46 yr old male with HFrEF with type 4 cardi renal symdrom with DCMP with ischemic Hepatits
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Team:
Interns-
M Supriya
Mohitha
K Sowmya
Sanjay
Amrutha
Dr.Druga Krishna PGY1
Dr.Ajith Kumar PGY2
Dr.Laxma Reddy PGY3
Dr.Manasa PGY3
Dr.Vijaya Lakshmi (Ast.Prof.)
46 years old old male patient came with
c/o abdominal distension since 20 days
c/o shortness of breath since 20 days and
c/o pedal edema since 20 days
Patient was apparently asymptomatic 6 years back then had throne pricking on the left foot followed which he developed swelling of the left foot for which dialysis was done 6 years back probably necrotizing fasciitis ,after 4-5 episodes of hemodialysis patient was absolutely normal up to 6 years,
Recently 20 days back patient notice swelling of the both legs with abdominal distension which was insidious onset and gradually progressive associated with shortness of breath which was relieved on medication then patient was referred to KIMS for further evaluation
N/o of decreased urine output, chest pain, palpitations, PND,orthopena,
-past History-
History of hemodialysis done in 2015 i/v/o necrotizing fasciitis
Known case of hypothyroidism, HTN on irregular medication
O/E
pt conscious,coherent,cooperative
Patient was apparently asymptomatic 6 years back then had throne pricking on the left foot followed which he developed swelling of the left foot for which dialysis was done 6 years back probably necrotizing fasciitis ,after 4-5 episodes of hemodialysis patient was absolutely normal up to 6 years,
Recently 20 days back patient notice swelling of the both legs with abdominal distension which was insidious onset and gradually progressive associated with shortness of breath which was relieved on medication then patient was referred to KIMS for further evaluation
N/o of decreased urine output, chest pain, palpitations, PND,orthopena,
-past History-
History of hemodialysis done in 2015 i/v/o necrotizing fasciitis
Known case of hypothyroidism, HTN on irregular medication
O/E
pt conscious,coherent,cooperative
pedal edema present since 20days pitting type
No signs of pallor, icterus,cynosis clubbing, koilonychia,lymphedenopathy
Vitals
Temp-afebril
PR-84bpm
BP-160/100
spo2-98%at RA
-Systemic Examination-
CVS-
Temp-afebril
PR-84bpm
BP-160/100
spo2-98%at RA
-Systemic Examination-
CVS-
-inspection
JVP-not elevated
No parasternal heave
apical impulse -no visible
no engorged veins,
-palpitations
apex beat felt at 0.5cm lateral to the mid clavicular line in 6th intercostal space
All inspectory findings confirmed
-percussion
Hearts boarders percussed
-Auscultation
s1,s2 +
no murmurs
RS-BAE+
P/A-
P/A-
-inspection-
distended abdomen,umbilicus centeral, inverted , no engorged veins,no scars,no sinus,no visible pulsation
-palpitations-
no local raise of temperature
soft,non tender,no guarding,no rigidity
no organomegaly, hernial orifices normal
-percussion-
dull node on percussion over flank,
shift in dullness present,fluid thrill present
-Auscultation-
Bowel sounds present
CNS-higher mental functions normal
no focal neurological deficit
Investigations
on the of admission
1.INJ LASIX 40MG PO/BD
2.T.SORBITRATE 5MG PO/OD
3.TAB NODOSIS 500MG PO/BD
4.TAB OROFER XT PO/BD
5.TAB SHELCAL PO/OD
6.TAB .ASPIRIN 75MG PO/OD
7.TAB.CLOPIDOGREL 75MGPO/OD
8.TAB ATORVAS 40MG PO/OD/HS
DAY 1
1.INJ LASIX 40MG PO/BD
2.T.SORBITRATE 5MG PO/OD
3.TAB NODOSIS 500MG PO/BD
4.TAB OROFER XT PO/BD
5.TAB SHELCAL PO/OD
6.TAB .ASPIRIN 75MG PO/OD
7.TAB.CLOPIDOGREL 75MGPO/OD
8.TAB ATORVAS 40MG PO/OD/HS
9.TAB MET XL 25MG PO/BD
DAY 2
1.INJ LASIX 40MG PO/BD
2.T.SORBITRATE 5MG PO/OD
3.TAB NODOSIS 500MG PO/BD
4.TAB OROFER XT PO/BD
5.TAB SHELCAL PO/OD
6.TAB .ASPIRIN 75MG PO/OD
7.TAB.CLOPIDOGREL 75MGPO/OD
8.TAB ATORVAS 40MG PO/OD/HS
9.TAB MET XL 25MG PO/BD
Provisional Diagnosis
-HFrEF WITH type 4 cardio renal syndrome with DCMP with Ischemic Hepatits
-HFrEF WITH type 4 cardio renal syndrome with DCMP with Ischemic Hepatits
