GENERAL MEDICINE assignment (July 22)
Q1.Peer review:
A 52yr old patient came to the ward on 29 June 2021 with chief complaints of right lower limb swelling, intermittent fever (alive and well), shortness of breath since 3days, and burning micturition for 15 days.
This is a case of
Right lower limb cellulitis
Right heart failure 2nd degree to COPDAKI 2nd degree to cellulitis - resolved
DM-II
Heart failure with a preserved ejection fraction (HFPEF)
This was done as elog by my classmate
The patient was first asymptomatic later he developed right lower limb pain upto knee and then came up with many complaints...what I have observed is that
there are elevated levels of urea,creatinine,uricacid and low level of chloride in RFT and elevated levels of total and direct bilirubin in his LFT
Random blood sugar level which is low
Complete urine examination is also done
Haemogram which showed high neutrophil count and low leucocyte count ( normocytic normochromic neutrophili with leucocytosis)
These were the test findings which were done to patient on the day of joining
And around a week later again RFT was done which showed normal urea, uricacid and creatininebut same low levels of chloride
ABGand complete blood picture was done that sho normal neutrophil count but low leucocytes.A few days later he was discharged taking the prescription given by the doctors.. Right lower limb pain is diagnosed as cellulitis which is caused due to microorganisms..for which he got done with surgery.He also has pulmonary tension which is the cause for heart failure of the patient.
Q2
N
I haven't asked anyone to give a case for elog because I don't have an idea about doing an elog..if I got clarity on it I'll try to do my best..
Q3
AKI:
CKD:
ACUTE ON CKD:
COMA N RENAL FAILURE:
I see a there was a different types of renal related cases here although some of the symptoms for renal disease may be same but..there is a clear diagnosis of each case..by this I learned that each symptom and eachceach of the patient should be taken into consideration..then only we are able to diagonse patient...there were many efforts kept by our doctors to diagnose the disease..there is more to learn from this elogs..
QUESTION:4
ACUTE KIDNEY DISEASES:
It is sudden in onset, primarily reversible. Generally, the patients come to OPD with c/o oliguria, lower abdominal pain, decrease in urine output with burning micturition, SOB, fever, vomitings- bilious, pedal edema in bilateral lower limb pitting type. It can be identified by serum creatinine levels O/e it shows low albumin levels, with normal hemoglobin concentration, not associated with anemia [rarely anemia can be noticed], normal lipid profile. Sometimes AKI are associated with other diseases like hepatomegaly, pancreatitis, CHF. Renal transplantation is not required, the patient should be on dialysis for a short period of time.
CHRONIC KIDNEY DISEASES:
It is sudden in onset, predominantly irreversible. General c/o of patients are muscle aches, fever, generalized weakness, vomitings- non-bilious, normal or increased urinary output [polyuria], no pedal edema [if associated with pedal edema there is periorbital edema too which indicates severe kidney damage], SOB- absent. O/e size of the kidney is reduced, hemoglobin concentration decreased, anemia is seen, marked changes in lipid profile [decreased HDL, increased LDL, TG]. Renal transplantation is necessary, dialysis- required repeatedly.
ACUTE ON CHRONIC KIDNEY DISEASE:
Sudden fall in GFR is diagnosed as acute kidney disease, nevertheless, some pt has pre-existing kidney injury leading to CKD.
Q5.
It's been six weeks we have started with online general medicine clinical postings.if we concentrate more on subject learning then I think there will be a possibility to get understood each complaint..I am not sure each nd evry will understood because the diseases and their conditions are getting more and more complicatedd by day
So atleast we will get an idea about how to take a history from the patient how to and what to react to the patient condition.
