1. SABRINA TAMILMANY
012011100237

2. • NAME : JACKSON TEA JIA SHENG
• AGE : 6 YEARS 4 MONTHS
• GENDER : MALE
• RACE : CHINESE
• ADDRESS : SETIAALAM
• DATE OFADMISSIO : 17TH MARCH 2014 @ 12 AM
• DATE OF CLERKING : 18TH MARCH 2014
• INFORMER : MOTHER (RELIABLE & ADEQUATE)

3.  Jackson, aged 6 years 4 months old, chinese
boy was admitted to HTAR ( KLANG ) due
to vomiting and diarrhea for the past 2 days
since 15th march 2014.

4.  This little boy was apparently well until 2 days ago when he
started to have fever. It was a sudden onset, low grade and
intermittent fever but no rigor. But, the fever was resolved on
that day itself when the mother gave him some of his previous
medicines and vitamins at home. Soon after the fever
resolved, he had vomiting and continued with diarrhea.

5. • VOMITING
 Had 6 episodes of vomiting for the past 2 days.
 vommits soon after taking meal and was projectile
 vomitus contained food particles, no blood or bile content.
•DIARRHEA
 8 episodes for the past 2 days
 Was watery stool and yellowish
 no blood or mucus content.
 was small amount each time pass motion.

6.  Had chest discomfort but Patient was still eager to drink water and
taking orally well.
 became less active, lethargic and weak.
 Urine output was normal.
 Patient had outside food the day before but none of the family
members had similar symptoms.
 Apart from that, he had no cough, no shortness of breath, no bloody
vomiting or bloody diarrhea, no dark or bloody urination. He also
did not have abdominal pain or distention, no anal redness, no rashes
and no seizures. Had no history of travelling.

7.  Had neonatal jaundice and was admitted in HTAR for 3 days.
 Had heart disease.
 found 2 months after birth and had undergone follow up and surgery
in IJN.
 resolved after surgery when the child was 9 months old and still on
follow up once every year.
 the last follow up was on 12th march 2014, and according to the doctor
patient was completely fine.
 Had no any other medical illness.
 Not any medication due to this medical illness.

8.  Had heart surgery before 5 years, when the
child was 9 month old.
 There was no any complication due to the
surgery.
 Surgery done at IJN, in Kuala Lumpur.

9.  ANTENATAL :
 Attended regular antenatal check-ups.
 Had gestational diabetes mellitus, found during third trimester
and was on diet. No any medications.
 No hypertension.
 No seizure attacks and no fever with rash ( No
TORCH infection), No urinary tract infection.
 Only took vitamin, iron and folic acid
supplements. No any other drugs or medication taken.
 took anti-tetanus toxoid vaccine.
 No exposure of radiation and no ante-partum-
hemorrhage.

10.  NATAL :
 Delivery was through a nomal vaginal delivery.
 Artificial rupture of membrane was done.
 There was spinal anesthesia given to the mother during labor.
 It was full term delivery. Birth weight was 3.6 kg.
 POSTNATAL
 Baby cried vigorously soon after birth.
 Within a few days after birth, baby had neonatal jaundice.
 undergone phototherapy 3 times within a month.

11.  No exclusive breast feeding. He was breastfed for 2
months only because the mother was pregnant after that
period. He was bottle-fed since then till now.
• He was given ANMUM formulae until he was 3 years.
• he was introduced with porridge and home cooked adult
food after 2 years, in small quantity.

12. • His mother was satisfied with her child’s growth.
 Physical growth and development
- normal physical growth
- had started to lose teeth.
 Thinking and reasoning (cognitive development)
- able to communicate and respond well.
- could express himself well through words.
- could understand and write.

13.  Emotional and social development
 according to the mother, child is very active in school and
home.
 does well in education.
 Language development
 could describe a favorite television show, movie, story, or
other activity.
 could Speak with correct grammar
 could write his name and spell simple words.
 Sensory and motor development
 All senses and motor reflexes is normal.
( could perform normal activities like other normal kids.

