Case Discussion

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

SYARIFAH ANISA
1808436248
 Patient’s Identity
• Name : By. BS
• Age : 34 mounth
• Gender : Male
• Address : Sungai parit, INHU
• No. of Medical Record : 989264
• Date of Hospital Admission : 18th March 2019
• Date of examination : 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 : mild illness
• Conciousness : obey command
• Nutritional status : ≤90 % (bw: 36 kg, height: 147 cm)
• Vital Sign
– Blood pressure : 100/70 mmHg
– Heart rate : 100 beat/min
– Respiratory rate : 18 breath/min
– Temperature : 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) • Tuberculine test : 7 cm
– Hb: 12,6 gr/dl • Gene expert : (-)
– Ht: 38 % • Histopathology
– Wbc : 9.700/uL – Excisional biopsy (7/3/2018)
– Neutrofil : 66,8 % – There was chronic
– Lymphosite : 21,9 % inflammation tissue due to
– Monosite : 7,6 % Mycobacterium tuberculosis
– Eosinofil : 3,4 %
– ESR : 50 mm/hour (High)
Chest X-ray
 Tb scoring in pediatric
• Tb contact : 0 (-)
• Tuberculine test : 3 (> 10 cm)
• Nutritional statue : 1 (bw/h : < 90 %)
• Fever with unspecific time : 1 (> 2 weeks)
• Cronic cough : 0 (-)
• Lymphadenophaty : 1 (> 1 lymph node enlargement)
• Swelling in pelvic, knee, finger : 0 (-)
• Chest X-ray : 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 Pharmacology
• IVFD RL 26 tpm • 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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