13 may e log

 Hello all, iam an Intern, and this is a case history of one of our patient's who got admitted . This is to complete my log book as  a part of internship duties. 


A 21 yr old girl 
Case report:
2016 
The patient had generalized edema, so she went to the hospital where on  investigation on 24hr urinary protein it was 5.2 which was in nephrotic range Proteinuria . On further evaluation, histopathology of renal biopsy showed it as focal segmental glomerulosclerosis.  She  was on steroids for 1 year after which she stopped the medication because of steroidogenic effects. The histology slides of the renal biopsy: 

2020 
Patient came with complaint of loose stools since 2 weeks. 5-6 episodes/day. 
 Associated with mucous. 
Non blood stained
Non foul smelling
C/O vomiting after eating food 
Non bilious
Non blood stained 
Associated with pain in the left iliac fossa radiating to the loin.
Not associated with fever, pedal edema, decreased urine output,  burning micturation.
Symptoms did not decreased on treatment [ inj metrogyl and tab levofloxocin] × 5 days. 

She was diagnosed as hypertensive 4 days back at a local hospital and is on 
Tab. Cilindipine 10mg BD. 

ON EXAMINATION 
Pt was c/c, moderately built and nourished
Pallor( +ve) 
Icterus, cyanosis, clubbing, lymphadenopathy, pedal edema (-ve) 
Moderately dehydrated
Tempzerature 98.6° F
Pulse rate : 100bpm
Respiratory rate: 19 cpm
Blood pressure: 150/100 mm hg
Saturation at room air : 98%
CVS : S1 S2 heard. No murmurs
Respiratory: BAE+ ,  NVBS heard
P/A  soft, non tender
CNS: HMF intact
          Speech N
          Sensory system - decreased field of 
                                           vision ( periphery) 
                                           Decreased far vision
                                           Remaining N                                           
          Motor system  N

In view of vision complaints ophthalmology consultancy was taken, their report says : 
     Exudative retinal detachment,
      multiple haemorrhages
     Exudative  membranes all over macula
    Discreet deposits around macula
Patient need to have B scan and FFA

INVESTIGATIONS 
 HAEMOGRAM      1/5/20    8/5/20    11/5/20
 HB-                             6.4           6.8             6.6
TLC-                           6900        8100         5800
Lymphocyte-              27             33             23
Platelets-                    1.71         1.41          1.28

CUE                                 6/5
Albumin                          3+
Sugar                              1+
Pus cells                        6-8
RBC                                 8-10
Epithelial cells                3-4

RFT                         7/5               9/5             11/5
Urea                        74                   67               55
Creatinine               7.3                7.8              7.3
Uric acid                6.7                  6.4              6.2
Calcium                  8                     8.6             7.9
Phosphorus          8.3                  6.4              6

SERUM ALBUMIN       1/5/2020      3.1g/dl
STOOL FOR OCCULT BLOOD +VE
24 hr urinary protein  1/4/2020 =  1020mg
Stool culture and sensitivity -  normal
Ultrasound-  Renal parenchymal disease,            
                        Pelvic ascitis. 

DIAGNOSIS:  
    K/c/O nephrotic syndrome with 2° to FSGS
   K/C/O Htn
  With A cute GE ( resolved) 
 With pelvic ascitis

TREATMENT;
     IVF   NS & RL @ 75ml/ hr
    Inj   PANTOP 40 mg OD
 INJ  ZOFER  4MG/IV/TID
Inj  metrogyl 500 mg tid × 5 days
Oral fluids upto 2litr/ day
ORS sachets 200 ml after each episode
T. Sporolac DS   BD
T. RACEDOTRIL 150mg BD
T. CLONIDINE 10mg BD
T. TELMA 40mg OD (BAM) 



PROCEDURE:
 I have done an ABG when I was posted as an internee in amc, on a ckd patient who was very dyspneic suddenly. The procedure was very useful at that point of time to check out his po2. 

NEET TOPIC: WILSON'S DISEASE
Wilson's disease is a rare autosomal recessive inherited disorder that causes copper to accumulate in the liver, brain and other vital organs. 
Most people with Wilson's disease are diagnosed between the ages of 5-35.

Signs and symptoms depends upon the parts of the body effected by the disease. 
Fatigue, loss of appetite, or abdominal pain. 
Golden brown eye discoloration ( kayser-fleischer ring) 
Fluid buildup in the legs
Problems with speech, swallowing, or physical coordination. 
Uncontrolled movements and muscle stiffness 
Treatment:   
     Penicillamine
    Trientine
    Zinc acetate

    





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