Anemia, Rickets and Recurrent Diarrhea
 
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Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B St Francis Road, Vile Parle {W}, Mumbai 400056. India.


Clinical Problem :
A 2 and a half years old boy presented with abdominal distension and recurrent diarrhea for 6 months. Stools were frothy and had oil droplets. He also had a blood transfusion 2 month ago. At that time he had black coloured stools. There was no fever, bleeding from any site. Bone marrow examination at that time was normal. Doctor noticed bow legs at that time and gave 6 lakhs of Vitamin D. There was no jaundice, exposure to chronic drug abuse or altered sensorium. Diet was balanced mixed diet and immunization and milestones were normal. On examination, he was found to have palmar erythema, double malleoli, bow legs and hepatosplenomegaly with dilated tortuous abdominal veins with flow away from umbilicus. Other systems were normal.


Question :
With is the cause of his symptoms_?

Expert Opinion :
This child has organomegaly with palmar erythema suggestive of liver disease. He has dilated tortuous abdominal veins with flow away from umbilicus and splenomegaly suggestive of portal hypertension. Malena could be due to bleeding from varices. Malabsorption in form of frothy and oil droplets in stools suggests fat malabsorption which could be due to liver or pancreatic disease. Fat malabsorption leads to poor absorption of fat soluble vitamins such as Vitamin A, D, E and K. This could explain the rickets in the child. Anemia needing blood transfusion could be due to bleeding from varices or hypersplenism. Thus, the cause of problems in this child is chronic liver disease with portal hypertension even though child has never had jaundice.

E-published: September 2010 Vol 7 Issue 9 Art No. 55


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