FINAL SHORT III
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60 year old female , ex farmer presented to casuality with c/o
* Pedal edema since 2 months
*Decreased urine output since 2 months
HISTORY OF PRESENTING ILLNESS
Patient is ex farmer by occupation , was apparently asymptomatic 2 months ago .
Patient was apparently asymptomatic 5 years back, then she met with RTA, Where she fell on the divider and sustained injury on right side of head.
CT showed bleed and was operated as per patient.? Craniotomy
-Intially she noticed b/l swelling of lower limbs , gradual onset and progressive . Pitting type and extending upto knees .
Not associated with shortness of breath
Associated with decreased urine output
Not associated with orthopnea and PND
No h/o chest pain , palpitations
In view of pedal edema , patient visited local hospital and was told ,She had a stone in one of her kidneys and both her kidneys failed .
She used NSAIDS for over 3 months I/v/o low backache.
She was advised maintenance hemodialysis,but patient denied and was discharged on medications .
Later, pedal edema subsided after using medications .
She continued taking medications , but noticed loss of appetite, fatigue and generalized weakness .
No h/o pus in urine , burning micturition , frothy urine .
As she had generalized fatigue ,loss of appetite and elevated urea and s. creatinine ,she visited our hospital and was initiated on hemodialysis by placing central venous catheter in right internal jugular vein .
Patient had 4 sessions of hemodialysis .
She went to Hyderabad and got A-V fistula on his left hand .
C/o Low back ache and body pains .
C/O abdominal distension since 5 days , sudden onset and progressed gradually . Associated with increased sob on lying down and abdominal tightness.
Pedal edema is mild extending upto ankle joint.
No h/o yellowish discoloration of eyes . No h/o binge alcohol intake .
PAST HISTORY
K/c/o HTN since 10 years and is not on regular medication .
NOT a k/c/o DM, TB , ASTHMA,CAD , EPILEPSY,CVA .
No surgical history and past Medical history
PERSONAL HISTORY
Regular bowel and bladder movements
Adequate sleep
Loss of appetite present
Mixed diet
FAMILY HISTORY - Not significant
Addictions - Toddy drinker occasionally -3 times /week . 90 ml
Non -Smoker
GENERAL EXAMINATION:
Pt C/C/C
No pallor, icterus , clubbing, cyanosis,koilonychia , lymphadenopathy
B/L pedal edema - pitting type present. extending upto ankle .
Jvp - couldn't be assessed due to central line .
Skin - Dry ,scaly , itching present .
Eyes - Grade 2 HTN retinopathy changes noted on fundoscopy .
Vitals :
Bp - 140/90 mmhg - Right arm supine posture
Pulse - 130 bpm ,regular ,normal volume, condition of vessel wall - normal, no radio-radial or radio-femoral delay.
Resp rate - 26/ min
Spo2 - 97% o
Grbs - 110 mg/dl
Temp -99 F
SYSTEMIC EXAMINATION :
GIT EXAMINATION :
INSPECTION :
Shape of abdomen - Distended-uniform
Flanks – Full
Umbilicus – Everted
Skin – Stretched, shiny
No scars, sinuses, striae, nodules , discoloration.
Dilated veins – absent
Movements of the abdominal wall - All quadrants equally moving with respiration .
Abdomino - Thoracic type of breathing
NO visible intestinal peristalsis
Hernial Orifices normal
Cough impulse - Negative
PALPATION
No local rise of temperature
No tenderness
Hernial Orifices - normal
Murphy’s Punch/Renal angle tenderness - no tenderness
PERCUSSION:
Fluid Thrill - Absent
Shifting dullness - Absent
AUSCULTATION:
Bowel sounds – Present
Aortic, Renal Bruit - Absent
CARDIOVASCULAR EXAMINATION :
INSPECTION:
Chest wall shape - Ellipsoid and b/l symmetrical
No Precordial bulge, Pectus carinatum/excavatum
No Kyphoscoliosis
No Dilated veins, scars, sinuses
Apical impulse - Visible in left 5 ICS 1 cm lateral to MCL .
Pulsations – epigastric, parasternal - absent
PALPATION:
Apical impulse – Tapping type , felt in left 5 ICS 1 cm lateral to
No Thrills and palpable heart sounds .
Auscultation :
S1 S2 heard in Aortic , pulmonary,tricuspid and mitral areas .
No added sounds
No murmurs
Respiratory system -B/L NVBS
CNS - NO abnormality detected
PROVISIONAL DIAGNOSIS
Chronic kidney disease secondary to NSAID abuse
INVESTIGATIONS
FINAL DIAGNOSIS
Chronic Kidney Disease with egfr 25 mL/ min square.
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