Bimonthly assessment 2

https://medicinedepartment.blogspot.com/2020/11/blended-learning-bimonthly-assignment.html?m=1


1st case:

https://sreejaboga.blogspot.com/2020/11/is-online-e-log-book-to-discuss-our.html?m=1

Chest pain:epigastric region-may be in esophagus (Gerd)or pancreatitis, peptic ulcer, inferior wall MI


Abdominal distension : hepatitis,cirrhosis hypoalbuminemia or renal failure or heart failure. In surgical point of view we can also consider peritonitis as he also have abdominal pain (site not mentioned), hollow viscus perforation. 


He is a known case of alcoholic so we can also think of hepatorenal syndrome.


He also have SOB which can be attributed to lung pathology or heart failure or renal failure which lead to pulmonary edema or pleural effusion causing SOB. He is also a smoker so it goes in favour of lung pathology. His chest X-ray showed pleural effusion. So that explains the crepts in systemic examination.His ABG also shows acidosis which can also cause SOB. 


Events:

Congenital bow leg deformity----> Alcohol & smoking (30 years)----> Abdominal pain & distention , SOB , chest pain , decreased urine output (3 days)


OUTCOMES:


Urine output increased , pedal edema and SOB decreased (Day-2)---->Altered sensorium (Day-3)----> Dialysis done (Day-4)----> Bilious vomiting (Day-5)---->Dialysis done (Day-6)----> Abdominal pain & vomitings subsided (Day-8)---->MHD for his renal failure ----> Patient died (Day-15)


Pharmacological interventions

Fluid therapy in view of third space volume loss in acute pancreatitis.

Antibiotics for pancreatitis.

Tramadol for pain management.

Zofer-for complaints of nausea and episodes of vomiting 

Lasix-for ascitis and decreased urine output.

 Nebulization because of his creptitations


Non pharmacological interventions

NBM

Oxygen for his decreased saturation. 

Rules tube insertion


2nd case:

https://aakansharaj.blogspot.com/2020/11/55-year-old-male-with-anemia.html?m=1

It is a case of fever and going by the history we can suspect UTI or respiratory tract infection as there are chills and rigors. Further into the discussion we can also include tuberculosis,malignancy.

Tuberculosis is favoured by low grade intermittent fever,with productive cough with weight loss, loss of appetite.

The patient has generalised weakness,weight loss, chronic anemia which may include malignancy as the differential.

Patient also gives GI symptoms of vomiting, pain abdomen in right hypochondriac region where liver is present. This may also include hepatitis. Hepatitis is further supported by vomiting, abdominal pain, loss of appetite, weight loss.

Timeline of events:


Alcohol & smoking (35 years)----> Stopped alcohol (4 years)----> Fever , generalised weakness & anemia - 2 units blood transfusion (1.5 years)----> Stopped smoking (4 months)----> Low grade fever , generalized weakness , headache , neck pain , loss of appetite , weight loss (2 months)----> Cough & SOB (2 weeks) ----> Vomiting & pain abdomen (2 days).


OUTCOME:


Some symptomatic relief and referred to higher centre in need for oncologist.


Pharmacological intervention:

Antibiotics

Blood transfusion


Non pharmacological intervention:

Pleural fluid analysis

Imaging -xray skull, HRCT chest

Serum electrophoresis,sputum culture


3rd case:

http://nithishaavula.blogspot.com/2020/11/51-yr-old-male-with-hfref.html?m=1

1)pedal edema with abdominal distention with sob suggestive of right heart failure or renal failure


B)etilogy of rt heart failure


Timeline of events:


Tobacco chewing (40 years) ----> Alcohol (10 years)----> DM (7 years) ----> HTN (5 years)----> 1st Episode GTCS (3 years) & AF with HFpEF ----> 2nd Episode GTCS (2 years)----> HFrEF & Anasarca (1 year) - (subsided with medication)----> Pedal edema (6 months) ----> Increased pedal edema , abdominal distention , SOB and decreased urine output (3 days)


OUTCOME:

Symptomatically releived and discharged.


Pharmacological interventions:.

Preload reducers

Diuretics

Ace inhibitors

Beta blockers-Rate controlling agents

Antiepileptics for known case of epilepsy

Insulin for glycemic control in diabetes.


Non pharmacological interventions:

Salt and fluid restriction


4th case:

https://nairaditya97.blogspot.com/2020/11/31-yr-old-male-with-bl-pedal-edema-with.html?m=1

HEART FAILURE (pedal edema , penile & scrotal swelling and SOB) :

May be due to Alcohol causing wet beriberi


AXONAL SENSORY POLYNEUROPATHY:

May be Alcohol induced 


Timeline of events 


Alcohol & khaini (3 years) ----> Pins and needles (1 year) ----> Palpitations (8 months)----> PND (3 months) ----> Pedal edema and SOB (2 months)


 OUTCOME: 


Completly relieved of his symptoms as the wet beriberi resolved.


Pharmacological interventions:

1)Lasix- to reduce edema

2)Thiamine-nutritional supplementation for wet beri beri

3)Telmisartan


Non pharmacological interventions


1)fluid and Salt restriction.


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