1 / 23

Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Infor

Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Informant :Father ,Mother & self(reliable) DOA:17-03-05. No h/o cough, fever, chest indrawing No h/o palpitation,edema of feet,decrease urine output.

boaz
Download Presentation

Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Infor

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. Name :PUJAPPA • Age :14yrs • Sex :Male • Address:Marenali Bagnur post ,yelanka ,Bangalore North. • Informant :Father ,Mother & self(reliable) • DOA:17-03-05

  2. No h/o cough, fever, chest indrawing • No h/o palpitation,edema of feet,decrease urine output. • No h/o headache,vomiting,convulsions, weakness of limbs.

  3. Past h/o:h/o URI 2-3 times /year No h/o suggestive of ALRI No h/o admission to hospital • Family h/o:non consanguineous marriage.

  4. No h/o CHD

  5. Birth h/o:unbooked & unimmunised 1—no h/o drug intake,fever with rash 2--- no h/o suggestive PIH,DM home delivery conducted by untrained dai. BCIAB avg wt baby.prelacteal feeds sugar water 2-3spoons .started breast feeding 2hr after birth till 5months. No h/o intermittent feeds No h/o sweating over forehead during feeding

  6. No h/o fever ,cough, chest indrawing. • Immunisation h/o: Unimmunised(unawareness) • Development h/o:appropriate for age.

  7. Required Required Getting Getting deficit deficit 2400 Kcal 2400 Kcal 1400 1400 58% 58% 70 gms 70 gms 48 48 65% 65% NUTRITION H/o

  8. Socioeconomic h/o:Father 1st std ,Mother illiterate --coolie Rs 500/month. 1room 1kitchen kerosene stove cooking out door sanitation. low socioeconomic status

  9. summary • 14yr old male boy pujappa 5th child of non consanguineous marriage presented with h/o breathlessness on exertion with squatting episodes since age of 3yrs. h/o cyanosis h/o not gaining wt. no h/o repeated ALRI/CCF

  10. CCHD with decrease pulmonary blood flow • TOF • TGV with VSD with PS • DORV with PS • Single ventricle with PS

  11. ANTHROPOMETRY expected • Wt 24kg (5th centile) 35kg • Ht 142cm(25th centile)150cm • HC 51cm • CC 57cm • Wt age • Ht age 13 yrs weight more affected • Wt for ht 77.4 than height • US/LS 0.9

  12. VITALS • PR -72/min regular, good volume,all peripheral pulses well felt,no R-R,no R-F delay • BP- 100/68mmhg—UL, 110/70 –LL. • RR-18/min • Temp –Afebrile • JVP--N

  13. HEAD TO TOE EXAMINATION • Head –N • Eyes –conjunctival xerosis,conjunctival suffusion • Ears –N • Nose –N • Neck –no lymphadenopathy • Mouth – lips & tongue –cyanosis ,no caries • Hands –nails –cyanosis,clubbing –grade 3 • Feet –toes-- cyanosis,clubbing –grade 3,no pedal edema • SMR –stage 2

  14. Thorax & abdomen –Branding marks + • Skin –N • Bones & joints –N • Spine– N • No facial dysmorphism • No extracardiac markers • No features of infective endocarditis.

  15. SYSTEMIC EXAMINATION • PR-72/min BP-100/68-UL,110/70-LL JVP-N • Inspection :Apical impulse seen in 4th ICS medial to MCL. No precordial bulge No other visible pulsations.

  16. Palpation :Apical impulse seen in 4th ICS 0.5cm medial to MCL,Normal. Thrill left 2,3,4 ICS along sternal border. Parasternal heave grade 1 no epigastric pulsation, no palpable P2 Percusion :left border corresponds to apex.

  17. Auscultation :heart sounds S1 S2 heard ejection systolic murmur of grade 4 heard best in left upper sternal border with diaphragm ,during inspiration,with sitting posture. MA:S1S2+ same ejection systolic murmur + PA : S1S2+, single S2,well heard , same ejection systolic murmur . TA: S1S2+ AA:S1S2+

  18. RS :Trachea central B/L symmetrical chest movement+ B/L air entry NVBS+ • P/A:Soft no organomegaly ,BS+ • CNS:No focal neurological deficits.

  19. Impression :CCHD with decreased pul blood flow in sinus rhythm, with out failure, with no evidence of IE. TOF DORV with PS TGV with VSD with PS

  20. Investigations • Hb :16.8 gm/dl • PCV:58.8% • TC-8,600cells/cumm • DC N-71% L-22% E-4% M-3% • RBC 7.55million/cumm • Platelet :2.23lac • PBS:normocytic normochromic

  21. ECG:HR-72/min regular rhythm PR interval 0.16sec QT interval 0.32 sec Right axis deviation (+120) RVH –Tall R wave in V1 &deep S wave in V6

  22. Chest X-ray: • ECHO:

More Related