Question of the Week

Question :
Posted On : 27 May 2017
A 8year old male child born of a consanguineous marriage of degree 2nd without significant past history presented with fever since 1 and ½ to 2 months,Yellowish discoloration of eyes since 1 months,Pain in the abdomen since 10 -15 days.Oedema of feet since 7 days,No h, o altered sensorium, No h, o haematemesis.,No h, o bleeding per rectum,No h, o contact with jaundice person,No h, o Tuberculosis or contact with Tuberculosis person,No h, o blood transfusion in the past,No h, o chronic intake of medication.
On examination-Child is conscious, well oriented, having icteric look, oedema of feet.
Vitals- stable,Temperature-99.8 degree F.BP- 110, 58mmHg.
Systemic examination-
PA Examination- Abdomen distended, umbilicus transversely stretched, fullness of dilated vein.
Hepatomegaly- rt lobe about 4cm ,left lobe about 6cm,Tender, firm in consistency, surface is smooth, no nodularity detected, Liver span- 13 cm.Splenomegaly- about 6 cm, tender,Free fluid in the abdomen is present.
RS examination-Air entery bilaterally equal , clear, no foreighn sound heard.
CVS examination-Both S1 and S2 heard , systolic murmer heard over the mitral area, grade III, not radiating to back or axillary area.
CNS examination- NO Singns of focal neurological deficit.
Investigations in the past
CBC{24, 03, 10}- Hb- 9.3gm percent, Total WBC- 10,100 cells, Cumm, N-63.1, percent L-29.7 percent, Platelets- 3.02L, Cumm.
Malarial parasite{24, 03, 10}- Negative. SGPT{ 24, 03, 10}- 343 IU, L. Urine routine- normal.Brucella tube method {17, 95, 10}- Negative. Serum CERULOPLASMIN {26, 03, 10}- 0.27 { Reference range- 0.25- 0.46}.USG Abdomen {24, 03, 10}- hepatosplenomegaly with focal lesion.No evidence of portal hypertension
Recent Investigations-
CBC- {2, 06, 10} Hb- 7.9gm percent, Total WBC- 5,800 cells, Cumm, N-56.8, percent L-38.7.0 percent, Platelets- 2.02L, Cumm.
HBsAG { 2, 06, 10}- Negative.Serum Bilirubin-{2, 06, 10}-Total Bilirubin- 3.7mg percent.Direct-1.5mg percent.Indirect- 2.2mg percent.SGPT {2, 06, 10}- 255 IU, L.HIV TEST- negative.ESR {2, 06, 10}- 40 mm.WIDAL Tube method- negative.USG abdomen { 7, 06, 10}-Hepatosplenomegaly, ascites plus, no evidence of portal hypertension.
2D ECHO- Dilated cardiac chambers, Coronary origination not confirmed.
Expert Answer :
It seems to be chronic liver disease with ascitis. Since the child is 8 years old, do 24 hours urine copper pre and post penicillamine. Also do autoimmune markers such as ANA, Anti smooth muscle antitbody and Anti LKM. Also do HCV and urine routine to look for albuminuria. Since Echo shows dilated cardiac chambers, one should rule out budd chiari. A colour doppler of IVC and hepatic veins should be done.
Answer Discussion :
Nitesh choudhary
4 years ago
DrMuhammad Muzammil
Glandular fever
4 years ago
pushpa latha

4 years ago
RajendraN Patil
Buddchiari syndrome
4 years ago
consanguinity, chr anemia of infectious origins focal lesion in liver,needs further evaluation
4 years ago

Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0