55 yr old with recurrent diarrhea

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


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 patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome

 

Case discussion


A 55yr old female patient came to opd with complaints of abdominal pain,loose stools and vomitings since 10days.

Pain abdomen diffuse in nature,non radiating

Vomitings 3 episodes per day ,non projectile, contains food particles,immediately after eating,non bilious and not blood tinged.

Loose stools 3-4 episodes per day ,small in volume, watery in consistency not associated with blood

Patient was apparently asymptomatic 10years back then she developed joint paints for which she had taken NSAIDS given by the local RMP .

8yrs back she had similar complaints of pain abdomen with loose stools for which she was given symptomatic treatment (unknown medication) given by local RMP.

Inspite of  using those medications(irregualr)  for 1 year, as the symptoms did not subside ,she consulted gastroenterologist where the following investigations were done and diagnosed as acute on chronic colitis, errosive gastritis








Tab.MESACOL 1.2gm OD 
Tab.TRYPTOPHAN 25mg HS
Prescribed by the gastroenterologist 

Symptoms relieved on taking these medication and recurrence of similar symptoms due to irregular medication from past 6 years.

Incidentally pt noticed black colored stools(malena) 6yrs back.

Diagnosed as diabetes and hypothyroidism 8yrs back and on regular medication T.Glimiperide 1mg BD and T.Levothyroxine 88mg OD respectively. 

Throwing some light on her personal life 
She got married at the age of 14years and blessed with 4sons out of which 3sons were expired
1st child was a premature baby died after birth
2nd son died 3years back due to snake bite
3rd son expired 6months back due to MI
No h/o similar complaints in family 


Not a k/c/o HTN,Epilepsy,asthma,CAD,CKD.
Previous h/o blood transfusion 8yrs back.( for her anaemia)

Vitals:
Afebrile
BP - 110/80
Pulse - 84bpm
RR - 16cpm
GRBS - 126gm/dl

Pallor present ,no signs of clubbing, icterus, cyanosis, lymphadenopaty,edema.

O/e signs of dehydration present such as loss of skin turgor,dry lips and dry tongue.

RS - bae +,nvbs +,no added sounds
CVS - S1S2 heard,no murmurs
P/A - soft,tender,BS +

CNS EXAMINATION

HMF normal 

All Cranial nerves intact 

Gait - waddling gait (osteoarthritis)

Motor system:

          Bulk - normal 
          Tone- normal
          Power -normal

          Reflexes-          right               left

          Biceps                +2                 +2
          Triceps               +2                 +2
          Knee                   +2                 +2
          Ankle                  +2                  +2
          Plantar          extensor        extensor

Sensory system examination : normal

Cerebellar signs - intact

Following investigations were done:















Treatment given:


Day 1

1)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Buscopan BD
)Inj. Panto 40mg OD
4)Inj.  Zofer 4mg SOS
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) access. to sliding scale

Day 2

1)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Buscopan BD
)Inj. Panto 40mg OD
4)Inj.  Zofer 4mg SOS
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) access. to sliding scale
8)Inj.Fe & sucrose 1amp in 500 ml NS slow iv
9)Tab.Sporolac DS  TID

Day 3

Pain abdomen subside and no complaints of loose stools,no.of stools passed is only 1episode small volume & normal consistency 


1)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Tramadol BD
3)Inj. Panto 40mg OD
4)Tab. Sporolac DS/PO/TID
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) acc. to sliding scale
8)Tab. Folvite 5mg OD
9)Inj. Ciprofloxacin 500 mg BD
10)Inj. Metronidazole 100 mg TID

1unit of PRBC transfusion was done.
Present Hb - 8.9


Day 4

)Inj.Optineuron 1Amp in 100 ml NS 
2)Inj. Tramadol BD
3)Inj. Panto 40mg OD
4)Tab. Sporolac DS/PO/TID
5)Tab. Mesacol 1.2mg TID
6)Tab. Levothyroxine 88mcg OD
7) Inj. HAI (sc) acc. to sliding scale
8)Tab. Folvite 5mg OD
9)Inj. Ciprofloxacin 500 mg BD
10)Inj. Metronidazole 100 mg TID




Comments

Post a Comment

Popular posts from this blog

65 yr old male with acute onset of seizure

Image
  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  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 patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome   Case discussion 65yr old male pt who was a farmer by occupation brought to casuality with c/o 2 episodes of seizures 3hrs back. Pt was apparently asymptomatic 6yrs back then he had a h/o trauma for which he went to a local hospital and CT brain was done which came out to be normal. At that hospital he was diagnosed to be hypertensive and was put on amlodipine but patient was not on regular medication. Then 1yr back he started having symptoms such as forgetfulne
Read more

Biweekly exam

 1)Anatomical diagnosis -? Glomerulosclerosis                                                                        Etiological diagnosis -  ?? Nephrotic syndrome secondary to the diabetic nephropathy or CKD.      2)Reasons for I) Azotemia : impaired renal excretion of urea and creatinine secondary to CKD.  II) Anemia : decreased erythropoietin.  III) Hypoalbunemia: capillary basement membrane and podocytes damage.  IV)  acidosis: acidification of urine is lost.                                       3) Rationale : syp potchlor was given because of the hypokalemia.. Inj. NaHCO3 was given because of metabolic acidosis ..Insulin and antihypertensives are given because known case of DM and HTN. Orofer XT was given because of anemia.. Inj. Lasix was given to decrease her volume overload. Spironolactone was given it was a potassium sparing diuretic.Calcium was given to the patient  because of hypocalcemia secondary to CKD. Indications of NaHCO3:metabolic acidosis in cardiac arrest, Tricycli
Read more

70 yrs male with multiple skin lesions

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  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 patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome   Case discussion      70yr Male patient came to opd with c/o lesion associated with itching all over the body since 20days. Pt. was apparently asymptomatic 20days back then he developed intense itching over the posterior trunk then his attender noticed fluid filled lesion over the back The lesion is initially small in size and gradually increased in size. lesions rupture spontaneously or by scratching. The lesion ruptures and serous discharge is present resulting in t
Read more