ abnormal cells7. Needs BM biopsy to exclude