COMMAND: Do general physical and relevant examination of 4 month infant with jaundice since birth.
D/D :
Neonatal hepatitis
Biliary Atresia
Galactosemia
Hypothyroidism
PFIC
I have examined 4 month old Ahsan who is a well looking, active and co-operative infant with obvious scleral icterus , having normal facies, pink in room air with no respiratory distress.
His Right radial pulse rate is 110/min which is regular , good in volume , RR is 29/min and he is afebrile with temperature of 99 degF.
His OFC is 44cm , length is 67 cm and weight is 5.8Kg ,i would like to plot on percentile charts,
He has jaundice with no evidence of pallor, petechiae or bruises, cataract, edema, coarse dry skin, hypothermia, protruding tongue or hypotonia. BCG scar is present, oral cavity examination is normal, his cornea are are healthy looking.
Abdomen is distended with a central , everted umbilicus with a horizontal slit , there are prominent veins with that fill away from umbilicus., there are no scar marks, abdomen is nontender, liver is palpable 4cm below RCM e upper border in 4th ics in MCL e total span of 8 cm,it is nontender firm in consistency ,regular margins, left lobe is not palpable.Spleen is enlarged 4cm below LCM towards Lt Iliac fossa,it is firm in consistency and splenic notch is palpable, and hand cannot be instituted beneath LCM, it is not balotable. There is no other visceromegaly and no masses are palpable, there is evidence of free fluid in the abdominal cavity in the form of shifting dullness.BS are audible and of normal intensity.
hernial orifices are intact , genitalia exam and examination of back is normal,testes are palpable in scrotum,I could not see stools in diapers i would like to see the diapers with stools if possible.
Examination of CVS , CNS , Resp system is unremarkable.
I would like to do fundoscopy of the infant and do formal developmental assessment.
D/D :
Neonatal hepatitis
Biliary Atresia
Galactosemia
Hypothyroidism
PFIC
I have examined 4 month old Ahsan who is a well looking, active and co-operative infant with obvious scleral icterus , having normal facies, pink in room air with no respiratory distress.
His Right radial pulse rate is 110/min which is regular , good in volume , RR is 29/min and he is afebrile with temperature of 99 degF.
His OFC is 44cm , length is 67 cm and weight is 5.8Kg ,i would like to plot on percentile charts,
He has jaundice with no evidence of pallor, petechiae or bruises, cataract, edema, coarse dry skin, hypothermia, protruding tongue or hypotonia. BCG scar is present, oral cavity examination is normal, his cornea are are healthy looking.
Abdomen is distended with a central , everted umbilicus with a horizontal slit , there are prominent veins with that fill away from umbilicus., there are no scar marks, abdomen is nontender, liver is palpable 4cm below RCM e upper border in 4th ics in MCL e total span of 8 cm,it is nontender firm in consistency ,regular margins, left lobe is not palpable.Spleen is enlarged 4cm below LCM towards Lt Iliac fossa,it is firm in consistency and splenic notch is palpable, and hand cannot be instituted beneath LCM, it is not balotable. There is no other visceromegaly and no masses are palpable, there is evidence of free fluid in the abdominal cavity in the form of shifting dullness.BS are audible and of normal intensity.
hernial orifices are intact , genitalia exam and examination of back is normal,testes are palpable in scrotum,I could not see stools in diapers i would like to see the diapers with stools if possible.
Examination of CVS , CNS , Resp system is unremarkable.
I would like to do fundoscopy of the infant and do formal developmental assessment.
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