A 38 year old man with abdominal distension,pedal edema and facial puffiness





  

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 box is welcome.

Here is a case i have seen:


 A 38YEAR OLD MAN,WOOD CUTTER BY OCCUPATION,UNMARRIED AND A RESIDENT OF NALGONDA CAME WITH C/O PEDAL EDEMA,ABDOMINAL DISTENSION AND FACIAL PUFFINESS SINCE 1 MONTH,(GRADUALLY PROGRESSIVE SINCE ONE MONTH)

THREE YEARS BACK,H/O BINGE INTAKE OF ALCOHOL AND FIVE DAYS LATER H/O INVOLUNTARY MOVEMENTS AND VISUAL HALLUCINTAIONS.H/O LOC.NO H/OTRAUMA. NO H/O UPROLLING OF EYES,FROTHING,TONGUE BITING.

ONLY ONE EPISODE OF INVOLUNTARY MOVEMENTS,SINCE THEN NO SUCH EPISODES.

H/O JAUNDICE ONE YEAR BACK--USED HERBAL MEDICATION

H/O DARK COLORED STOOLS,DECREASED APPETITE SINCE 15 DAYS

H/O VOMITINGS,INTERMITTENT, HALF AN HOUR AFTER FOOD INTAKE SINCE 10 DAYS

H/O SHORTNESS OF BREATH ON EXERTION SINCE 10 DAYS

H/O B/L LOIN PAIN SINCE 10 DAYS,AGGRAVATED ON BENDING AND  PROLONGED SITTING

NO H/O PAIN ABDOMEN,LOOSE STOOLS,LOSS OF WEIGHT,NIGHT SWEATS,FEVER,ITCHING,HEMATEMESIS,CHEST PAIN,PALPITATIONS,BURNING MICTURITION

NOT A K/C/O DM,HTN,ASTHMA,EPILEPSY,CAD

H/O ALCOHOL CONSUMPTION SINCE 25 YEARS-- CONSUMES 180-280ml OF WHISKEY EVERYDAY

H/O SMOKING FOR MORE THAN 15 YEARS

—> 5-6 CIGARETTES/DAY

SLEEP DISTURBANCE+ 

O/E:PATIENT IS COSCIOUS,COHERENT AND COOPERATIVE

MODERATELY BUILT

BP:110/70 mm of Hg

PR:78bpm

TEMP:AFEBRILE

RR:18cpm


 G/E:ICTERUS PRESENT 

 PEDAL EDEMA PRESENT



  NO PALLOR,CLUBBING,CYANOSIS,LYMPHADENOPATHY

      ASTERIXIS PRESENT

SYSTEMIC EXAMINATON:

CVS:S1S2 +

RS:BAE +

CNS: NAD

P/A:DISTENDED,SOFT,NON TENDER,BS+

      SHIFTING DULLNESS PRESENT

      FLUID THRILL ABSENT



INVESTIGATIONS:























REVIEW USG SHOWED:MILD SPLENOMEGALY AND MILD ASCITES
 




ASCITIC FLUID CYTOLOGY: NEGATIVE FOR MALIGNANCY

UPPER GI ENDOSCOPY: REVEALED GRADE 1-GRADE 2 VARICES

 
TREATMENT GIVEN:

1.FLUID RESTRICTION<1.5lit/day

   SALT RESTRICTION<2.5gm/day

2.PROTEIN POWDER 2tsp IN ONE GLASS OF MILK/PO/THRICE DAILY    8am--2pm--8pm

3. 2-3 EGG WHITES/DAY.

4.INJ.THIAMINE 1amo in 100ml NS/IV/BD

5.TAB PAN 40mg/PO/BD

6. SYP.POTKLOR 15ml in 100 ml WATER/TWICE DAILY

7.TAB LASILACTONE(20/50mg)/PO/OD

8.SYP.LACTULOSE 15ml/PO/BD(TO PASS 2-3 STOOLS/DAY    1--x--1

9.TAB.LORAZEPAM 2mg/PO/HS  x--x--1

10.TAB.BACFEN-XL 20mg/PO/HS  x--x--1

11.VOVERAN GEL FOR L/A

12.TAB HIFENAC-MR/PO/BD

13.GRBS CHARTING 6th HOURLY

14.INJ.OPTINEURON 1amp in 100ml NS/IV/OD

15.TAB FOLVITE 5mg/PO/OD


Comments

Post a Comment

Popular posts from this blog

January bimonthly exam

  26 year old woman with complaints of altered sensorium somce 1 day,headache since 8 days,fever and vomitings since 4 days More here:  https://harikachindam7. blogspot.com/2020/12/26-year- old-female-with-complaints-of. html Case presentation  links:  https://youtu.be/fz9Jssoc-mA https://youtu.be/d4lLX04oL8s https://youtu.be/CSCxw2zp7Oc a). What is the problem representation of this patient and what is the anatomical localization for her current problem based on the clinical findings? A 26year old female patient who is k/c/o SLE presented with complaints of headache since 8 days, fever and vomitings since 4 days and altered sensorium since 2 days.Anatomical localization - brain b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis?  Please chart out the sequence of events timeline between the manifestations of each of her problems and current outcomes.   b) etiology:  CVA , TB Meningitis , SLE vasculitis ,SIADH secondar
Read more

A 65YEAR OLD MAN WITH SELF TALKING,VISUAL HALLUCINATIONS,IRRELEVANT TALK ,SLEEP DISTURBANCE,INVOLUNTARY MICTURITION AND A NON HEALING ULCER

Image
November 25,2020   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 box is welcome. Here is a case i have seen: A 65 YEAR OLD MALE PATIENT PRESENTED WITH COMPLAINT OF ALTERED BEHAVIOUR AND AN ULCER OVER ANTERIOR ASPECT OF RIGHT FOOT SINCE 6 MONTHS. PATIENT WAS APPARENTLY ASYMPTOMATIC 6 MONTHS BACK, WHEN HE SUSTAINED AN INJURY-A THORN PRICK TO HIS RIGHT LOWER LIMB, WHICH RESULTED IN CELLULITIS FOR WHICH HE WAS TAKEN TO A RMP, WHERE DEBRIDEMENT FOLLOWED BY DRESSING WAS DONE.HE WAS ON REGULAR DRESSINGS. IT RESULTED IN AN ULCER OVER THE
Read more

EXAM

Image
  Questions: Please go through the patient data in the links below and answer the following questions: 1) A 55 year old man with Recurrent Focal Seizures Detailed patient case report here:  http://ushaindurthi. blogspot.com/2020/11/55-year- old-male-with-complaints-of. html 1. What is the problem representation of this patient and what could be the anatomical site of lesion ? A 55 year old male, construction worker with Type2 DM, who is a chronic alcoholic & smoker, came with c/o weakness of right upper limb with involuntary movements of both right UL & LL  2. Why are subcortical internal capsular infarcts more common that cortical infarcts?   Subcortical areas are supplied by penetrating branches that arise from initial segments of the arteries near the Circle of Willis at the base of the brain.Occlusion of these penetrating arteries result in subcortical infarcts . These penetrating arteries arise at acute angles from major vessels and are thus, anatomically prone to constric
Read more