Case Discussion Atresia Ani: Icd 10: A18.2 Skdi: 4a

Case Discussion Atresia Ani ICD 10: A18.2 SKDI: 4A

SYARIFAH ANISA 1808436248

Patient’s Identity • • • • • • •

Name Age Gender Address No. of Medical Record Date of Hospital Admission Date of examination

: By. BS : 34 mounth : Male : Sungai parit, INHU : 989264 : 18th March 2019 : 20th March 2018

Chief Complaint Not Found anal since birth

Present Illness • 34 month ago, his mother said not found anal when his birth, After that his was diagnosed atresia anal. His used NGT and counseling to Regional hospital AA. • 33 month ago, patient to does colostomy. • 2 mount ago, patient does posterosagital anorectoplasty. • 1 day ago, patien does closing of colostomy.

• History of the decreased appetite (-), weight loss (-), bloated (+), nausea (+), vomiting(+)

Past Illness • History of cronic cough (-) • History of alergy of sulfonamide (+)

Family History • History of cronic cough (-) • Her aunt got carcinoma mammae

Medication History • • • • •

Herbal medicine (+) Antibiotic (+) Antiinflammation (+) Antipiretik (+) Analgetik (+)

Social economic • Patient live in densely populated area

Physical Examination • • • •

General appearance Conciousness Nutritional status Vital Sign – Blood pressure – Heart rate – Respiratory rate – Temperature

: mild illness : obey command : ≤90 % (bw: 36 kg, height: 147 cm) : 100/70 mmHg : 100 beat/min : 18 breath/min : 36,2 °C

Physical examination • • • • •

Head and neck : localized statue Thorax : normal Abdomen : normal Extremities : normal Genitourinary : normal

• Extra-oral examination (right side of neck) – Inspection : there was 2 nodules, erythema (-) – Palpation : 2 noduls was felt in the right side of submandibular region with imprecise border of nearly 3 cm x 3 cm and 2 cm x 1 cm, firm, mobile, firm in consistency, pain (+).

• Extra-oral examination (left side of neck) – Inspection : there was 2 nodules, erythema (-) – Palpation : 2 noduls was felt in the left submandibular region with imprecise border of nearly 2 cm x 1 cm and 1 cm x 1 cm, firm, mobile, firm in consistency. Intra-oral examination - Odontogenic involvement (-)

Working Diagnosis: Multiple Cervical Limphadenophaty due to suspect Tuberculous Lymphadenitis

Differential Diagnosis: Non tuberculous mycobacteria (NTM) lymphadenitis

Laboratory work up • • • •

CBC, Diff.count, LED test Chest X-ray Tuberculine test, gene expert Histopathology

• CBC, Diff. count, ESR(10/2/2018) – Hb: 12,6 gr/dl – Ht: 38 % – Wbc : 9.700/uL – Neutrofil : 66,8 % – Lymphosite : 21,9 % – Monosite : 7,6 % – Eosinofil : 3,4 % – ESR : 50 mm/hour (High)

• Tuberculine test : 7 cm • Gene expert : (-) • Histopathology – Excisional biopsy (7/3/2018) – There was chronic inflammation tissue due to Mycobacterium tuberculosis

Chest X-ray

Tb scoring in pediatric • • • • • • • •

Tb contact Tuberculine test Nutritional statue Fever with unspecific time Cronic cough Lymphadenophaty Swelling in pelvic, knee, finger Chest X-ray

: 0 (-) : 3 (> 10 cm) : 1 (bw/h : < 90 %) : 1 (> 2 weeks) : 0 (-) : 1 (> 1 lymph node enlargement) : 0 (-) : 0 (normal)

Total score : 6 1Dinihari TN,

Dewi R. Petunjuk Teknis Manajemen TB Anak. Jakarta: ISBN, 2013.

Diagnosis Multiple Cervical lymphadenophaty due to Tuberculous Lymphadenitis stade 1

Treatment Non Pharmacology • IVFD RL 26 tpm

Pharmacology • Paracetamol 3x500 ng • INH 1x300 mg • Rifampisin 1x150 mg

Cervical Lymphadenophaty Definition • A disorder of cervical lymph node which are abnormal in consistency and size.

Etiologies: • Acute bacterial lymphadenitis, subacute lymphadenitis, TB lymphadenitis (most common), Kawasaki disease, malignancy, etc

Tuberculous Lymphadenitis • The most common extrapulmonary manifestation of tuberculous • “Scrofula” : the classical term of tuberculous lymphadenitis • Incidence of tuberculous lymphadenitis depends on the endemicity of Mycobacterium tuberculosis

Diagnosis of Tuberculous Lymphadenitis • History : history of contact with source case like living in TB endemic community or children who is a household with infectious case TB, immunosupression condition like malnutrition, post measles or HIV, not BCG vaccinated. • Clinical presentation to suspect TB in children : cough, weight loss, fever and lymph node enlargement is persistent (>1 month) and not responsive to antibiotic • lymph node enlargement is most common in cervical region, painless, multiple, discreet or matted and in palpation, nodes are typically large > 2x2 cm 1International Union

Against Tuberculosis and Lung Disease. Child TB Management and IMCI. 2017

Classification of periferal tuberculous lymph node • Jones and Campbell : 1. Stage 1 : enlarged, firm, and mobile node showing non specific reactive hyperplasia 2. Stage 2 : large rubbery node fixed to surrounding tissue. 3. Stage 3 : central softening due to abscess formation 4. Stage 4 : collar-stud abscess formation 5. Stage 5 : sinus tract formation 1Mohapatra PR,

Janmeja AK. Tuberculous Lymphadenitis. JAPI. 2009; 57: 586

1Esposito

S, Tagliabue C, Bosis S. Tuberculosis in Children. Mediterr J Hematol Infect Dis. 2013; 5(1): e2013064

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