HarikaKathumandirollno54: July 2022

46 yr old male with Shortness of Breath, Abdominal distension, pedal Edema.

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A 47 year old male resident of Keshavapuram, Shephard by occupation presented with

Chief complaints:

Shortness of Breath since 6 years

Cough since 4 years

Abdominal distension since 3years

Puffiness of face since 3 years

Pedal Edema since 3 years.

History of presenting illness:

Patient was apparently asyptomatic 6 yrs back then he developed Shortness of Breath which was insidious in onset , gradually progressed from Grade1 to Grade 2 not associated with dyspnoes on lying down.

He had cough since 4 years which is associated with yellow coloured sputum.

He noticed abdominal distension since 3 years

He noticed puffiness of face since 3 years..

He noticed pedal Edema ( below the knee) since 3 years .

He had Hard stools since 10 days not mixed with blood .

Past History:

No similar complaints in the past .

Not a Known case of Diabetes mellitus, Hypertension, Tuberculosis,Asthma,coronary artery Disease, Epilepsy.

Surgical History- Underwent Cataract surgery in 2021

Treatment History- Used locally prescribed antacid tablets.

Family History

No member of the family has similar complaints.

Personal History

Appetite is normal.

Diet: Mixed

Bowel& bladder: Bowel - Hardstools since 10 days

Bladder movements regular

Sleep: Adequate

Addictions: He consumes Alcohol since 30 years (200 ml/ day) stopped 3months back

He smokes cigarette & beedi since 30 years 12/ day .

No food& drug allergies

Daily routine

He wakes up at 5 am and goes to animal shed and comes home at 8am eats rice at 10 am ,goes to work in farm and comes home by 6 pm ,used to consume alcohol occasionally and takes dinner by 9pm and goes to bed by 10 pm.

General examination

Patient is conscious coherent cooperative moderately bulit and nourished.

Pallor absent

No icterus, cyanosis , clubbing,

Bilateral pedal edema prese

Generalised lymphadenopathy - Absent

Vitals :

Pulse rate -82 bpm , regular in rate rhythm and normal volume , bilaterally present

Bp:110/90 mm of Hg

Temp :99

Respiratory rate:20/ min

JVP - slightly elevated

SYSTEMIC EXAMINATION

RESPIRATORY SYSTEM:

Inspection:Shape of the chest- pectus excavatum

No scars and sinuses

Tachea central

Wheeze is heard.

Palpation:

Inspectory findings are confirmed

Palpable sounds .

Movements of chest - symmetrical?

Tactile vocal fremitus-?

Percussion:

Resonant note present in all lung areas

Auscultation:

Rhonchi heard

crepts are heard in Infrascapular area,Infra axillary area.

ABDOMEN:

Inspection - Abdomen is distended,umblicus everted.

Dilated veins( caput medusae) present.

No scars, sinuses .

Palpation:

Inspectory findings are confirmed

No Tenderness,

Shifting dullness: present

Fluid thrill: Absent

Percussion : Resonant note all over the abdomen

Auscultation: Normal bowel sounds heard

No bruit heard

CVS :

Inspection : Bilaterally symmetrical chest present

No scars sinuses

No visible pulsations

Palpation:

Inspectory findings are confirmed

Apex beat cannot be localised

No palpable heart sounds or murmurs

Auscultation :

S1 S2 heard

No murmurs or additional heart sounds

CNS : Higher Mental functions Intact

No focal neurological deficits.

Cranial nerves intact.

Provisional Diagnosis:

Chronic Liver Disease ?

Right Heart Failure.

Investigations:

Ultrasound Abdomen

2D Echo

Liver function test:

Serum Electrolyte:

Chest xray

Electrocardiogram

Treatment:

56 yr old Male with Ulcer on right foot and rat bite on the right index finger

This is an online E log book 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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Case :

A 56 year old male had come to the OPD with chief complaints of ulcer on the right foot since 18 days and rat bite on the right index finger since 10 days.

History of Present Illness :

Patient was apparently asymptomatic 18 days ago, then he developed a painless blister on the medial aspect of his right foot which eventually burst to form an ulcer.

