Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 30 views

    NC - Immanuel Ata Turu

    Uploaded by

    Dodi Di
    A 2-year-old boy presented with an enlarged abdomen. Imaging showed an intra-abdominal mass suspected to be hepatoblastoma. Labs showed anemia, elevated liver enzymes, and hypoalbuminemia. The working diagnoses were intra-abdominal tumor suspected to be hepatoblastoma and anemia of chronic disease. The patient received a blood transfusion, antibiotics, and pain medication. Further imaging and consultations were planned.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    NC - Immanuel Ata Turu

    Uploaded by

    Dodi Di
    30 views20 pages
    A 2-year-old boy presented with an enlarged abdomen. Imaging showed an intra-abdominal mass suspected to be hepatoblastoma. Labs showed anemia, elevated liver enzymes, and hypoalbuminemia. The working diagnoses were intra-abdominal tumor suspected to be hepatoblastoma and anemia of chronic disease. The patient received a blood transfusion, antibiotics, and pain medication. Further imaging and consultations were planned.

    Original Title

    NC_Immanuel Ata Turu

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    A 2-year-old boy presented with an enlarged abdomen. Imaging showed an intra-abdominal mass suspected to be hepatoblastoma. Labs showed anemia, elevated liver enzymes, and hypoalbuminemia. The working diagnoses were intra-abdominal tumor suspected to be hepatoblastoma and anemia of chronic disease. The patient received a blood transfusion, antibiotics, and pain medication. Further imaging and consultations were planned.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    30 views20 pages

    NC - Immanuel Ata Turu

    Uploaded by

    Dodi Di
    A 2-year-old boy presented with an enlarged abdomen. Imaging showed an intra-abdominal mass suspected to be hepatoblastoma. Labs showed anemia, elevated liver enzymes, and hypoalbuminemia. The working diagnoses were intra-abdominal tumor suspected to be hepatoblastoma and anemia of chronic disease. The patient received a blood transfusion, antibiotics, and pain medication. Further imaging and consultations were planned.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    CLINICAL CONFERENCE

    HEMATOLOGY ONCOLOGY DIVISION


    (New Case)
    March 04, 2023
    Dhody Setiamal/ Junior Divisi
    Randy suryawan,A. Alfia Mutmainnah, Nicholas Redly/ Madya Divisi
    Dina Fadihilah Monika,Syahrurrahman, Arwini Avissa Abdullah,Kartika Setiawaty
    / Senior Divisi
    PATIENT IDENTITY
    A.T, 2 years old (male)
    MR Number 10113045
    Date of Birth july 18th, 2008
    Admission Date March 13, 2023

    MEDICAL DIAGNOSIS
    - Intra-abdominal tumor et causa suspected Hepatoblastoma differential diagnosis of hepatocellular
    - Anemia of Chronic Disease dd Iron deficiency anemia
    - Leukocytosis
    - Elevated transaminase Enzyme
    - hypoalbuminemia
    Chief Complaint HISTORY TAKING
    Enlarged abdominal
    History of Present Illness
    A boy 2 years old was reffered from Elim Rantepao Hospital with diagnosed intraabdominal
    mass et causa suspek hepatoblastoma

    There was abdominal enlarged since 2 weeks before admitted to the hospital.
    No fever, no seizure
    No cough no shortness of breath
    Good appetite
    Defecation: normal
    Urination : yellow normal
    HISTORY TAKING
    History of Past Illness
    - History of pale since 1 week before admission to the hospital
    - No history of bleeding gums, epistaxis, reddish urine and melena
    - No history of joint pain
    - No History of weight loss
    - No Family history of malignancy.
    - No history of living near rice fields and factory
    - History patient was hospitalized at Elim Hospital for 2 days and received
    ceftriaxone/intravenous, paracetamol/intravenous, zinc/oral.
    PHYSICAL EXAMINATION
    History of Vaccine
    Month Years
    Vaccine
    Not 0 1 2 3 4 5 6 7 8 9 12 15 18 24 3 5 6 7 8
    given
    Hep B √ √ √ √ √ √

