The history of the disease in pediatrics. Diagnosis: opisthorchosis
The history of the disease in pediatrics.
Diagnosis: Chronic opisthorchiasis, clinically expressed form.
Complaints on admission:
- Recurrent epidemiological pains in the right hypochondrium, epigastrium and around the navel. Between attacks there are constant pains of weak intensity, which increase when taking fatty food, physical activity. Acute pain is accompanied by multiple vomiting of bile and diarrhea.
- General weakness
- Subfebrel temperature (36,9 – 37,5 C)
- 2. Beginning and further development of the disease:
Attacks, according to the mother, appeared at the age of 2 years. In the family, the use of river fish is not denied.
Recurrent exudative pain in the right hypochondrium, epigastrium, and around the navel. Between attacks there are constant pains of weak intensity, intensifying when taking fatty food, chocolate, physical activity; the chair remains normal; appetite is bad. Acute pain relief is accompanied by paleening of the skin, sweating, repeated bile vomiting, which is removed only medication (tserukal) and diarrhea. In faeces there are undigested residues of food. The frequency of attacks on average 1 time in 3 months, the last attack occurred in late November, after which the gastroenterologist, who observed the child, issued a direction for admission to the Regional Children’s Clinical Hospital, where the patient is from December 9, 1998.
III. Anamnesis of the patient’s life:
The first child in the family, infected.
At birth, weight – 2800 g. Height – 50 cm.
Up to 1 year weight – 8kg., Height – 76cm.
It was applied to the chest 20 hours after delivery.
There was no jaundice. The umbilical wound healed in 5 days without complications.
Up to 1.5 years, breastfed milk was fed, from 2 months. began to receive litter.
In 3 months. began to turn over. The first tooth slit in 5 months.
To speak – in 9 months. To go – in 1g. 2 months.
Allergy – not detected.
Anamnesis of the life of parents.
Father 29 years , oilman – watchman. Hereditary diseases – not detected. Bad habits – smoking.
Mother 24 years old, a confectioner. Hereditary diseases – not detected. In the period of pregnancy, infectious-viral diseases were not tolerated. Bad habits – no.
Conditions of life and upbringing of the child.
Material support – Satisfactory.
Hygiene – observes.
The main educator – Mom.
Mode – spend at least 3 hours in the afternoon in the afternoon; TV – no more than 3 hours a day; goes to bed at 21:00; dream is good.
DDU – visited at the age from 2 to 3 years and from 4 to 5 (in the interspecific period)
Data of objective research
General condition of the patient – satisfactory
Temperature – 36,9 C
Position – active
Facial expression – calm
Eyes – wide open pupils – the same size,
reaction to light – living
Pulse – 95 ud \ min
Breath – 20 moves \ mins
Growth – 104 cm
Physical form – normostenick
Weight – 17 kg
Leather: elastic, clean, itchy – absent., Humidity – moderate, skin color of the face, neck, arms, body – easily pale, turgor retained
Mucous membranes – pink, pure
Subcutaneous tissue – expressed moderately, uniformly distributed, swollen no.
Lymph nodes (consistency, size, pain, twitching) – soft-elastic consistency, spindle
Salivary glands (submaxillary, parotid) are not enlarged, painless
The salivary glands (submaxillary, parotid) are not enlarged (0,2 x 0,3 cm), painless, mobile, no joints are detected. Muscular System – Medium Degree of Development, Tonus – Moderate, Morbidity and Seizures in Muscles Not Found
Bone system (configuration, pain) – without anomalies, painless. Skull – symmetrical, round shape
Joints – normal configuration, painless, volume of movements is not limited
Limbs – straight, proportional developed
Oral cavity – mucous smooth, pink; tonsils – not enlarged, not loosened, purulent detachable, pink; tongue – pink with a white patch
Teeth – complete children’s tooth formula (20 teeth, a good condition; at the top 4 right tooth there is no crown)
Neck (thyroid gland, vessels): thyroid iron is not enlarged; two portions are palpated; if swallowed, it is not determined;
the vessels of the neck are not enlarged, are located correctly
Form – funnel
Epigastric angle – 40 0
Intercostal bones – do not explode
Over- and sub-spaces – expressed moderately
Symmetry of respiratory movements symmetrical
Circumference with a quiet breath – 58 cm.
