45 year old male with vomitings and decreased appetite















 January 02,2023

45 year old male resident of narketpally driver by occupation came to op with chief complaints of vomitings since 3 days, decreased appetite and weaknes since 3 days 

 HOPI

Patient was apparently asymptomatic 4 years back , then he developed fever , joint pains , muscle cramps and loin pain for which he went to the near by hospital and diagnosed to have chikungunya . And he was Also diagnosed to have kidney injury .

He was treated conservatively and sent back home 

He has constant pain in the loin region since 4 years and his pain increased while driving long distances . He used nsaids when his pain increased.

One year ago he had similar complaints of vomitings and decreased appetite.

3 days ago he came with vomitings immediately after consuming food , non projectile , non bilious containing food particles and decreased appetite and weakness.

At our hospital he underwent 3 episodes of dialysis . After which his symptoms have decreased and his back pain decreased.

Daily routine:

Patient wakes up around 5 Am , have his breakfast around 7 am and goes to work around 8 am , lunch around 1 pm and dinner around 9 pm . Through out the day he has constant back pain while driving but the pain was not severe dull pain was present didn’t restrict his daily activities.

Since three days he was unable to go to work because of weakness and vomitings.

Personal history:

Diet : mixed 

Appetite:normal

Sleep : normal.

Bowel and bladder: regular 

Addictions: none

Treatment history:

Conservative therapy for ckd .

FAMILY HISTORY No significant family history


GENERAL EXAMINATION


Patient was conscious coherent and cooperative

 Moderately built and nourished  

Pallor present

Icterus absent

Cyanosis absent

Clubbing absent

Generalized lymphadenopathy absent

Bilateral pitting type of pedal edema present

Vitals 

Temperature Afebrile 

Pulse rate 88bpm

Respiratory rate 17 cpm

Blood pressure 130/70

GRBS -110

SYSTEMIC EXAMINATION


Respiratory System


Inspection


Symmetrical chest is seen




No scars and sinuses 




Trachea is Central in position




Palpation:




Inspectory findings are confirmed 


Expansion of chest is equal in all planes 






Percussion: 




Resonant note present over all lung areas




Auscultation:




Normal vesicular Breath sounds heard. 




PER ABDOMEN 




Inspection: 


Abdomen is flat


No Abdominal distension 


No scars, sinuses, mass visible 


No engorged veins are seen


Umbilicus is central and inverted 


No visible pulsations


Movements are equal over 9 regions during respiration




Palpation:




All inspectory findings are confirmed 




No local rise of temperature




 No Tenderness




No hepatomegaly and No spleenomegaly 


Percussion 


Normal


Auscultation




: Normal bowel sounds heard




No bruit heard




CARDIOVASCULAR SYSTEM EXAMINATION 




Inspection : Bilaterally symmetrical chest present 




No scars, sinuses






Palpation:




Inspectory findings are confirmed




Apex beat normal




On Auscultation : 




S1 S2 heard




No murmurs or additional heart sounds heard




CENTRAL NERVOUS SYSTEM EXAMINATION 


No focal neurological defecits  


PROVISIONAL DIAGNOSIS 

Chronic kidney disease with association with NSAID abuse ?

ECG :




Investigations:








Treatment:

Fluid restriction: less than 1.5 liter per day 

Salt restriction: less than 2 g per day 

Tab.shelcal -500 mg 

Tab nodosis-100 mg 

Injection orofer:100 mg 

Injection epo 4000 I U weekly once subcutaneous 

Syrup :potklor 15ml /TID .






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