14.  His mother claimed that her child’s immunization was
up-to-date and followed the schedule.
 He had received all BCG, Hep B, DTeP, Hib and IPV
injection.
TREATMENT / ALLERGIC HISTORY
 Patient had No known allergy to food or medication

15. • There is not consanguinity marriage in the family.
• No one among the family members have this kind of medical
problem.
• No one in the family suffers from asthma, epilepsy and any other
gene related or chromosomal diseases.
• No abortion or miscarriage had taken place before.
36
36 32
8 years old
( schooling )
7 years old
( schooling )
5 years old
( schooling )

16.  Patient lives with his family in an double storey house in Setia Alam, and
adequate electricity and water supply.
 His mother works as a clerk in a company at Subang Jaya. His father
works as an executive manager at Petaling Jaya.
 Patient stays in day care with his sister after school and there are few
other kids living with them and no history of similar illness from the
other kids.
 His parents are non-smoker and both of them do not consume alcohol.
 They came from a moderate socioeconomic class with an average
monthly income of RM 4000.00 combined.

17.  my patient, Jackson who is 6 year
4 months old chinese boy
presented with vomiting
and diarrhea for past 2 days.
It was associated with chest
discomfort and there is no
any other associated symptoms.

18. AZLINAH BINTI MOHAMED IQBAL
012011100190

19.  General inspection
 Patient was comfortably lying supine, alert and
conscious.
 Interacting well with his mother.
 Did not look in pain or distress.
 Nutritional and hydration status was normal.
 BCG scar was seen on his left deltoid muscle.

20.  General examination
 Head
 Anterior fontanel was normal
 Eye
 Conjuctiva was not pallor and no icterus
 Mouth
 Good oral hygiene
 No bluish discoloration of lips
 No dehydration of lips

21.  Nose
 No any discharge or bleeding
 Ear
 No any discharge or bleeding
 Hand
 Cold, moist and pink
 no clubbing, no peripheral cyanosis
 pulse rate were 86 beats per minute with regular
rhythm, good volume and normal character.

22. - Neck
 no enlargement of lymph nodes
 no stiffness of neck
- Throat
 no tonsillitis
- Axillary
 no lymph nodes enlargement
- Lower limb
 no deformities
 no muscle wasting
 no pitting edema

23. - Skin
 light pinkish color tone
 no rashes
 no pigmentation

24.  Temperature: 37°c ( reading taken at
axillary)
 Pulse Rate: 86 bpm
- rhythm : regular
- volume : normal
 Respiratory Rate : 24/minute
 Blood Pressure : 100 /56 mmHg (taken by
brachiocephalic during supine position)

25.  Anthropometry
 Weight: 20 kg
 Length : 119 cm
 BMI : 14.1 kg/m²

26.  RESPIRATORY SYSTEM
 inspection: shape of the chest was normal,
chest move with respiration bilaterally
 palpation: chest expansion was normal
 percussion: chest sound at upper & lower
zones, anterior & posterior was resonant
 auscultation: normal vesicular sound was
heard , no crackles or rhonchi sound

27.  CARDIOVASCULAR SYSTEM
 inspection: no chest deformities, there was well
healed midline scar on chest, apex beat was visible
and no visible pulsations
 palpation : no collapsing pulse, no radio-radial
delay
 auscultation : heart sound was normal without any
added sound (murmurs)

28.  GASTROINTESTINAL SYSTEM
 inspection: no abdomen discomfort , no
pigmentation, umbilicus centrally located and
inverted
 palpation: spleen and liver was not palpable, no
palpable mass felt
 percussion: dull sound heard, shifting dullness
present
 auscultation: normal bowel sound heard

29.  On examination, patient was well hydrated and
doesn’t show any significant sign and symptoms.
Furthermore, capillary refill time was not prolonged
and he was not anaemic.
 On systemic examination, the abdomen appeared
normal, there was no organomegaly and bowel
sound were present.