with deep breathing – 59 cm
with deep exhalation – 57 cm
The nature of the percussion sound of the tip of the lung – pulmonary
Mobility of the lung edge to the left and to the right – about 5 cm
the character of respiration – puerillium (exhalation is louder and
long – 1 \ 2 inhalation)
rips – not detected
noise of pleura friction – absent
bronhofoniya – uniform sound conduction (on the periphery
can be heard irresolute sounds)
Nasal breathing – free
Examination of the region of the heart and large vessels
Deformation, pulsation of the vessels of the neck – absent
apical impulse in 5 intercostal space, on the midlectric line, not spilled, not strengthened
The limits of the relative dullness of the heart:
Upper – 2 intercostal space
Right – Inward from the right parasternal line
left – 0.5 cm from the outside of the median-clavicular line (5 m \ r)
Auscultation of the heart:
1 tone – better heard at the top
– coincides with the pulse on the ray artery
– listens after a long pause
– on the top louder than 2 tones
– on the apex below the tonality than 2 tones
– listened after a short pause
– higher about tonality
– stronger on the aorta than on the pulmonary artery
Pulse – the same on both hands, normal filling, tension, wave of correct form, rhythmic, not frequent.
– on the right hand mm.rt. Article
– on the left hand mm. ht Article
pulse mm. ht Article
Study of the abdomen
The usual form. Visible peristalsis – no .. In palpation – mild, pain in the epigastrium and right hypochondrium.
Stomach at inspection – symptom of “shaft” negative
percussion – lower border above the navel of 1.5 cm.
palpation – large curvature is determined 2 cm above the navel, the wall is even, elastic, painless .
Liver Dimensions by Kurlov – 5: 4: 3.5 cm
The edge of the liver appears from below the right edge arch on the median-clavicular line at 1 see
Spleen upper face tsa – 9 rib, lower – 11 (spleen not enlarged)
Colostrum At palpation – elastic consistency, wall smooth, smooth, mobility sufficient, painless
Symptom of Pasternatsky (effusion) – negative
Palpation of the kidneys – not palpated
Urination – not difficult, painless, up to 6 – 7 times a day and 1 time at night
The state of the psyche and the nervous system
Memory – good | || 437
Behavior – without features
Vision: 1.0 for both eyes, the colors distinguish correctly
Taste: not perverted, sensations differentiate
smell: odors distinguish
hearing: not lowered
touch: heat / cold distinguishes
Assessment of physical development.
- Age 5.5 years
- Body length (standing) 104 cm
- Body weight 17 kg
- Circumference of the head 52 cm
- weight by age – 3 corridor (average indicator ı)
- length by age – 2 corridor (index below average)
- length by weight – corresponds to normostenic development
Conclusion: nervno- psyhycheskoe Physical Development and age of the child and corresponds otsenyvaetsya As harmonychnoe.
Biochemical blood test:
- Glucose 4.3 mmol / l
- Total protein 60 , 0 g \ l
- Bilirubin 4.6 μmol \ l
- Alpha-amylase 248 E \ l
- AHT 22.5 ME
- АсАТ 27,7 МЕ
- Alkaline phosphatase 328 ME
- Timolat test 1.8 ED
- Wasserman test t.
Conclusion: The rhythm is sinusoid. Heart rate 75 ud \ min. Horizontal position of the electric axis of the heart. Sinus arrhythmia. A-B Block I of Art. Signs of overload of the left ventricle.
