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Chronic diarrhea in HIV Family Case PowerPoint Presentation

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Description : Family Case

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Published on : Feb 23, 2020 | Views : 2373 | Downloads : 4

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Slide 1-

REPUBLIC OF THE PHILIPPINES DEPARTMENT OF HEALTH DR. JOSE R. REYES MEMORIAL MEDICAL CENTER Medical Grand Rounds Moderator: Dr. Higinio Mappala Reactor: Dr. Mario Panaligan Dr. Darshan Kumar Gurung Dr. Madelle De Leon Dr. Nawli Manandhar Double Trouble: Chronic diarrhea in HIV
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Objectives: To present a case of chronic diarrhea in HIV patient. To discuss the approach to diagnosis and management of HIV patients with chronic diarrhea. To present the epidemiology of HIV and AIDS in the Philippines. To present the fast tract approach to target sustainable developmental goal in HIV/ AIDS patients in the Philippines.
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General data L.G. 26-year old Male Single Bulacan City
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Chief complaint loose watery stools
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History of present illness
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History of present illness
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History of present illness ADMISSION
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Review of systems
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Past Medical History Non-hypertensive Non- diabetic No history of PTB Non-asthmatic No history of blood transfusions, tattoos No known food and drug allergies
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Family history (-) hypertension (-) Diabetes (-) cancer (-) stroke
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Personal social history non-smoker occassional alcoholic beverage drinker denies illicit drug abuse occupation: respiratory technician sexual history: Multiple male partners
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Physical Examination
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Physical examination
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Salient features 26M chronic watery stool, abdominal pain, loss of appetite and fever weight loss 7kg over 1 month Multiple Male sexual partners Febrile Tachycardic at 102bpm Dry lips, Whitish plaque buccal mucosa Flat, soft, hyperactive bowel sounds
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Initial Impression: Chronic diarrhea of undetermined etiology with mild dehydration.
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Courses in the ward
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1st hospital day intermittent fever Loose watery diarrhea Diagnostics: CBC Na, K creatinine fecalysis urinalysis Treatment: Paracetamol 300mg IV q 4 hrs for fever Nystatin 100,000 IU/ml 5ml qid Referred to ID service
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2nd hospital day IDS: Impression: Immunocompromising conditions with multiple opportunistic infections: Oral Candidiasis Chronic diarrhea TB and PCP Hepatitis B infection Piptazo 4.5mg IV q6 TMP-SMX 160/800mg 1 tablet OD Continue Nystatin
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2nd hospital day Additional labs were requested such as Hepatitis profile blood CS mycobacterial blood C/S RPR, VDRL serum CALAS modified acid fast stool PPD
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4th hospital day intermittent fever diarrhea occasional cough INH 300mg/tab 1 tab q24h Azithromycin 500mg/tablet 2 & ½ tablet every Saturdays
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5th hospital day episodes of vomiting hypotensive episodes 70/40 Fluid challenge of 1L
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10th hospital day Sent home with following meds: Levofloxacin 750mg/tab OD for 6days TMP-SMX 160/800MG 2tabs three times a day for 2 weeks then OD Azithromycin 500mg/tab 2and ½ tab q weekly (every Friday) till follow up INH 300mg/tab 1tab q24 for 9 months Multivitamin 1 tab OD Nystatin 100,000 units/ml 5ml TID for till follow up
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Diarrhea passage of abnormally liquid or unformed stools at an increased frequency stool weight >200 g/d
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Diarrhea >4 weeks
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Chronic infectious Parasites: G. lamblia, E. histolytica AIDS related: Viral: CMV Bacterial: C. difficile, Mycobacterium avium complex Protozoal: microsporidia (cryptosporidium, isospora belli,enterocytozoon bieneusi)
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Inflammatory conditions Idiopathic inflammatory bowel disease Crohn’s and chronic ulcerative colitis Malignancy lymphoma Adenocarcinoma Radiation enteritis HIV Enteropathy
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Final diagnosis HIV enteropathy Acute hepatitis B infection, infective
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Thank you..
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WAB UTZ 9/21/2016: Hepatomegaly with fatty infiltrates, normal sized GB with reactive GB wall thickening, minimal ascites, bilateral pleural effusion
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Blood c/s : no growth
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Urine R/E: Color: yellow Character: clear Reaction: 6.0 Sp gravity: 1.020 Sugar/protein/bil/ketone/urobilinogen/nitrite- negative RBC: 0-3 WBC: 0-2 Crystals: none found Epithelial cells: few Bacteria: few Cast : none Mucus thread: few
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