1 / 26

Case of H.C.

Case of H.C. Pedia -Ortho SGD. General Data. H.C. 6 years old Male From Urdaneta R flank mass and R inguinal mass. History of Present Illness. Diagnosed case of Pott’s disease since March 2009, currently on his 3 rd month of treatment with HRZE

bazyli
Download Presentation

Case of H.C.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case of H.C. Pedia-Ortho SGD

  2. General Data • H.C. • 6 years old • Male • From Urdaneta • R flank mass and R inguinal mass

  3. History of Present Illness • Diagnosed case of Pott’s disease since March 2009, currently on his 3rd month of treatment with HRZE • Patient was referred to Rehab for fabrication of TLSO brace, because patient will need brace immediately post-op

  4. 8 mos PTA (Nov 2008) • Patient’s mother noted 1x1cm mass on the R lower lumbar area. The mass was movable, fluctuant and non-tender. No consult was done.

  5. 7mos PTA • The mass was noted to be enlarging, occupying the lower lumbar area, with associated 50% weight loss and anorexia, occasional cough, undocumented fever (Paracetamol) and night sweats.

  6. 3mos PTA • Continuous increase in size of the mass and fever prompted consult to a private doctor. Chest X-ray was done which revealed PTB. Patient was started on Anti-Koch’s medications (HRZE)

  7. 1week PTA • Patient’s mother noted the presence of • 3x4cm soft, non-tender, non pulsatile R inguinal mass • 6x5cm soft, non-tender non-fluctuant R flank mass • Patient was brought to the ER and was advised for admission

  8. Review of Systems (+) fever (+) unprod cough (-) abd’l pain (+) weight loss (-) colds (-) BM changes (+) anorexia (-) dyspnea (-) GU changes (-) headache (-) orthopnea (-) dysuria (-) nausea (-) chest pain (-) vomiting (-) easy fatigability (-) BOV (-) easy bruisability

  9. Past Medical History • (-) previous hospitalization • (-) allergies • (-) other illness

  10. Family Medical History • (-) DM, BA, HD, thyroid disease • (+) HPTN- maternal

  11. Birth and Maternal History • Born FT to a then 26y/o mother G2P1(1001) via NSVD in a lying-in clinic assisted by a midwife. With regular PNCU’s c/o local health center. Mother denies any maternal illness, (-) fetomaternal complications. • Patient was born with good cry and good suck

  12. Personal and Social History • Middle child, w/ 10yo brother and 3yo younger brother • Mother 32yo, housewife • Father 35yo, tricycle driver

  13. Nutritional History • Patient was exclusively breastfed until about 1 year of age • (+) complimentary feeding started at 6-8 months old

  14. Immunization History • BCG • DPT 3doses • OPV 3 doses • Hep B 3 doses • Measles • c/o Local Health Center

  15. Developmental History • Generally at par with age • Grade 1 student

  16. Physical Examination

  17. General • Alert, awake, conscious, not in cardiorespiratory distress • HR= 140’s • RR= 38 • T= 38.4 C

  18. HEENT • Slightly pale palpebral conjunctivae, anicteric sclerae, (-) NVE • (+) multiple CLAD

  19. Chest and Lungs • Clear breath sounds • (-) use of accessory muscles • (-) suprasternal/ intercostal retractions

  20. Heart • Adynamic precordium • Distinct heart sounds • (-) heaves, thrills,murmurs

  21. Abdomen • Firm and globular abdomen • NABS • Non-tender, (-) masses • Non-palpable liver edge, intact Traube’s space

  22. Extremities • Pulses full and equal, CRT<2s • DTR’s: normoreflexive • Full ROM’s • MMT: • C5-T1: 5/5 • L2-S1: 5/5 • Sensory: (-) sensory deficits • C5-T1: 100% • L2-S1: 100%

  23. Present Working Impression Pott’s Disease, ongoing treatment Abscess R paravertebral area with psoas extension • s/p Anterior Debridement, Decompression and Interbody Fusion T11-L1 (7/6/09, PGH)

  24. Medications on Board • Isoniazid • Rifampicin • Paracetamol PRN • Clindamycin

  25. Thank you!

More Related