35 year old female with ascites

-

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


 A 35 yr old female came to casualty with complaints of pedal edema since 6 days, which is insidious in onset and gradually progressive, worsening since 3 days.

- c/o abdominal distension since 6 days

- h/o decreased urine output since 2 days

- h/o vomiting s 4-5 episodes since 1 day

HOPI :pt was apparently asymptotic 1 week back, then he developed pedal edema ,which is bilateral ,pitting type it is worsening since 3 days

H/o burning micturition

H/o vomitings ,4-5 episodes which are non bilious,non projectile

No H/o loose stools

H/o fever in the last month, and that was diagnosed to be Dengue possitive and was treated symptomatically

Past history :

She is not a k/c/o DM, HTN , Asthma ,TB , epilepsy

On examination : 

Pt is C/C/C

No pallor , icterus clubbing cyanosis lymphadenopathy, edema



Thickening of skin (generalised)

Vitals :temp : 98.6f

CVS :S1S2 +

RS : BAE+ , NVBS

CNS - No focal deficits




Provisional diagnosis

Ascites under evaluation ,B/l pleural effusion

?SCLERODERMA









Treatment:

1)Fluid restriction< 2L /day

2)Salt restriction <2g/day

3)inj.zofer 4 mg IV.sos

4)Inj.Tramadol 1 amp in 100 ml NS/IV SoS

5)Tab.Dolo 650 mg po/sos

6)syp.potchlor 10 ml po /BD in a glass of water 

7) abdominal girth monitoring

8)daily weight monitoring

9)vitals monitoring 6th hourly

10) Tab.Lasilactone 20/50 mg

11)Tab.ultracet 1 1/2-1/2-1/2-1/2(QID)


Derma cross



UGIE




2hrs after CECT:

Patient suddenly became unresponsive at 3:15PM in the ward, was shifted to ICU along with CPR being done.

Patient couldn’t be revived after 6 cycles of CPR and declared dead


Diagnosis: ? Acute pulmonary embolism ,systemic sclerosis with ascites secondary to

?non cirrhotic portal sclerosis



Comments

Post a Comment

Popular posts from this blog

QI PROJECT- IMPROVING POST-GRADUATE RESEARCH PROJECTS

-
Image
We, from the Department of General Medicine, at Kamineni Institute of Medical Sciences made high-quality research our top priority. Research within the field of General Medicine is crucial for advancing medical knowledge, improving patient outcomes, and implementing evidence-based medicine in practice. In our department, several research projects are currently underway, addressing a wide range of clinical issues. However, the effectiveness and efficiency of ongoing research projects can be significantly influenced by organizational and procedural frameworks within a department. Despite the commitment to high-quality research, various challenges have been identified that may hinder the successful completion and impact of these projects. The main challenge was insufficient research knowledge among post-graduates conducting the research. Their research needs improvements in terms of organizing the collected data and defining objectives and methodology to initiate with. Further improvement
Read more

CLINICAL NEUROLOGY: THEORY TO PRACTICE-Teaching course

-
Image
 Teaching course-          “ CLINICAL NEUROLOGY”          “THEORY TO PRACTICE ” A well-organized teaching course in neurology was designed by me with the help of my fellow senior residents (Dr. Shashikala, Dr. Manasa, Dr. Pradeep, Dr. Vamshi, Dr. Manoj, Dr. Gouthami) with the support of our beloved HOD, Dr. Rakesh Biswas.  The main aim of this teaching course is to create interest among postgraduates in learning and teaching aspects of neurology. I planned to teach them on how to convert theoretical knowledge in neurology into practice.  I organized the course in such a way that each theory/seminar topic is followed by a relevant case presentation and journal. Postgraduates are trained in the theoretical aspects of the topic in the first class, and in the second class, the main focus is on examination techniques, making differential diagnoses, how to order appropriate investigations, and discussions on the management plan. Attendance to these sessions is monitored. Each seminar will be
Read more

51 year old male with gaze palsy

-
Image
 NEUROLOGY DIARIES: 51 year old male ,Carpenter by occupation came with the chief complaints of  Inability to look at bright lights (R eye>Left eye) since 6months Decreased eyeball movements and slowing of activities since 6months Low volume of speech since 6months Stiffness of right upper limb since 6months HOPI:Patient was apparently asymptomatic 6 months ago.Since 6months patient has c/o inability to look at bright lights,Photophobia since 6 months,more in right eye compared to left eye associated with watering from eyes on sun exposure,not associated with redness of eyes or pain in eyes.No c/o discharge,burning sensation of eyes.c/o diplopia on looking at objects occasionally. Patients wife notices that patient has decreased eyeball movements in both eyes and patient is turning his entire head to look sideways and above and downwards. C/o slowness of activities with right upper limb such as eating and combing hair since 6months.Patient is taking food to the mouth slowly and is a
Read more