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Anamnesa dan PF anak

History

On the basis of the chief complaint, the pediatrician must ask question that help distinguish between common and potentially life threatening entities.

Common complaints

Altered mental status

Vomiting
Respiratory distress Fever Abdominal pain

Altered mental status

Should inquire about the presence of fever or headache Screening Q?:

Feeding changes

Medication in the household


Trauma possibility

Lethargic in febrile patients must be differentiated from lethargic child with sepsis or meningitis Child w/ sepsis or meningitis:

May have irritability history And/or inconsolability

Not waking up for feeding


Poor feeding Grunting respiration

Seizures
Decreased urine output

Patiens w/ poisoning or inborn error metabolism can also be present with lethargy, poor feeding, seizure and vomiting.

Nonaccidental trauma should always be considered in lethargic infant.


Child w/ meningitis may hv:

History of fever
Complaints of neck pain Photophobia vomiting

In ingestion can be present:

Ataxia
Slurred speech Seizures

Characteristic constellations of vital sign changes


Other physical findings (toxidromes)

vomiting

Vomiting is a very common complaint of intestinal, abdominal (pancreas,liver) or non-GI (hyperammonemia, increased intracranial pressure)

Care should be taken to determine whether the emesis is bilious => suggestive of intestinal obstruction

Other historical data

Presence of abdominal distention

Weight changes
Presence of diarrhea Obstipation or hematochezia History of trauma Presence of headache

Common causes of vomiting are gastroesophageal reflux and viral gastroenteritis In infant, bilious emesis and abdominal distention and/or pain are worrisome for obstruction. Important to consider extra-abdominal causes in neonate e.g: hydrochepalus, incarcerated hernia, inborn errors of metabolism, nonaccidental trauma

In older child, the DD includes:

Intussusception (vomiting, colicky abdominal pain may present)


Incarcerated hernia

Diabetic ketoacidosis
Appendicitis Poisonings

Trauma

Patient w/ headache and vomiting, concern for increased intracranial pressure and should be questioned about neurologic changes, meningismus and fever

Respiratory distress

Normal variations in respiratory patterns must be distinguished from true respiratory distress Ask about associated symptoms such as fever, limitation of neck movement, drooling, choking, stridor ,or wheezing History of apnea or cyanosis warrants further investigation

Infants with congenital heart defects may be tachypneic but may lack any signs of resp.distress. In older children with wheezing after coughing or choking episode must be evaluated for a foreign body aspiration. Stridor is most commonly due to croup

Toxic appearing child w/ resp distress

Check possibilities of:

Epiglotitis
Bacterial tracheitis Rapidly expanding retropharyngeal abscess (may present with drooling, limitation of neck movement (esp. hyerextension)

Fever

Most fevers are the result of self limited viral infections In first 3 months, pathogens that can cause sepsis:

Group B streptococcus
E. coli Listeria monocytogenes Herpes simplex virus

In neonates, history mus include obstetric information and patient's birth history Septic infant can present w/:

Lethargy

Poor feeding
Grunting respirations Impaired perfusion fever

Bacterial pathogens in infants above 3months:

Streptococcus penumoniae
H.influenzae type B Neisseria meningitidis

Other ailments with fever manifestation

Septic arthritis (only one joint, painful and often w/ pseudoparalysis of that joint) Osteomyelitis Juvenile rheumatiod arthritis (pain, stiffness, swelling, warmth in several joints) Kawasaki disease

Abdominal pain

Often this symptom is due to a minor illness such as:


Constipation Functional abdominal pain

Urinary tract infection


Gastroenteritis

Ask about: stooling patterns, abdominal distention, fever, urinary symptoms, vomiting.

In neonates,appear ill and tender abdomen is concerning for presence of small bowel obstruction. There may be history of vomiting and decreased or no stooling

Bloody stools can also present in milk protein intolerance but these infants are well appearing and no abdominal tenderness

Diagnosis of appendicitis in the child younger than 3 years is difficult because they do not localize their pain well. Diagnosis is often made after the appendix has ruptured.