- Background – disorganized, frequency 8-9 Hz, amplitude 75-190 μV, modulation – no, shape waves – sharpened
- beta activity – diffuse, frequency 30-32 Hz, amplitude 10 -25 μV || 676
- Delta activity – single diffuse waves, frequency 1,5 – 2 Hz, amplitude 60 – 90 μV
- sharp waves – single diffuse ones
- paroxysms – no
- Activation reaction – weakly expressed
interhemispheric symmetry – there is
focus t oligarchic activity – no
- reactive EEG – assimilation inconclusive at 4Hz, 8Hz
- reaction to hyperventilation – single, generalized BSCD alpha-0 range up to 1.5 sec.
Focal changes – no
General cerebral changes – sufficiently expressed
Epicactivity – no. Signs of mild irritation of the stem structures of the cerebrum.
- Recurrent exudate pain in the region of the right hypochondrium, epigastrium, and around the navel. Between attacks there are constant pains of weak intensity, which increase when taking fatty food, physical activity. Acute pain attack accompanied by multiple vomiting of bile and diarrhea.
- General weakness.
- Subfebral temperature (36.9 – 37.5 C) || | 723
Microscopy of stool
10,12,98 eggs of the worm – pozit, opisthorchiasis.
On the basis of clinical symptoms, analysis of subjective data and results of paraclinical studiesdiagnosis:
- Major disease: Chronicle Rhoz, a clinically expressed form.
- Complications: No .|| 744
Covert vertebro-basilar insufficiency.
Chronic opisthorchiasis must be differentiated with chronic cholecystitis.
- Recurrent exudative pain in the right hypochondrium, in the epigastrium, around the navel.
- Between acute attacks there are more or less permanent pressure pains of the same localization. | ||
- Provokes pain intensification: the use of greasy, fried, cold food; Physical and nervous overload
- The state of chronic intoxication, which causes prolonged subfebrile, weakness, astenisation of the nervous system (headache, dizziness).
- When palpation of the abdomen is pain in the right hypochondrium or in
- Enlargement of the liver (protruding on the right midlectric line by 1 cm).
For chronic cholecystitis
– reduction of gall bladder concentration capacity
– dyskinesia and various anomalies of the biliary tract with cholecystosis
– change in the echoliness of the walls of the gall bladder with ultrasound
For chronic opisthorchiasis:
– blood eosinophilia
VII. ETIOLOGY AND PATHOGENESIS
The causative agent is a cat or Siberian (Opisthorchis felineus); flat leaf-shaped helminth of the class Trematod-sassilians., which parasitizes in the bile ducts of the liver, gall bladder and pancreas. The first cycle of the development of opisthorches occurs in the reservoirs, the intermediate host for them is the carp species, the final owners are human and carnivorous animals; fish (cat, dog, pig, fox) are included in the food of the kotryhs.
Opisthorses injure the mucous membranes of the pancreatic and biliary tract as spines covering the body of young parasites and suction cups. The accumulation in the ducts of a large number of helminths (25000 to 36000 cases are known) create obstacles for the timely outflow of bile, contributing to the development of cystic dilatation of ducts. Hyperplasia of the glandular epithelium in opisthorchiasis predisposes to the growth of tumors in the liver. Extensive mechanical damage to the liver parenchyma and the replacement of defects with the connective tissue can lead to cirrhosis of the liver and, as a consequence, chronic hepatic insufficiency. There is also a toxic and nervous-reflex action of helminth, causing a disruption of the functions of other organs and systems (stomach, cardiovascular and nervous systems). At an early stage, there is a pronounced allergy to the body (eosinophilone leukemoid reactions of the blood).
VIII. TREATMENT OF THIS DISEASE:
Before treatment of opisthorchiasis spend weekly preparation of the patient:
- Antihistamines therapy
– Tavegil – inward for 1 \ 2 tablets (0.5 mg) in the morning and evening.
- Digestive enzymes
– Festal – 1 tablet during or immediately after meal.
