1801006086 CASE PRESENTATION

long case

A 29 year old female who is a known case of SLE , customer service executor by occupation, resident of akkinepalli came to OPD with

cheif complaints :

swelling of both legs since 3 days swelling around eyes since 3 days .

*History of presenting illness:-

Pateint was apparently asymptomatic 6 years ago, then she developed oral ulcers and rash on face and joint pains , hair loss without scaring for which she went to a hospital and diagnosed with Systemic lupus erythematosis (2017).

She was on Hydrochloroquine 200 ,wysolone,azathioprine medication continuously till November 2022

In November she was admitted in our hospital , emergency due to shortness of breath on exertion which is sudden in onset gradually progressed to shortness of breath at rest ,they diagnosed it as kidney failure and did dialysis for four times and sent her home with some medication.She was also diagnosed with hypertension and started on nicardia 30 mg .

But after 2 months on February 5 th she was admitted to hospital with history of vomitings and diarrhea since 10 days and diagnosed as acute kidney injury on chronic renal failure, they started her on dialysis and prescribed with below medication

Rabeprazole + domperidone

Tab orofer xt po/od 8am

Tab shelcal 500mg po/od

Tab sodium bicarbonate 500mg po/bd

Tab nicardia 20mg po/tid

Probiotics

Since then she is coming to hospital for regular dialysis that is once in 3 days .

H/o edema of legs upto knees since 3 days , pitting type which is insidious in onset gradually progressive.

H/o reduced urine output

H/o puffiness around the eyes since 3 days ,prominent during morning and subsides by night

Past history :-

Diagnosed with hypertension 5 months back ( on November 2022 secondary to kidney failure) and on regular medication.

Not a known case of diabetes mellitus, tuberculosis, thyroid disorders, epilepsy

*Personal history:-

Daily routine: Her day starts at 7 AM ,she used to get ready for work and went to office by 8 AM ,used to have breakfast around 10 am in the office ,her work was more of attending client calls with 1 to 2 breaks in between till 6 PM more of sedentary work ,sleeps at 11 pm .But since one month she is staying at home ,she has quit her job due to regular dialysis.

Diet - mixed

Appatite- loss of appetite

Sleep- adequate

Bowel and bladder - bowel regular, reduced urine output

No Addictions

*Family history:-

Mother is known diabetic

No history of autoimmune diseases in the family.

MENSTRUAL HISTROY:

Age of menarche:12 years.

Menstrual cycles :Her Menstrual cycles were irregular since 2 months.

Her last Menstrual period was Dec 25th 2022

Obstetric history:- para 2 live 1

*General examination:-

Patient is conscious, coherent, cooperative

Well oriented to time, place and person,moderately nourished thin built.

Pallor:- present

Icterus: absent

cyanosis :absent

clubbing : absent

generalized lymphadenopathy : absent

Bilateral pedal edema present, pitting type

Systemic examination:-

CVS:

S1 ,S2 present

No murmurs

Respiratory system:

Bilateral air entry present

Normal vesicular breath sounds heard

No dyspnoea and no wheeze

Per abdomen:

Shape of abdomen:

scaphoid

Liver and spleen are not palpable

CNS:

Patient is conscious

Speech: normal

Cranial nerves: normal

Motor and sensory system: normal

Glassgow coma scale: E4 V5 M6

Provisional diagnosis: Chronic Renal failure secondary to lupus nephritis on maintaining hemodialysis.

INVESTIGATIONS:

15.03.2023

Blood urea -79 mg/dl (N=12 to 42 mg/dl)

Serum creatinine-4mg/dl(N 0.6 to 1.1)

Serum electrolytes-

Na :141mEq/L(N-136 to 145)

K:3.5mEq/L(N:3.5 to 5.1)

Cl:102mEq/L(N=98 to 107)

Ionized ca+2:1.01mmol/L.

14.02.2023

HEMOGRAM:

Hb 8.5gm/dl.

Total count:12000 cell /cumm

Neutrophils:83 %

Lymphocytes:11%

Pcv:24.3 volume %

Platelets :l.lL / cumm.

Impression :Normocytic normochromic anemia with neutrophilic lymphocytes and thrombocytopenia.

Renal function test:

Urea:157mg/dl

Creatinine :6.9 mg/dl.

Uric acid :6.5 mg/dl.

*Treatment:

Tab Nicradia 30mg,po/tid

Tab lasix 40mg , po/bd .

Tab wysolone,po/bd.

Tab azathioprine 50 mg po/ od

Tab hydroxychloroquine 200mg po/od.

Tab Met xL 25 mg ,po/od.

Tab nodosis 500mg po/od.

Tablet shelcal 500mg po/od

Tab orofer xt po/od

Tab Pan 40mg po/od.

Tab biod3 po/ weekly twice .

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short case

Chief complaints

A 50 year old male resident of nalgonda presented to opd on 2/1/23 morning with chief complaints of pain Abdomen since 6hours.

History of present illness:

Patient was apparently asymptomatic 6hours then he developed pain Abdomen which was sudden in onset at 12am on 2/1/23 and gradually progressive. Pain was diffuse but more in umbilical and left lumbar region. It was colicky type and non radiating but continuous in nature. History of alcohol intake present. There are no aggravating and relieving factors. No h/o fever, nausea, vomiting and loose stools.

Past history :

Similar complaints in the past 2 years back and was diagnosed as Acute pancreatitis.

Patient is know case of diabetes since 2 years and is on medication. Patient is not a know case of Hypertension, Asthma, tuberculosis, thyroid abnormalities and epilepsy.

Family history: not significant

Personal history:

Daily routine : He wakes up at 8am and does his daily routine and does not go for work and takes 3 meals daily. He drinks alcohol and smokes intermittently through the day and sleeps by 10 pm.

Diet: mixed

Appetite: normal

Sleep : disturbed since 2 days

Bowel and bladder movements: regular

Addictions: Chronic alcoholic since 30 years and takes 180ml per day on an average. Cigarette (tobacco) 2-3 packs daily since 30 years.

Allergies : none

General physical examination:

Patient is conscious, coherent and cooperative. Moderately built and nourished.

Pallor : absent

Icterus : absent

Cyanosis : absent

Clubbing: present

Lymphadenopathy: absent

Edema : absent

Vitals:

Blood pressure: 150/100 mmHg

Pulse rate: 65bpm

Respiratory rate: 20cpm

Temperature: afebrile

Systemic examination:

Abdomen:

Inspection: Abdomen is obese, Umbilicus is central and inverted. All quadrants of Abdomen are moving accordingly with respiration. No visible scars sinuses or engorged veins.

Palpation: All inspectory findings are confirmed. Abdomen is soft and tenderness is present in the umbilical region and left lumbar region. No guarding, no rigidity, no Hepatosplemomegaly and hernial orifices are free .

Percussion: no shifting dullness.

Auscultation: Bowel sounds present.

CVS: S1 S2 present , no murmurs heard

CNS: No focal neurological deficits.

Respiratory system : Bilateral air entry present. Normal vesicular breath sounds heard.

Provisional diagnosis: Acute on chronic pancreatitis secondary to alcohol intake

Investigations:

HAEMOGRAM: