Case on Pedal oedma and enlarged lymp nodes
















 


E-LOGS GENERAL MEDICINE


 
Roll no 36
Hi, i am tejaswi5th Sem Medical Student. This is an online e-log book to discuss our patient's health data shared after taking his/her/guardian's consent. This also reflects patients centered care and online learning portfolio. 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. Hope this will be informative!

* This is an ongoing case. I am in the process of updating and editing this ELOG as and when required.


A 47 yr old female patient came with cheif complaints of shortness of breath and pedal odema from 2 months. She also presented with abdominal distension from past 2 months . Has enlarged lymp nodes the right side of neck. 


History of present illness 


Patient was apprently a symptomatic 6 yrs back and had generalised body weakness for which she went to the hospital and was diagnosed with sugar and was on regular medication . 
2 months back she had pedal odema bilateral pittingvtype below the hip and abdominal distension for which she went to the hospital and was diagnosed with hypertension and hypothyroidism for which medication was started . 
The pedal odema gradually subsided with medication but abdominal distension persisted for which she came to our hospital for draining the fluid . She was admitted for low SAAG ascites and low protein ascites 
Fluid was drained . 
FNAC was done diagnosed with chronic granulomatous lymphadenitis 
Now the patient is came for excisiinal biopsy . 


Past history 


K/c/o diabetes since 6 yrs insulin subcutaneous 4 u
K/c/o hypothyroidism and hypertension since past to months 
No history of tb , seizures 

Treatment history 

Diabetes HAI 4 u sc tid ( human actrapid ) 
Hypertension telma 40 mg od 

Personal history 

Married occupation housewife 
Appetite decread 
Non veg 
Bowel and bladder movements regular
Ni known allergies 
No addictions 


Family  history 

Not significant 

Menstrual historyy 

 Hysterectomy done 10 yrs back 

GENERAL EXAMINATION 

Pallor - Present 
Icterus - absent 
Cyanosis- absent 
Clubbing- absent 
Lymphadenopathy- present  
Edema - present bilateral pedal 

VITALS : 

Temperature – 98°F 
Pulse rate –78 per min 
BP –110/70
Respiration rate –16
GRBS –  
SPO - 96 percent


SYSTEMIC EXAMINATION 
    CVS 
No Thrills 
Cardiac sounds S1,S2+ Jvp slightly elevated 
No murmurs 

RESPIRATORY SYSTEM 

Dyspnoea - present 
Wheeze - absent 
Position of trachea - central 
Breath sounds are vesicular

ABDOMINAL EXAMINATION 

Abdomen  distended 
No Tenderness 
No palpable mass 
Hernial orifices normal 
free fluid presnt 
No bruits 
Liver is not palpable 
Spleen is not palpable 
Bowel sounds heard 

CNS 
 Conscious
Speech is normal 
Signs of meningeal irritation- no neck stiffness
                                                 Kernings sign negative 
Cerebral signs - No finger nose in coordination 
                           No knee-heel in coordination 






Investigatons







Diagnosis 


Low SAAG low Ascites secondary to diabetic nephropathy
Right lymphadenopathy - chronic granulomatous lymadenitis 

Treatment

Inj LASIX 20 mg BD 
Tab TELMA 40 mg OD
Tab ULTRACET 1/2 QID
Tab OROFER OD
Inj HAI SC tid before meals

5/7/22 
No fever 
Same treatment given 
Inj LASIX 20 mg BD 
Tab TELMA 40 mg OD
Tab ULTRACET 1/2 QID
Tab OROFER OD
Inj HAI SC tid before meals

6/7/22
No fever 
Inj LASIX 20 mg BD 
Tab TELMA 40 mg OD
Tab ULTRACET 1/2 QID
Tab OROFER OD
Inj HAI SC tid before meals

7/7/22
Patient had slight fever 
Genrealised bodyy weakness 
Inj LASIX 20 mg BD 
Tab TELMA 40 mg OD
Tab ULTRACET 1/2 QID
Tab OROFER OD
Inj HAI SC tid before meals

8/7/22 
Generalised body weakness present 

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