    BCG √
    DPT √ √ √ √

    Hib √ √ √ √

    OPV √ √ √ √

    IPV √

    MR √ √
    Rotavirus √

    Influenza √
    Japanese √
    Encephalitis
    PCV √
    Varicella √
    Hepatitis A √
    Tifoid √
    PHYSICAL EXAMINATION
    Vital Sign Antropomethry
    General condition: severe illness/ under Body weight : 9,3 kg
    nourished/GCS 15 (E4M6V5)
    Length : 84 cm
    Blood pressure : 90/60mmhg
    Head circumference: 46 cm ( Normal 52-57 cm)
    Heart Rate : 100times/min
    Anthropometry:
    Temperature: 38°C
    Respiration Rate : 22 times/min PB/Age : Between -2SD and median (normal stature)
    BB/Age : Between -2SD and -3SD (underweight)
    SpO2 : 99 % BB/PB: Between -2SD and -3SD (undernourished)
    Pain Scale : 1 FLACC
    Head circumference: 46 cm ( Normal 46-51 cm)
    BB/PB: Between -2SD and -3SD
    (undernourished)
    BB/Age : Between -
    2SD and -3SD
    (underweight)
    PB/Age : Between -2SD
    and median (normal
    stature)
    PHYSICAL EXAMINATION
    There was pale. No icterus Abdomen
    No stomatitis Peristalsis was normal, distended
    Pharynx not Hyperemesis prominent veins, palpable mass in the right hypochondrium
    Tonsil T2-T2 hyperemis measuring 10 x 10 x 7 cm, flat surface, solid consistency, immobile,
    no Lymphadenopathy non-tender, past midline shift, blunt edge, color and same as
    around.
    Pulmo spleen not palpable
    Vesicular breath sounds
    no ronkhi, no wheezing.
    Extremities
    Cardiovascular
    Warm acral, , CRT < 3 detik
    I / II heart sound, Regular rhythm
    Manifestations of spontaneous bleeding : none
    no murmur
    LABORATORY FINDING
    Elim Wahidin
    Laboratory Normal Value
    10/03/23 13/03/23

    Hb 8,9 7,2 12.0 – 16.0 gr/dL


    WBC 16.800 16.200 4.0 – 10.0/μL
    ANC 1075 7824 >2000
    PLT 596.000 435.000 150.000 – 400.000/mm3
    MCV 60 63 80 -100 μm3
    MCH 19 19 27 - 32 Pg
    %NEUT 64,3 48,3 52 – 75 103/μL
    %LYMPH 28,7 39,4 20 – 40 103/μL
    %MONO 4 9,7 2 – 8 103/μL
    Ret - 2,35 0,5 – 1 /μL
    Wahidin
    Laboratory 13/03/23
    Normal Value

    Ureum 15 10 - 50 mg/dl

    Creatinine 0,29 <1.3 mg/dl


    SGOT 145 < 38 u/l
    SGPT 23 < 41 u/l
    Albumin 3,3 3.5 – 5.0 mg/dl
    136-145
    Natrium 140

    Kalium 4,5 3,5-5,1


    Clorida 101 97-111
    LDH 600 210-425 U/L
    AFP >400 0-7.02 IU/ml
    Beta HCG <2.00 <=4 mIU/ml
    Ferritin 171,87 13-400 ng/ml
    Peripheral blood Wahidin hospital (13/03/2023
    Erythrocytes: Normocytic normochrome,
    anisopoikilositosis, ovalocytes (+),akantocyte (+) target
    cell (+) helmet cell (+), iclusion (-), normoblast (-)
    Leukocytes: increased, PMN>limfocyte, hypersegmentasi
    (+), granulasi toxic (+), young cell (-)

    Platelets: normal
    Impression: anemia normositik normokrom, suspeck
    cronic disease with liver function disorder
    Radiology FINDING

    USG Elim Hospital 11/03/2023


    Impression: The mass in the liver matches the
    appearance of hepatoblastoma

    Thorax's photo of 11/03/2023


    Impression: Elevation of the right diaphragm ec process
    on the liver
    ASSESMENT
    - Intra-abdominal tumor et causa suspected Hepatoblastoma
    differential diagnosis of hepatocellular
    - Anemia of Chronic Disease dd Iron deficiency anemia
    - Leukocytosis
    - Elevated transaminase Enzyme
    - hypoalbuminemia
    Working Diagnosis

    - Intra-abdominal tumor et causa suspected Hepatoblastoma


    differential diagnosis of hepatocellular
    - Anemia of Chronic Disease dd Iron deficiency anemia
    TREATMENT
    - Infusion Dextrose 5%
    - Tranfusion packed red cells/intravenous ( target by age)
    - watch for signs of tissue anoxia
    - 2) Ceftriaxon/intravenous
    - Paracetamol 100mg/8jam/intravenous ( if pain scale >3FLACC)

    Planning:
    - MSCT Abdomen with contrast
    - Consult to Gastrohepatology division
    - Consult to pediatric surgeon
    THANK YOU

    You might also like