Patient ID: A.C, a 4 year old female from Daraga Albay. History source – Mother 100 % reliability. Chief compliant: Persistent vomiting. History of present illness: 2 weeks PTA the patient experience abdominal pain with painful urination. No fever, no vomiting, nor watery stool. No medication nor consult was done. 7 days PTA, the patient presented with an episode of vomiting with the passage of live worms. She also experience abdominal pain without passage of stool for 2 days. 6 days PTA, the abdominal pain was persistent and with several episodes of vomiting but no passage of live worms. A few hours PTA, the persistence of abdominal pain, increased frequency of vomiting and presence of abdominal distention prompted them for consult. Past medical history: (+) Bronchial asthma with last attack 1 month ago. (-) Heart disease.
Patient ID:
A.C, a 4 year old female from Daraga Albay. History source – Mother 100 % reliability.
Chief compliant: Persistent vomiting.
History of present illness:
2 weeks PTA the patient experience abdominal pain with painful urination. No fever, no vomiting, nor watery stool. No medication nor consult was done.
7 days PTA, the patient presented with an episode of vomiting with the passage of live worms. She also experience abdominal pain without passage of stool for 2 days.
6 days PTA, the abdominal pain was persistent and with several episodes of vomiting but no passage of live worms.
A few hours PTA, the persistence of abdominal pain, increased frequency of vomiting and presence of abdominal distention prompted them for consult.
Past medical history:
(+) Bronchial asthma with last attack 1 month ago.
(-) Heart disease.
Family history:
(+) DM, maternal and paternal side.
(-) Cancer, cardiac disease, kidney and asthma.
Birth and Maternal history:
24 G1P1 mother with intake of FeSO4 and Ca. She is born term, with good cry and activity at birth. With passage of meconium @ first 24 hours of life.
Nutritional history:
Exclusive breastfeed until 1 year and 2 month, then given bear brand. Complimentary feed @ 7 months. Preferred foods are rice, fish meat and eggs. Dewormed once @ 2 years old after passing out worm in stool.
ROS:
No weight loss, fever, headache, epistasis and difficulty of swallowing. No coughs/colds. No palpitations, No edema, no seizures. (-) chest pains. Occasional abdominal pain with on and off passage of soft watery stool.
PE:
Wt: 11 HT: 92 cms
T: 38.1 deg C.
CR: 115/min, RR: 32/min.
HEENT: anicteric sclera, pale palpebral conjunctiva, (+) cervical lymphadenopathies.
Chest and heart: Symmetric expansions. Clear breath sounds, tachycardia, no murmurs.
Abd: Hypoactive bowel sounds, tympanic all over, (+) tenderness.
Extremities: Full and equal pulses, CRT <2 seconds.
DRE: No mass, tight sphincter tone. Empty rectal vault, (+) dark red blood on examining finger.
Imaging:
UTZ - unremarkable liver, biliary tree and spleen
Abd x-ray: Complete bowel obstruction.
Final diagnosis: Complete Small bowel Intestinal obstruction secondary to parasitic infection.
Questions:
- What are the possible signs and symptoms of intestinal obstruction in the patient?
- What is the most common nematode
parasite that can cause intestinal obstruction? Draw its infective and diagnostic stages. - Will you perform fecal analysis? Why or why not?
- What is the anti-parasitic drug of choice used for this parasite?
- Is co-infection possible? If yes, what is the most likely intestinal nematodes that can co-infect in humans?
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