– Allochol tablets – 1 tablet 3 times a day after meal.
– Essentiale – 2 capsules 3 times a day.
- Diet – table number 5 (proteins, fats, Carbohydrates – 1: 1: 4: The food is given in 4-5 receptions, always in warm form. Special culinary processing of products: chopping, peeling, wringing up to softness, steaming, products with lipotropic action – cottage cheese, egg white, cod, yeast. Fats – Vegetable Oil and Vegetable Oil Native form Various fruits, berries, vegetables, which are good causative agents of appetite, preventing constipation, having choleretic effect. Moderately limited consumption of cooked salt.
After the preparation, conduct specific antihelminthic treatment with the preparation Bilitricide:
The drug is taken inward at night according to the scheme:
– 50% dose at 22:00 hours
– 25 % dose at 2:00 hours
– 25% dose at 6:00 hours
At 8:00 am, a duodenal probe is performed (for a strengthened in
After duodenal prophylaxis, enter intravenous droplet Haemodez 200.0 ml once.
Treatment of lambliosis (a concomitant illness) also requires a weekly preparation of a boys according to the above proposed scheme, after which a specific treatment is performed Trichopolum (metronidazole):
– daily dose 0.25 g. Take in 1/2 tablets (0,125 g)
2 times a day during meals within 10 days. || | 867
After discharge from hospital to patient it is recommended:
– for 1 month to stick to the diet table No. 5.
– for 2 weeks, to take choleretic and hepatoprotectors
– for 1 week – toyabizy on Demyanov (take on an empty stomach 20 ml
30% solution Magnesium sulfate and lie with a warmer on the right side of the 2 hours.
After 6 months, make a second duodenal sounding.
The condition is satisfactory. Temperature 37.2 C
Complaints of pain in the right upper quadrant and around the belly button, fast fatigue. The appetite is bad. Treatment for lambliosis is prescribed. There is an examination: the feces are delivered to the eggs of the worm.
The condition is satisfactory. Temperature 37.0 C
Complaints of pain in the right hypochondrium and around the navel, fast fatigue. The appetite is bad. Treatment continues against lambliosis. The type of parasitosis is described – opisthorchiasis. Preparation of the patient for anti-helminthic therapy is underway.
The state is satisfactory. Temperature 36,7 С
Complaints of pain in the right hypochondrium and around the navel, fast fatigue. The appetite has improved. On December 23, a course of anti-helminthic therapy was conducted with Bilitricide.
The condition is satisfactory. Temperature 36,6 C
Complaints of pain in the right upper quadrant and around the belly button have decreased. The appetite has improved. The mood is cheerful. Repeated analysis of feces on opisthorchine eggs is negative. The patient prepares for an extract.
Time of arrival Dec. 9 1998
Age 5 years
Blood group IV, Rh Deny.
Diagnosis of the direction:
Chronic gastroduodenitis, exacerbation phase. Lymbilosis.
At the time of admission, he complained:
- Recurrent exudate pain in the right hypochondrium, epigastrium, and around the navel. Between attacks there are constant pains of weak intensity, which increase when taking fatty food, physical activity. Acute pain is accompanied by multiple vomiting of bile and diarrhea.
- General weakness.
- Subfebral temperature (36,9 – 37,5 C)
Frequency of attacks on the average 1 time in the faeces. For 3 months, the last attack occurred in late November, after which the gastroenterologist, who observed the child, issued a referral for admission to the Regional Children’s Clinical Hospital, where the patient is from December 9, 1998.
- Major disease: Chronic opisthorchiasis, clinically expressed form.
- Complications: None.
- Hypertension syndrome.
- Hidden vertebro-basilar insufficiency.
The patient received an antihelminthic course Preparation of Bilitricide and 10-day course of trichopolum versus concomitant lambliosis.
Outcome of the illness Recovery
Discharged December 28, 1998. To the patient given recommendations.