A 70 year old with loin pain since 5 months


 


CASE;
E.Likhitha 
Roll no.34

   A 70 year old  female,resident of Erupu village of suryapet district,home maker by occupation came to the hospital with,
 
C/O, 
Loin pain on Right side since 5 months,
Pedal edema on both legs since 2 months.




HISTORY OF PRESENTING ILLNESS:


Patient was apparently asymptomatic 3 years back and then she developed loin pain on right side,pricking type ,which is insidious in onset and gradually progressive .

Then she developed fever from 2 years associated with chills and on medication from 2 years ,it subsides after taking and again regains after sometime.

H/O  shortness of breath from 3 years which is of         Grade-4 ,breathlessness during resting position 

H/O bilateral pedal edema of pitting type since 2 months
associated with decreased urine output

Hypertension and Diabetes mellitus (type-2) was diagnosed at the date of admission on (22-12-22).For that she is on medication .


No H/O  burning micturition, cough ,vomitings.

She is on haemodialysis from 5 months (2 times per week).


PAST HISTORY:

K/c/o DM and Hypertension since 5 months .
No history of similar complaints in the past.
No H/O TB ,Asthma,Epilepsy,CAD


PERSONAL HISTORY:

Diet -mixed
Appetite-less appetite
Sleep-adequate
Bowel and bladder-regular
Addictions -none

DRUG HISTORY:

Tab.Paracetamol since 2 years(2-3 pills /day)


FAMILY HISTORY:

No significant family history.


GENERAL EXAMINATION:

Patient is conscious ,coherent and cooperative and moderately built and nourished

Pallor present
Pedal edema present
No signs of icterus ,clubbing,cyanosis,lymphadenopathy.






VITALS: 

Temperature-afebrile
BP:130/80mmHg
RR:20cpm
PR:80bpm


SYSTEMIC EXAMINATION :

Cardiovascular system-S1 and S2 are heard ,no murmurs present.

Respiratory system-Trachea central and normal vesicular breath sounds are heard.

Central nervous system-no neurological deficits

Per abdomen- soft ,non tender ,no organomegaly.

Inspection:
       On inspection abdomen is flat, symetrical,and slightly distended.
   Umbilcus is centre and inverted
   No scars,engorged veins are seen.
   All 9 regions of abdomen are equally moving with respiration.

Palpation:
      On palpation abdomen is soft and non tender
.On bimanual examination of kidney is not palpable.All inspectory findings are confirmed.

Percussion:no shifting dullness, no fluid thrills
.
Auscultation:normal bowel sounds are heard.


INVESTIGATIONS:










PROVISIONAL DIAGNOSIS:

CKD on haemodialysis.


TREATMENT:


Fluid restriction 
Salt restriction
Tab.LASIX 40mg PO/BD
Tab.NICARDIA 10mg  PO/TID
Tab.NODOSIS 500mg PO/BD
Tab.OROFER XT PO/OD
Tab.SHELCAL 500mg PO/OD
Tab BIO-D3 PO/OD
Inj.PAN 40mg IV/OD
Inj.EPO 4000 IV S/C  once weekly.

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