A female patient of age 45 years came to the medical opd with chief complaints of pain from waist to knee and was unable to swallow food or drink water.

Date of admission- 01-06-2023

 A female patient of age 45 years came to the medical opd with chief complaints of pain from waist to knee and was unable to swallow food or drink water.


 History of presenting illness:- patient was apparently asymptomatic 3 months ago and then she fell down in the bathroom backwards. She was fine for 5 days and then she was unable to walk or get up from supine position.
I month ago she developed dysphagia where she couldn’t drink or eat something.
She had pain while swallowing. And she stopped eating since 10 days ago and it was associated with several episodes of vomiting after eating
She also had severe pain which was radiating from hip to knee of both lower limbs. The was sudden in onset, gradually increased , twisting type of pain, no relieving or aggravating factors. Associated with weight loss of about 20 kgs.
No h/o epigastric pain
Fever
Burning micturition
Heart burn
Bleeding sites 
Hemoptysis 
Diarrhoea or bloating
On palpation 
No mass per abdomen
Or tenderness found.

History of past illness :-
12 years ago the patient went to a hospital for leg pain and has found with decrease in function of a kidney as there was anuria the attendants are unsure of which. She has taken medication for it.

Past history:
No h/o DM
HTN
Epilepsy, thyroid
TB,
Asthma,
Had blood transfusion during delivery 

Surgical history: 
LSCS-1

 Family history 
No significant history 

Personal history
Married 
Mixed diet
Normal bowel movements 
But low urine output
No burning micturition
Loss of appetite 
No known addictions or allergies

General examination 

Conscious, coherent 
 Presence of pallor

No cyanosis 
No icterus 
No clubbing of fingers
No lymphadenopathy 
No pedal Edema
Vitals

BP 90/60 mmhg
PR - 90 beats/ min
Spo2- 99%
Temp: 98.2F
GRBS - 109 mg/dl ( present)


Investigations:

GRBS - 82 mg/dl
Blood urea- 135 mg/dl
Serum creatinine- 4mg/ dl
 Electrolytes
Sodium - 143 m Eq/ l
Potassium- 4 mEq/l
Chlorine - 108 mEq/l


T. Bilirubin - 1.5 mg/dl
D. Bilirubin- 0.27 mg/ dl
 
SGPT- 10 IU/L
SGOT - 10 IU/L
ALP - 345 IU/L
T proteins - 4.6g/dl
Albumin - 2.03 g/dl
A/G ratio - 0.7

RADIOLOGICAL INVESTIGATIONS



ECG



Systemic Examination 

CNS examination 


1 . Level of consciousness-  conscious
2. Speech - normal
3. Signs of meningeal irritation- 
         - no neck stiffness 
          - no Kernig’s sign
 4. Cranial nerves - normal
5. Motor system - normal
6. Sensory system - normal

CVS examination 
No thrills
Cardiac sounds - S1 and S2 present
Cardiac murmurs - absent


Respiratory examination 
No dyspnea 
No wheezing 
Position of trachea- central
Breath sounds - vesicular 


Abdomen 
 Shape of abdomen - scaphoid
Tenderness - absent
Palpable mass - absent 
Hernial orifices - normal
Free fluid-  absent
Spleen - not palpable
Liver - not palpable 
Bowel sounds - yes

Treatment

3-06-23
1. Optineuron - 1 amp i.v OD

4-06-23
 Optineuron - 1 amp i.v OD
T. MVT
Lactulose TD
Shelcal tab- OD

6-06-23
T.Naredrena 2amp
T.Nitrofurantoin 100mg oral TID
IV NS @ 75ml/hr
Syp lactulose 15ml oral TID

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