a 69 yr old male with pedal edema

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Chief complaints:-

Pedal edema(pitting type) since 20 days

Decreased urine out put since 2-3 days

Shortness of breath since morning

Cough with sputum since morning 

History of presenting illness:-

Apparently patient was asymptomatic 20 days ago,developed pedal edema, gradually progressed to the knee(pitting type).Went to local hospital for used some tablets after which he developed anuria but pedal edema did not subside.

Daily routine:-

He usually gets up early in the morning and and eats break fast at 6-7am and goes to field for farming.He comes back at 6pm and and has dinner by 8pm and sleeps.

But 3 years ago he had leg trauma in which his both the hip joints got fractured.Hence rods were inserted.Since then he is not able to stand and walk and is bed ridden.So he stopped working and stays home.

History of past illness:-

Known case of  

Diabetis mellitus type 2 since 15-20 years

Leg trauma causing hip joint fracture 3 yrs       ago.Due to this he is bed ridden.

Shortness of breath since many years               which is associated with cough and   wheezing.

Surgical history:-

He got inserted with two rods in hip joint due to fracture caused by leg trauma.

Drug history:-

For diabetes-

 Tab.Metformin 500mg

For pain in the hip-

 Tab.Aceclofenac and paracetamol-100/325mg

Personal history:-

Diet-mixed

Built-low 

Appetite-decreased

Sleep-decreased 

Bowel movement-normal

Bladder movement-decreased 

Allergies- absent

Addiction-alcohol occasionally

 Bidi-1 pack for 2 days

Family history:- not significant 

General examination:-

Pallor,pedal oedema present

Ictreus,cyanosis,clubbing,lymphadenopathy absent

Vitals-

Temperature-98.9F

Pulse rate-96/min

Resperatory rate-28/min

Bp-140/90

Spo2-50%o2

Grbs-60%mg

Systemic examination:-

CVS

Cardiac sounds S1 and S2 present.

No thrills or murmurs.

Apex beat heard in 6th intercostal space lateral to mid clavicular line

Respiratory system

Chest is symmetrical, barrel shaped on inspection.

No visible deviation of the trachea, supraclavicular hollowing or unilateral sternocleidomastoid prominence.

No drooping of either shoulder.

There appears to be a retraction near the 7th intercoastal space on both sides.

On palpation, inspectory findings were confirmed. Trachea in midline, no intercoastal crowding, no rosary beads appearance at costochondral junctions. Pain is present at the site of retraction in the 7th intercoastal space. No dilated veins. Chest movements were normal, symmetrical. Tactile fremitus was more apparent on the right side.

On percussion, no dullness or abnormality was noted.

On auscultation, Bilateral crepts were present and wheezing was noted.

CNS

The patient is conscious, drowsy.

Speech is normal.

No neck stiffness. Kernig's sign is absent.

Abdomen

Normal shape. No tenderness.

No palpable mass. Liver and spleen not palpable. 

a 65 year male with vomitings

This is an online E logbook 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 a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs.

Chief complaints:-

Vomiting since 4 days

Fever since 4 days not associated with chills

Loose stools since 3 days not associated with blood.

History of presenting illness:-

The patient started developing these symptoms 5 days ago. He was at home when he got up from his bed and started vomiting (projectile) with the vomit comprising food or water, depending on what he consumed. He came to the hospital on the same day (6.10.2022) with complaints of projectile vomiting. He had 4-5 such episodes in one day. Even after vomiting everything that he consumed (in an episode), he still retched afterwards 3-4 times with no vomit. He then passed watery, greenish stools 4 times that day which was associated with squeezing type of pain in the epigastric region and developed a high grade fever. He also had associated shortness of breath. He came to this hospital on the same day, was medicated for it and discharged the next day.

The symptoms, however, did not subside and the patient was rushed to the ICU at 4pm on 9.10.2022 with complaints of vomiting and not being able to consume anything without vomiting. He hasn't been passing any stools till 9:30am yesterday.

Daily routine:-

He usually gets up early in the morning at 5am.Then he does his daily activites.He will have his breakfast at 7-8am.Then if he has any works he will go out otherwise he will stay at home.He will come home by 6pm and fresh up and have dinner by 8pm.He usually eats rice or chapatti or jowar roti.he usually sleeps by 9pm.

Past history:-

Known case of 

           Hypertension since 8 yrs

           Diabetis mellitus type 2 since 8 yrs

           Asthma since 6 months

Not known case of 

    Tuberculosis,leprosy, Cardiovascular diseases,chornic kidney disease and any other chronic illness.

He has been having joint pains since 10 years and has been going to the hospital repeatedly for his pains. He took painkillers and continued to work everyday till 4 days ago.

From 3 years ago, the patient has been getting scaly, itchy rashes with peeling of skin on his arms and legs. He was told this was due to diabetes.

Surgical history:- not significant

Drug history:-

 

For diabetes- 

   Tab.BAMILODIPINE 5mg+ATEMOLOL 50mg

For Hypertension -

   Tab.METFORMIN 500mg

For asthma-?

Personal history:-

Diet-mixed

Built-well built (obese)

Appetite -decreased

Bladder movment-normal

Bowel movements- irregular

Allergy-generalised itching

Addiction-alcoholic 38 yrs ago,chew betel leaf and Tobacco regularly but stopped 5 days ago.

Family history:- not significant

General examination:-

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema present 

Vitals:-

Temperature: 98.6°F

Blood pressure: 100/60 at time of admission 

Pulse rate: 84bpm

Respiratory rate: 20/min

Spo2: 98%

GRBS: 121mg%

The swelling on the dorsum of his left hand is 4×5 cm in size, elliptical, firm, non-reducible. Slip test is positive.

Systemic examination:-

Cvs- thrills-no

         Cardiac sounds -s1,S2 heard

         Cardiac murmur- absent

Respiratory system: position of trachea is central, vesicular breath sounds heard.

Abdomen: abdomen is distended and umbilicus is central, everted. Tenderness in the right hypochondrial and epigastric regions. Liver is palpable.

CNS: Patient is conscious, coherent and cooperative 

Glasgow coma scale: 15/15 f4v5m6

Investigations:-

2D echo:

ECG:

Provisional Diagnosis:-

Acute gastroentritis

Treatment:-

10/10/22-

11/10/22

12/10/22