GENERAL MEDICINE ASSIGNMENT

QUESTION :1 peer review

A 52 year old patient came to Hospital on 29 th june 2021 with chief complaints of Right lower limb swelling and intermittent fever ( alive and well), shortness of breath since 3 days and Burning 

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 blog was done 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 creatinine but same low levels of chloride
# ABG and CBP was done that showed 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.

QUESTION : 2 

I haven't done any E log because I don't have an idea about doing an elog . I'll try to do my best in next time .

QUESTION: 3 

# AKI ( Acute kidney injury )

# CKD ( Chronic kidney Disease )

# ACUTE ON CKD: 

# COMA N RENAL FAILURE
  
I have seen  there was a different types of renal related cases here although some of the symptoms for renal disease may be same however ...there is a clear diagnosis for each case.. from this I  have learned that each and every symptom of each patient should be taken into consideration...then only we can  able to diagonse  the patient...there were  by our doctors are keeping many efforts to diagnose the disease..there is a lot 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.

QUESTION : 5

It's been 2 months 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 and every complaint..I am not sure  that each and every one will understood because the diseases and their conditions are getting more and more complicated day by day...
So atleast we will get an clear idea about how to take a history from the patient  what to react to the patient condition.


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