For the first few days, the patient turned a deaf ear to the ulcer thinking it would get healed on its own. On Thursday (14th of July, 2022), on his way back home from work, he noticed watery discharge oozing out of the ulcer which was non foul smelling and non blood stained. After washing his foot, he noticed the skin over the ulcer chipping off. This was an alarming sign that had made him come to the hospital on Friday (15th of July, 2022).

10 days ago, in his sleep a rat bit him on the right index finger. Until the next morning, he had not noticed the bite.

Presence of ulcer on the plantar aspect of the left hand.

Daily Routine :

The patient is a lorry driver by occupation.

He wakes up at 5 AM in the morning and has his breakfast by 8 AM and leaves for work.

Usually has his lunch by 1 PM and Dinner by 8 PM. He has been drinking alcohol (90ml) everyday for the past 40 years now.

Past History :

Not a known case of Hypertension, Asthma, Epilepsy, Tuberculosis, Thyroid disorders.

The patient is a known case of diabetes type 2 since 7 years.

7 years ago, a blister was formed on the lateral malleolus of his left foot which he took no notice of. 4-5 days later, he started feeling giddy, tired and had downtime in his work. So he had been taken to the hospital and had been diagnosed with diabetes. He’s been on medication ever since.

Personal History :Sleep : Normal

Diet : Mixed

Appetite : Normal

Bowel and Bladder Movements :Regular

Addictions : Patient consumes alcohol everyday since 40 years. Patient used to smoke beedi (1 pack a day) and cigarette (1 pack a day) since the age of 12. He has quit smoking since 2 years.

Family History : No similar complaints

General Examination:

Pallor - absent

Icterus - absent

Cyanosis - absent

Clubbing of the fingers - absent

Lymphadenopathy - absent

Pedal Oedema - absent

Investigations :RBS - (20/07/2022] 8 AM - 198 mg/dl ; 2 PM - 158 mg/dl ; 8 PM - 358 mg/dl

[21/07/2022] 8 AM - 193 mg/dl ; 2 PM - 384 mg/dl ; 8 PM - 282 mg/dl

[22/07/2022] 8 AM - not taken ; 2 PM - 185 mg/dl ; 4 PM - 240 mg/dl ; 8 PM -

ECG:

Provisional Diagnosis : Diabetic ulcer on the right foot .

Rat bite on right index finger

Treatment :

Tab Glimi M1 OD

Tab Glimi M2 OD

Inj H Actrapid S.C GRBS 6th hourly

T Bact Ointment OD

T Fucid Cream OD

A 25 YR OLD MALE WITH BLOOD IN STOOLS,

This is online E log book 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 series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs .This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.

A 25 yr old male patient resident of Narketpally ,runs a wine shop ,presented with chief complaints of Blood in stools since 9 days ,

Shortness of Breath since 4 days , Headache since 9 days.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asyptomatic 5 months back then he noticed blood before and after passing stools for which he took medication( unknown) .

From 9 days he again complains of hard blood in stools associated with an episode of vomiting,not associated with pain in the abdomen,fever.

He had Headache since 4 days which is continuos with no aggravating and relieving factors .

He had Shortness of Breath Grade 2 since 4 days which is sudden in onset not associated with chest pain which aggrates on walking and relieves on sitting.

He went to a hospital in Nalgonda and he was found to have Hb -3.6 gm% came to Kims Narketpally for further management.

Past History :

He had similar complaints 5 months back.

No History of Diabetes mellitus,hypertension, Tuberculosis,Asthma, Coronary artery Disease , Epilepsy.

No surgeries underwent in the past.

Family History:

No member of the family has similar complaints.

PERSONAL HISTORY

He takes mixed diet,appetite is normal ,bowel and bladder movements regular ,sleep is adequate,He consumes Alcohol ( 1 beer),Toddy occasionally since 3 years .No history of smoking.

No known Drug,Food Allergies.

Daily routine:

He wakes up at 6 am and does his chores ,he goes to fish market and returns at 9 am , he'll have his breakfast and goes to shop by 10 am.

He'll take his lunch 2 pm and goes back home at

10:30 ,goes for dinner and sleeps by 11 pm.

General Examination:

Patient was conscious, coherent, cooperative

ill builtand poorly nourished.

Pallor: present.