Exam

A 55yr old male sandibatla Chief complaints : complaining of Pedal edema  and shortness of breath since 10 days and fever since 15 days.  HOPI: Pt was apparently asymptomatic 15 days back and then developed fever which was intermittent, not associated with chills and rigors.. relieving with medication.. After 4 days patient started developing pedal edema up to ankles,  which was progressive and Associated with Shortness of breath.. Then pt went to the local doctor where his creatinine was found to be 8.5 and patient was referred to kims for further evaluation.  Past history : k/c/o DM and on Insulin Mixtard 20 and 15 units and  K/C/O HTN since 5 years and on Atenolol 50 mg  Personal history :  PERSONAL HISTORY: Mixed diet, Appetite normal, Occasionally  alcoholic and Smoking 3 beedis per day.  No  other addictions. GENERAL EXAMINATION: Patient was consious, coherent, cooperative;oriented to time,place,person. Pallor present  No icterus, clubbing, cynosis, lypmhadenopathy. Bilateral ped

A 72yr old female with chronic kidney disease and HTN Complaints of shortness of birth since 20days;  vomitings since 20days ,intermittent type Bilateral pedal edema,facial puffiness and burning micturation(intermittent) since 20days. Loose stools since 20days associated with Tenesmus. Patient was apparently asymptomatic 5years back, then developed pain in the bilateral knee joints with low backache, patient went to the local doctor, where she was diagnosed with Hypothyroidism and was using medication 25microgram of Levothyroxine sodium and patient was normal upto the 2years. After the expiry of her husband , patient started developing  facial puffiness with bilateral pedal edema which aggravated on sitting posture , then patient visited local doctor where her creatinine was found to be 3 and also diagnosed with HTN & treated conservatively upyo 1year. Later because of personal reasons she started visiting NIMS , where she was on medical treatment for 2years and stopped using those

Chief complaints : A 39 yr old male resident of miryalaguda ,agriculture by Occupation complaining of Pedal edema and shortness of breath since 3 month along with decreased Urine output.  HOPI : Pt was apparently asymptomatic 3 months back then developed Pedal edema Grade 2 and shortness of breath for which he went to the local doctor where he was diagnosed with CKD and Hypertension ( Records not available) .For which he was started on medical management.. In spite of failure of the medical management he was Referred to kims for further evaluation...  Past History : 1) Hypertension since 3 months and using  2) laproscopic surgery in view of Intestinal obstruction??? 6 years back( No records)  Personal examination:  Mixed diet  Appetite normal  Alcohol intake : since 20years ..daily up to 180ml and  and non smoker  Generalized  examination :pt is c/c/c ,oriented to to time, place, person.  Pallor present  No icterus, clubbing, cynosis, lypmhadenopathy. Bilateral pedal edema present. 

 A 60 yrs female who was labourer by occupation  came with c/o pedal oedema since 1week and sob since 1week  HOPI : Pt was apparently asymptomatic 5yrs back then developed generalized weakness along  with pain in the joints which made her to stop going to the work followed by which after 6months Pt developed fever with vomitings and generalized weakness and pt went to the local hospital from which she was referred to hyderabad in view of kidney pathology (exact pathology and the reason for pathology not known and records not available) then Pt had consultation with nephrologist for about 2yrs , where conservative  management was given. The nephrologist has advised the admission but the Pt refused because of unoffordability and the Pt came to Kim's for further evaluation  2yrs back from that time she was on the maintenance hemodialysis  Past history : H/o fracture at the left wrist joint 10 yrs back and fracture of right wrist 5yrs back both are due to h/o fall  K/c diabetes since 5

case I: 1) What is the reason for this patient's ascites? Ans: excessive chronic alcohol use can cause chronic liver disease, alcholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis..  In absence of inflammation Or necrosis alcohol use can produce Fibrosis..  The clinical manifestations of cirrhosis include ascites, pedal edema, pain, fever, nausea, development of jaundice( scleral icterus) , upper gi hemorrhage..  In cirrhosis increase in portal hypertension causes sphlancnic vasodilation results in increase portal venous flow... Both these cause increased production of splanchnic lymph.. These hemodynamic changes result in sodium retention by causing activation of RAAS pathway with increase in aldosterone..  Sodium retention causes fluid accumulation and expansion of ecf results in edema and ascites..  2) Why did the patient develop bipedal lymphedema? What was the reason for the recurrent blebs and ulcerations and cellulitis in his lower limbs?   Ans: Bilateral pedal oede