long case,Wilms tumor Copy most common renal malignancy in children.pptx
- 1. Long case presentation Presenter Dr. Md Jafor Ekbal MS, Phase B Resident Paediatric Surgery, MMC
- 2. Particulars of the patient Name : Tayeba Age : 18 month Sex: Female Address : Modon, Netrocona Religion : Islam Date of admission : 19th August 2024 Date of examination : 19th August 2024
- 3. Chief complain Left sided abdominal swelling for 3 month.
- 4. History of present illness According to the statement of mother, the child was resonably well 3 month back. Then she incidentaly saw Left sided abdominal swelling. She said that swelling is rapidly increasing in size and painless. The mother did not give any history of fever, jaundice, hematuria, vomiting, cough, hemoptysis or bone pain. Her bowel and bladder habit is normal.
- 5. Treatment History The child was treated initially by local physicians and subsequently transfered to Paediatric department of MMCH. Then after some investigation she was diagnosed as a case of nephroblastoma and 6 cycle chemothery received but swelling did not subside. Now the patient admitted in Paediatric Surgery department of MMCH for further management.
- 6. Antenatal history : Uneventful Natal history : The child was delivered at term at home by NVD. Family history :.He came from low income family. Third issue of nonconsanguinous parents.There is no such kind of disease in her family. Dietary history :She lives on family diet. Immunization history :She is immunized as per EPI schedule.
- 7. General examination Appearance : ill looking Body built: average Anaemia: Mildly anaemic Jaundice : Absent Cyanosis : Absent Clubbing : Absent Edema : Absent Temperature : 98 尊F Respiratory rate : 25 breaths per minute Heart rate : 110 beats/ minute Lymph node : Not palpable
- 8. Systemic examination GIT Mouth and oral cavity : Healthy Abdomen: Abdomen is distended which is more marked on left side.Umbilicus is centrally placed. There is no visible peristalsis or engorged vein.There is a lump in left lumber region extending upto umbilical,left hypochondriac and left iliac region but not crossing the midline. Lump is15 13 cm in size, irregular in shape, non tender, firm in consistency, surface is smooth, margin is well defined and moves with respiration.
- 9. It is ballotable and is free from underlying structure. Right kidney is not ballotable, Liver, spleen, urinary bladder is not palpable. External genitalia are normal. Anus is in normal position. Hernial orifices are intact. DRE: No abnormality ditected.
- 10. Nervous system : Reveals normal Respiratory system : Reveals normal Cardiovascular system : Reveals normal
- 11. Salient feature Tayeba, !8 month old girl presented with Left sided abdominal swelling which is rapidly increasing in size and painless. Her mother did not give any history of fever, jaundice, hematuria, vomiting, cough, hemoptysis or bone pain. Her bowel and bladder habit is normal. The child was treated initially by local physicians and subsequently transfered to Paediatric department of MMCH. Then after some investigation she was diagnosed as a case of nephroblastoma and 6 cycle chemothery received but swelling did not subside.
- 12. Now the patient admitted in Paediatric Surgery department of MMCH for further management. The child is anemic but not icteric ,vital signs are within normal limit. Accessible LN are not palpable. There is no bony tenderness. Abdomen is distended which is more marked on lt lumber region measuring about 1513 cm in size, irregular in shape, non tender,firm in consistency, surface is smooth, margin is well defined and moves with respiration.It is ballotable, right kidney is not ballotable. No other organomegaly. There is no ascities. External genitalia are normal. Examination of other system reveals normal.
- 13. Provisional diagnosis Post chemotherapy state of Nephroblastoma
- 18. Continue..
- 23. Pre operative diagnosis Postchemotherapy state of nephroblastoma
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