55 yr old Male with SOB and swelling

A 55 year old male came to the hospital with the chief complaints of shortness of breath since 10 days and swelling of legs since 10 days and low grade fever since 5 days
HOPI- patient was apparently asymptomatic 10 days ago, then he developed shortness of breath which is insidious onset, gradually progressive grade 2 aggrevated on exertion and relieved on taking rest, he developed edema of legs bilateral pitting edema, extending till knees aggraveted on walking and relieved on rest 
11/03/2021- one session of dialysis is done, edema of left leg is reduced
history of knee joint pains, morning stiffness+
history of trauma of the right upper limb at the level of shoulder joint while playing kabbadi
no history of chest pain and palpitations 
past history- he had similar complaints 1 month ago, he went to the hospital and got diagnosed as ckd and undergone dialysis-5 sessions.
18/03/2022 -dialysis done,
19/03/2022-No SOB,No joint pains,No morning stiffness.
history of dm since 3 years and on metformin 
history of htn since 6-7 months 
no history of tb,asthma, epilepsy, thyroid disorders 
personal history - patient was farmer by occupation, he used to go to his farm daily. He developed joint pains since last 7-8 months for which he is taking painkillers one or two daily( depending upon the severity of pain) diet-mixed, appetite-decreased, sleep- inadequate due to pain, bowel and bladder movements- regular
addictions- country liquor since 5 years due to stress and Beedi (daily 5) since 20 years
but stopped having any right now.
general examination-
patient is conscious coherent and cooperative, well oriented to time place and person 
pallor- present 
icterus- present 
cyanosis,clubbing, generalised lymphadenopathy- absent 
bilateral pitting edema present 
vitals- 
temp- afebrile
pulse rate-76bpm
blood pressure- 90/60 mm of hg
respiratory rate- 16cpm
grbs- 235 mg/dl
spo2-98%
systemic examination
cvs- s1,s2 heard no murmurs heard 
respiratory system- vesicular sounds ,crackles ?
per abdomen - no visible scars or sinuses, all quadrants are moving equal with respiration, no hernial orifices seen 
no dilated or tortuous veins
liver palpable, spleen not palpable
no tenderness
shifting dullness+
CNS - 
Minimental status examination- normal
cranial nerve examination- normal
motor system - bulk of muscles - bilaterally symmetrical
tone of muscles- decreased on right side
power of muscles 
                        right. left 
upper limb 4/5 5/5
lower limb 4/5 5/5
reflexes 
                  right. left
biceps + ++
triceps + ++
supinator ++ ++
ankle + ++
knee + ++
plantar. no response. no response
investigations- cbp,ldt,rft, usg, grbs
usg showed all 4 chambers of heart are dilated
provisional diagnosis- ckd due to nsiad induced nephropathy?
heart failure with reduced ejection fraction
mild ascites 
Learning objectives:
14/03/2021- patient is in altered sensorium, fever +, TLC-27000, urea-187mg/dl, creatinine-7.9 mg/dl
One session of dialysis was done yesterday morning
Urea after dialysis- 95 mg/dl, creatinine-4.1mg/dl
Learning objectives from class
AKI causes- prerenal- dehydration, heart failure, sepsis
Renal - ATN, GLOMERULONEPHRITIS,vasculitis
Post renal- bilateral urinary calculi
Bph, bladder cancer 
CKD criteria

Comments

Post a Comment

Popular posts from this blog

56F Abdominal pain 5 years, ileal perforation 1 year, Lump abdomen 1 month

Image
 A 56 year old female have complaints of pain abdomen since 10 days History of presenting illness-patient was apparently asymptomatic 6 months ago then she was diagnosed to had intestinal obstruction for which she got operated.Now she has complaints of left iliac fossa pain since 3 months aggregated since 10 days pricking type of pain continuous and associated with fever. No ho vomiting,diarrhoea  No h/o blood in urine,Malena ,no h/o headacge,dizziness. No h/o SOB, palpitations,chest pain. K/c/o intestinal TB 3 years ago(used ATTmedication for 1year) K/c/o hypothyroidism 10 years ago on thyronorm 50 MCG  K/c/o CAD 6 months aho N/k/c/o hypertension,diabetes,asthma,epilepsy. Treatment history Sx laparotomy for iliac perforation. Personal history: Diet :Mixed Appetite : normal Sleep: adequate  Bowel and bladder movements: regular No significant family history General Examination: Patient is conscious,coherent and cooperative Moderately built and nourished Pallor, icterus, cyanosis , clubb
Read more

65 year old female patient with altered sensorium

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment" 65 year old female patient with altered sensorium - October 06, 2022  This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered
Read more

62 yr old male came to opd for dialysis

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment . Khushi Tulsyan Roll no. 75 A 62 yr old male farmer by occupation presented to opd for dialysis.  HISTORY OF PRESENTING ILLNESS- Patient was apparently asymptomatic 1 month back.Then he has shortness of breath while climbing Upstairs ( grade 2) Then he had decreased appetite. Then he started having shortness of breath since 10 days back even while talking . He had a decrease in his appetite since 10 days and low grade continuous fever so he visited local hospital where in routine exam
Read more