EDEMMA - ACUTE PANCREATITIS

This is a case of a 35 year old female who is a wig maker and goes to part time work in paddy and cotton field’s presented to the Emergency department with acute history of:-
 pain abdomen and vomiting’s since 4 days  
decreased urine output since 2 days 
swelling of legs since 1 day 

HOPI:-

Patient was apparently asymptomatic 4 days back but she developed Abdominal pain lower which is left hypochondriac and lumbar region and non-radiating with sudden in onset and gradually twisting type of pain 

H/O vomiting present with 4 episodes in a day non-projectile , non-bilious , contains food particles that are aggregated on taking food
H/o of Bleeding 
H/o decreased urine output
H/o of pedal edema which was gradual in onset nd progressive upto below knee 
 No H/o of Burning Micturition
 No H/o PND and ORTHOPONEA
 No H/o shortness of breath 
 No H/o chest pain 

MARRIAGE & OBSTETRIC HISTORY: 
Married at the age of 17 years , non-consanguineous. 

FIRST child at 18 years - death of the first child at 24years due to varicella zoster. 

2nd child at age of 21 years - gave birth to female child , now married 

3rd child at the age of 23 years -gave birth to female child , now married 

4th child at the age of 24years - gave birth to male child currently 10th class.

PERSONAL HISTORY:-
Mixed diet, appetite reduced

Constipation since 5 months

NON SMOKER AND NON ALCOHOLIC

FAMILY HISTORY:-

Mother is hypertensive and expired due to cerebrovascular accident and post stroke complications after 6 months.

DRUG HISTORY:-
 weekly she used to take 2-3 sachets of ENO (antacids)

EXAMINATION:-
Patient is conscious, coherent and Co-operative well oriented with time, place and person.

VITALS:-
Febrile to touch 99.1 F 

Blood pressure: 110/80mmhg in right upper arm supine position.

Pulse rate: 119 per minute, regular, normal volume 

Respiratory rate: 24 cycles per minute (pain induced tachycardia)

Room air saturation: 92%

GENERAL EXAMINATION:-

Looks grossly dehydrated with sunken eyes, dry oral mucosa and tongue with delayed capillary refill time (more than 3 seconds)

Pallor present

bilateral pitting type of pedal Edema present with scratch marks on both lower limbs (pruritus due to possible diabetic dermopathy)  

No icterus, cyanosis, clubbing, lymphadenopathy.

SYSTEMIC EXAMINATION: 

EXAMINATION OF THE ORAL CAVITY

 NO Oral thrush
 NO tonsilar enlargement
 NO pharyngeal deposits
 NO post nasal drip
 NO fetor hepaticus
 Fair oral hygiene
 No dental caries and no gum hypertrophy.

ABDOMEN:
INSPECTION:

1. Shape – distended-uniform

2. Flanks – full

3. Umbilicus – central, Shape-slit like and nodules.

4. Skin – stretched, no scars & sinuses, striae present, scratch marks.

5. No Dilated veins – front/back

7. Movements of the abdominal wall,NO visible gastric & intestinal peristalsis.

8. Hernial Orifices - normal
6. No Murphy’s Punch/Renal angle tenderness.

PERCUSSION:

1. Puddle’s sign present suggestive of mild fluid collection in abdomen.

2. Percussion of Liver for Liver Span - 13cms

AUSCULTATION:

1. Bowel sounds – sluggish

2. No Bruit – Aortic, Hepatic, Renal Bruit

3. No Venous Hum.

OTHER SYSTEMS EXAMINATION:-

CARDIOVASCULAR SYSTEM:-

No raised Jugular venous pressure

Apex beat in 5th Intercostal space on left mid clavicular line

S1 and s2 heard. NO murmurs.

EXAMINATION OF RESPIRATORY SYSTEM:-

No tracheal deviation

Respiratory movements are bilateral symmetrical

Resonant percussion in all lung field’s

Normal vesicular breath sounds

EXAMINATION OF NERVOUS SYSTEM:

Higher mental functions intact

All Cranial nerves on both sides are intact
No motor deficits
Sensory system :
Fine touch - absent below both ankles
Vibration - delayed in both lower limbs ( 6sec at ankle, 8 sec at knee ) and upper limbs ( 9sec in upper limb )

Gait normal

INVESTIGATIONS:-

Comments

Post a Comment

Popular posts from this blog

OSCE PRRFINAL

OSCE QUESTION:- How will the ventilator helps a pneumonia patient ? -Helps in opening alveoli  -Ventilators help pneumonia patients by providing support to their breathing.  -They deliver oxygen and help remove carbon dioxide from their lungs.  -It helps them breathe easier and allows their body to focus on fighting the infection. LEARNING POINTS:- 1) Once again got an opportunity to understand the art of case taking.  2) How to communicate with a geriatric age group patient. 3) Importance of adequate dose of drug administration ( MIDAZOLAM in this case) and effects of prescribing underdosage of midazolam 4) MIDAZOLAM - effect, adverse effects, therapeutic window.
Read more

83 Year old male with Pneumonia

Image
This is an a 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 online learning portfolio and your valuable inputs on the comment box is welcome. The patient/ attender was informed the purpose of the information being acquired. An informed consent was taken from patient/ attender and there is omission of information that was requested to be omitted. 83yr old male came with complaints of  shortness of breath since 10 days. chief  complaints:  cough since 16 days Fever since 14 days shortness of breath since 12 days History of Presenting illness: Patient was admitted to ICU 16 days back with  breathlessness. It was insidious in onset and g
Read more

CKD CASE -Laxamma

Image
CASE SCENARIO A 90yr old female came to the Casuality with Chief complaints of Fever since 7 days HISTORY OF PRESENTING ILLNESS:- Patient was apparently asymptomatic 10 days back but then she had bilateral pedal edema pitting type with fever and chills  intermittent and no evening rise in temperature she also had decreased urine output and decreased appetite since 10 days she has vomiting 3episodes 5 days back  which was non bilious and non projectile containing food particles resolved after taking medication CHIEF COMPLAINTS -     Fever -10 days     Decreased appetite - 10 days      B/L pedal edema - 10 days      Decreased urine output -10 days       Vomiting- 5 days back PAST HISTORY:-                                                               No C/O - chest pain   H/O- Hypertension - 2yrs on medication                                                 Not a K/c/o Asthma,Epilepsy,Tb TREATMENT HISTORY:- Tab.Amlodipine5mg             + Tab.Atenolol 50 mg PERSONAL H
Read more