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1. 7 - 14 days

2. Iron defeciency anemia

2.1. Pharmacological

3. Iron sulfate

4. Third Session

4.1. Step (9): Review of Learning Objectives

4.1.1. 1- Management of a patient presented with gastroenteritis due to rota virus infecion

4.1.2. 2- Managment of UTI and iron defeciency anemia

4.2. Step (10): Management

4.2.1. Rota virus Before going to the hospital Symptoms Cry without tears Sticky mouth Craving for fluids Depretion of the fontanal Managment Usually is self limiting 3-9 days Short term Long term

4.2.2. UTI Complicated Duration of treatment Non complicated Duration of treatment Comments If age less than 2 monthes >> immediate hospitlization If febrile more than 2 days >> increase the duration of treatment Consider the most common organism based on age and consider resistance

4.2.3. Iron Ferous sulphate Check the stool Check iron profile Tablets or inject Non pharamacological

4.3. Step (11): Feedback & Resources

4.3.1. Resources Uptodate Medscap

5. Second Session

5.1. Step (6): Review of Learning Objectives

5.1.1. Most commone cause infection (90 percent) Viral Rota Presentation Bacterial Presnetaion Organisms Parasite Developing countries Presentation Organisms

5.1.2. Hirshsprung disease

5.1.3. Anatomical abnormalities Achlordia Start to appear at 2 years of aga

5.1.4. Drugs Antibiotics Impaired water reabsorbtion

5.1.5. Food posiging Goes away with

5.1.6. IBS

5.1.7. Chron's disease

5.2. Step (7): Gathering Information & Inquiry Plan

5.2.1. History History of presenting problem More than 10 diapers - green watery no blood stool For 2 weeks and then stopped Vomited of of the milk last 12 hours Febrile Crys alot Tried different formulas Rash that got resolved 2 of his siblings had it for 2 weeks (2 and 5 years old) No family history of diseases Past 3rd episode of diaheeewa Before it was yallow No other diseases No drugs No allergies Smiled at Developing Smiled at 6 Babbling sounds Peri 3.15 49 head CIRCUMSTANCE is 13 Complicated with minor bleeding Hypertension in the last 5 weeks Discharged at day 4 Vacination Hep b Social Could not attend clinics Stressed all the time Father often away from home Social Sister advice her sister

5.2.2. Physical Examination Thin face Vital 38 130 85/60 40 less than 2 sec 25 - 50 per less than 3rd per Loss folds Liver 2 cm beolw the margin Papular rash in arms and trunks and scratches too sick for accurate developmntal assessment

5.2.3. Investigation CBC 90g/liter Microcytosis and hypochromia Urin Less than 10 RBC 10 - 100 Mixed growth No growth of organisms in blood Sodium is high Potassium is low Urea us high Cer high Bic is low

5.3. Step (8): Diagnostic Decision

5.3.1. Mechanism

5.3.2. Presentation Vomiting - diah and faliure to thrive febrile not feeding well - siblings complain of same problem - poor medical care

5.3.3. Supporting Data Vomiting dia and faliure to thrive febrile not feeding well - siblings complain of same problem - poor medical care - low Hb - iron defeciency - high sodium, cer and urea - bacterial growth in urine - rota virus

5.4. Normal pattern of feeding

5.4.1. Regularity

5.4.2. Amount

5.4.3. Consider the following

5.5. Causes of faliure

5.5.1. Decreased intake Anamoly

5.5.2. Decreased appetit Anemia Infection

5.5.3. Decreas absorbtion Diarrhea Cystic fibosis

5.5.4. Increased ultization Hyperthyrodism

5.5.5. Others Neglect Poor eating pattern

5.5.6. Defention Rate of gain of wight is less compared to other children with the same age and

5.5.7. Less than 80 percent

6. First Session

6.1. Step (1): Identifying Difficult Words & Cues

6.1.1. Difficult Words Misrable

6.1.2. Cues 9 months infant Small for his age 5 kg Vomiting and diarrhea Brother and sister are unwell with similar illnese Lives 40 minutes frim the city

6.2. Step (2): Problem Formulation

6.2.1. 9 months old infant presented with vomiting and diarrhea. His is small for his age. His brother and sister are complaining of the same problem.

6.3. Step (3): Hypotheses Generation

6.3.1. Infection

6.3.2. Lactose intolerance

6.3.3. Malnurishmint

6.3.4. Acute gasteritis

6.3.5. Congnital problem

6.3.6. Triggers of vomiting could be organic or physiological

6.3.7. Diarrhea is a defensive mechanism

6.3.8. Less likely to be immune related Because of tropism

6.4. Step (4): Hypotheses Organization

6.4.1. Infectious

6.4.2. Inherited

6.4.3. Metabolic

6.5. Step (5): Learning Objectives

6.5.1. Common causes of acute diarrhea and vomiting in children (offensive and watery type of diarrhea)

6.5.2. Normal patterns of feeding in infants

6.5.3. Cause for failure to thrive