final short case
A 39 years old Male patient who runs xerox came to opd with complaint of abdomin pain Since 6 months and selwelling of both limbs since 6 months.
He was apparently asymptomatic 6yrs back.6yrs back he intially noticed decreased appetite, weight loss( loosening of his clothes), low grade fever relieved on medication and low back pain.he visited local doctor took pain killers for relief of symptoms for 1 month.
Then it persisted and then Visted hospital and In blood test it reveled increased creatninine in blood.
Then he came to our hospital.
At our centre, his creatinine was (14), and his kidneys were bilaterally small in size and initiated on hemodialysis.
After one month of initiation of dialysis he undergone AV fistula for forearm since for about 4years he used to get dialysis once in ten days/ once in week ..
He had intermittent pedal edema which relieved on dialysis .
No symptomes of decreased urine output and SOB.noticed.
Used to have 10-15 cigarettes perday, alcohol 180ml once in a week
Since 3 years stoped drinking.
No realvent family history
Patient is concious cooperative. Coherent.
Pallor and pedel edema present.
Moderatley built and norished.
systemic examination:
Respiratory system-
b/l air entry present,
normal vesicular breath sounds heard.
cardiovascular -
inspection- b/l chest symmetrical,
apical pulse - visible
palpation-
apical pulse palpable at 6th intercoastal space lateral to midclavicular line,
ascultation - s1 s2 heard
GIT- distended with flanks full, umbilicus everted
no dilated veins
non tender, fluid thrill present
bowel sounds heard
CNS- no focal neurological defecit.
Investigations:
Ecg:
chest. Xray.
Provisional diagnosis:
Chronic renal failure
Ascities
Heart failure
