Update Management in common disease 28/10/59 , 31/10/59 รพ.กะเปอร์ นพ.ทวิพัฒน์ วัชโรทยางกูร

Outline Upper Respiratory tract symptoms Dyspnea Abdominal pain Urticaria Pediatric drug Fever Update CPG Leptospirosis

UPPER RESPIRATORY TRACT INFECTION

Upper Respiratory tract infection Common cold (acute nasopharyngitis) Pharyngitis Tonsillitis Sinusitis Most common cause is VIRAL.

Upper Respiratory tract infection History taking fever , cough , runny nose ,nasal discharge , sore throat

Upper Respiratory tract infection Physical examination

Upper Respiratory tract infection

Upper Respiratory tract infection

Upper Respiratory tract infection Diagnosis : dominant symptoms, examination Nasal symptoms: Rhinitis, sinusitis ,nasopharyngitis Nasopharyngeal symptoms: pharyngitis, nasopharyngitis Pharyngeal symptoms: pharyngitis ,sinusitis URI?

Upper Respiratory tract infection Management Advice : Rest, fluid intake, keep warm Medication : supportive treatment Avoid transmission. When to use Antibiotics?

Dyspnea

Dyspnea Dyspnea ≠ Tachypnea

Dyspnea Physical examination : Vital sign : Temp. ,BP ,PR ,RR Retraction Lung sound Stridor Wheezing Crepitation Secretion sound Rhonchi

Normal Breath sound

Wheezing

Wheezing

Wheezing

Rhonchi

Stridor

Stridor

Crackle /Rales /Crepitation

Crackle /Rales /Crepitation

Test

Management in dyspnea Reliable on severity and diagnosis(lung sound) Maintain airway O2 supply Definite treatment

Abdominal pain

Abdominal pain Localizing pain Physical Examination

RUQ+Epigastrium pain What organ? Differential diagnosis Dyspepsia Gastritis Hepatitis Billiary colic Cholecystitis Cholangitis Pancreatitis Peptic ulcer

RUQ +Epigastrium pain History taking Characteristic of pain ,onset ,duration ,timing ,severity ,cause ,factor ,radiation ,associate symptoms Liver+biliary system : Jaundice , dark urine, pale feces Stomach : Nausea/vomiting , meal/food, Pancrease : alcohol Intestine : diarrhea, constipation

RUQ +Epigastrium pain Physical examination Inspection : distend/scaphoid Palpation: soft/guard , tender? Purcussion : tympanic/dullness

RUQ +Epigastrium pain Differential diagnosis Dyspepsia Gastritis Hepatitis Billiary colic Cholecystitis Cholangitis Pancreatitis Peptic ulcer Tender

Lt.side Abdominal pain What organ? Differential diagnosis Dyspepsia Gastritis Pancreatitis Peptic ulcer Enteritis AGE

RLQ Abdominal pain What organ? Differential diagnosis Appendicitis Enteritis AGE Cystitis KUB stone PID Ovarian cyst Ectopic pregnancy

RLQ Abdominal pain History taking associate symptoms Appendicitis : fever ,Migratory pain, anorexia, N/V(Avarado score) Intestine : diarrhea, constipation KUB : hematuria ,dysuria Gyne : leucorrhea, LMP PE : Tender?

RLQ Abdominal pain Differential diagnosis Enteritis AGE KUB stone Cystitis PID Rupture Ovarian cyst Ectopic pregnancy Appendicitis Tender

Avarado’s score

URTICARIA

Urticaria Definition : Raised, itchy areas of skin that are usually a sign of an allergic reaction. DDx : Dermatitis, Anaphylaxis

Urticaria History taking : Duration, Allergen?(contact,eating) ,Hx.of allergy Rule out anaphylaxis : Shortness of breath ,chest discomfort ,collapse ,nausea/vomitting

Anaphylaxis

Urticaria Physical examination Vital signs : Temp., BP ,PR ,RR Heart & Lungs & Abdomen Skin ,mucosal

Urticaria

Urticaria

Urticaria Management Antihistamine : Chlorpheniramine Steroid? Topical agent : calamine lotion Advice for observe allergen and avoidance

Pediatric drug dose

Pediatric drug Antibiotics Amoxycillin Supportive drugs Erythromycin Glyceryl guaiacolate Co-trimoxazole Chlorpheniramine Acetaminophen Salbutamol Domperidone Dicyclomine

Pediatric drug 10 Kg/ 1tsp(5ml) 20 Kg/ 1tsp(5ml) Antibiotics Supportive drugs Amoxycillin Glyceryl guaiacolate Erythromycin Chlorpheniramine Co-trimoxazole Salbutamol Acetaminophen Domperidone Dicyclomine

Pediatric drug

FEVER

Fever Definition : Core Body temperature ≥ 100ºF (37.8ºC) Grading : Low 100-101ºF (37.8-38.3ºC) Moderate 101-102ºF (38.3-38.9ºC) High > 102ºF (38.9ºC) Variation by air temp.,location,timing Caused by inflammation/infection

Fever History taking Acute/chronic Characteristic of fever : timing,grading,duration,response Specific organ symptoms : Repiration,GI,GU,Soft tissue,CNS Systemic symptoms : Malaise,fatigue,myalgia,anorexia Personal history : travel, camping

Fever Physical Examination Vital sign Specific organ Specific sign: Eschar, conjunctivitis, PPE

Fever Diagnosis : up to cause of fever. Acute Febrile illness (AFI)

Fever Management Tepid sponge Advice : Rest , Hydration Medication : Acetaminophen

LEPTOSPIROSIS

Leptospirosis Leptospirosis is a zoonosis, endemic mainly in countries tropical climates. Caused by Leptospira (long corkscrew-shaped bacteria)

Leptospirosis of food/droplet aerosols of fluids contaminated by urine - Infection occurs through ingestion/inhalation of food/droplet aerosols of fluids contaminated by urine - The incubation usually lasts about 10 days (2 to 30 days).

Leptospirosis Clinical manifestation

Leptospirosis LAB investigation CBC , UA BUN, Creatinine ,LFT Confirm diagnosis 1. Culture : gold standart but has no benefit for treatment. 2. Serology : After day 5-7 of symptoms Microscopic agglutination test (MAT) indirect hemagglutination test (IHA) enzyme-linked immunosorbent assay (ELISA) Lepto dipstick

Update CPG Leptospirosis แนวทางการตรวจวินิจฉัยโรคเลปโตสไปโรซิส.pdf

Conclusion Upper Respiratory tract symptoms Dyspnea Abdominal symptoms Urticaria Pediatric drug Fever Update CPG Leptospirosis

References Harrison internal medicine 19th edition. Symptomatology-student pocket book of symtomps and sign. www.thinklab.com www.who.int/zoonoses/diseases/Leptospirosissurveillance.pdf med.md.kku.ac.th/site_data/mykku_med/701000033/Leptosp irosis.pdf

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