30. C.K.SURENTHIRAN
012010090079

31. POINTS FAVOURING
1. Vomiting
2. Diarrhea
3. Fever
4. Fatigue

32. 1. Food Poisoning
POINTS FAVOURING POINTS AGAINST
-Vomiting
-Fever
-Diarrhea
-Fatigue
-Consumption of outside
food
-No abdominal pain
-No headache
-No aching limbs
-No muscle weakness
-Other family members do
not present
similar symptoms

33. 2. Giardasis
POINTS FAVOURING POINTS AGAINST
-Diarrhea
-Vomiting
-Fever
-No general malaise and
weakness
-No abdominal distension
-No weight loss
-No passing of greasy stools

34. 3. URINARY TRACT INFECTION (UTI)
POINTS FAVOURING POINTS AGAINST
-Fever
-Vomiting
-No flank/abdominal pain
-No urinary symptoms
(dysuria,urgency,frequency)
-No history of incontinence

35. ABISHAG A/P KALI
012011100113

37. 2. BUSE
-electrolyte imbalance and dehydration
3. Urine Analysis
-rule out urinary tract infection
4. Stool Examination
-culture and sensitivity
5. Arterial Blood Gas (ABG)
6. Acid-Base Balance
7. Random Blood Glucose
-rule out lactose intolerance/hypoglycemia

38.  ORS plan A (200cc)
 Give extra fluid(IV/drinking water)
 Iron tablets
 Antibiotics
 Encourage orally
 Monitor patient’s vital signs
 Monitor plasma electrolytes
 Continue observation
 Return when there is poor oral intake, fever and
bloody stool

39. MATHILASHINI RETNAM
012011100178

40.  Drinking well water
 Eating undercooked food, especially seafood
 Improperly stored food
 Travel to high risk areas
 Any condition that causes a weakening of the
immune system such as:
 Diabetes
 Organ transplant
 Chemotherapy
 AIDS
 Living around poor sanitation

41.  Viruses (∼70%)
 Rotaviruses
 Noroviruses (Norwalk-like
viruses)
 Enteric adenoviruses
 Calciviruses
 Astroviruses
 Enteroviruses
 Protozoa (<10%)
 Cryptosporidium
 Giardia lamblia
 Entamoeba histolytica
 Bacteria (10-20%)
 Campylobacter jejuni
 Non- typhoid Salmonella
spp
 Enteropathogenic
Escherichia coli
 Shigella spp
 Yersinia enterocolitica
 Shiga toxin producing
E coli
 Salmonella typhi and S
paratyphi
 Vibrio cholerae

42.  Vomiting
 Watery diarrhea, sometimes
bloody mucus
 Abdominal pain, loss of
appetite
 Dizziness, headache
 Flu - like symptoms (fever,
chills)
Signs of dehydration :
 Urine scanty
 Rapid pulse
 Weight loss
 Loss of skin elasticity
 Infants:
 Depressed fontanelle
 Weak sucking reflex
 Reduced blinking eyelids
 Very low urine production

43.  Medical history and physical examination.
 Tests that may be used to evaluate gastroenteritis
 Stool culture
 Complete blood count
 Coagulation profile
 Liver profile
 Kidney profile
 Perform a blood culture if giving antibiotic therapy.
 Children with E. coli O157 infection require specialist
advice on monitoring for haemolytic uraemic
syndrome.

44.  A stool culture can detect:
 Cholera
 Shigella infection
 Campylobacter enteritis
 Cryptosporidium enterocolitis
 Giardiasis
 Pseudomembranous colitis:
 Clostridium difficile
 Salmonella gastroenteritis
 Traveler's diarrhea due to bacterial infection
 E. coli

45.  Oral rehydration solution
 The treatment of choice for children with mild to moderate
gastroenteritis,
 Agents used in the treatment and prevention of acute
pediatric gastroenteritis includes:
 Probiotics - used in the treatment and prevention of acute
diarrhea
 Zinc – used to treat diarrhea
 Metronidazole - In patients infected
with C.difficile and Giardia
 Tetracycline and doxycycline - For cholera
 Vaccine - In February 2006, the US Food and Drug
Administration (FDA) approved the RotaTeq vaccine for
prevention of rotavirus gastroenteritis

46.  Dehydration
 Metabolic acidosis
 Electrolyte disturbance (hypernatraemia,
hyponatraemia, hypokalaemia)
 Carbohydrate (lactose, glucose) intolerance
 Susceptibility to reinfection
 Development of food (cow's milk, soy protein)
intolerance
 Haemolytic uraemic syndrome
 Iatrogenic complications (due to inappropriate
composition or amount of intravenous fluids)
 Death

47.  http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1764079/
 http://www.freemd.com/gastroenteritis

48. THANK YOU