Continuous
Gastrointestinal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P8_F1.jpg"}},{"insert":"\n\n"},{"insert":"It has been a busy, but otherwise completely banal Monday so far. \r\n\r\n\u0022Shall I send the next patient in, doctor?\u0022, the nurse asks.\r\n \r\nA couple of seconds after you nod \u0022yes\u0022, a mother and baby are in front of you.\n\nThirty-three year old Jacqui is well known to you. You first saw her around a year ago, when she became pregnant for the first time.\r\n\r\nFollowing an uncomplicated pregnancy, her daughter Lily was delivered vaginally, at term. Thus far, both mother and baby have been healthy.\n"}]}
1
{"ops":[{"insert":"Three-month-old Lily is the patient today. \u0022She has been coughing quite a lot lately\u0022, Jacqui says, and continues, \r\n\r\n\u0022She is also a little unsettled, especially during feeding, and sometimes she vomits right after feeding, and now I\u0027m short on breast milk.\u0022\n\n\u0022She is hungry and fussy, but she won\u0027t latch on, so I tried formula, but she hasn\u0027t been too keen on that either. Do you think she is getting sick?\u0022, Jacqui asks worriedly.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P8_F3.jpg"}},{"insert":"\n\n"},{"insert":"Jacqui describes her baby\u0027s cough as non-productive, with white-colored vomitus.\r\n \r\nNo other symptoms are present, her growth and development are age-appropriate, and all immunizations are up to date.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P8_F4.jpg"}},{"insert":"\n\n"},{"insert":"Upon examination, you note that Lily\u0027s heart rate is 140 bpm, respiratory rate is 30 cycles per minute, and temperature is 37\u00b0C.\r\n \r\nHer anterior fontanelle is open, and tympanic membranes and throat are of normal appearance. Auscultation of her chest reveals no untoward findings.\n\nLily cries loudly during the physical examination, but shows good head support, and establishes brief eye contact.\n\n\u0022Well, my guess is that Lily\u0027s cough is due to milk reflux\u0022, you say.\n"}]}
4
{"ops":[{"insert":"What will you recommend?\n"}]}
1. An antacid suspension for infants
2. An omeprazole suspension
3. Improved breastfeeding technique and positioning
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