45 YEAR OLD FEMALE

                                                     ELOG BASED CASE STUDY

DATE: 24/08/21

 A 45 year old lady came to Medicine OPD on 24/08/21 afternoon with the chief complaints of burning micturition, fever , pain in Right loin since 7 days , pain abdomen since 3 days , loose stools since 2 days  and SOB , nausea since 1 day.

Patient was apparently asymptomatic 1 week ago. Then she developed burning micturition one week , not associated with increased frequency of passing urine and urgency. she also developed pain in the right loin. Inspite of the above symptoms, she went for planting mirchi in her farm. Later, after  couple of days she developed fever which was intermittent ( on and off ), relieved on medication. associated with loose stools. she is also complaining of breathlessness since one day( grade 2).

Then, she was taken to outside hospital , treated symptomatically, dengue test was done and turned out to be positive and she was referred to our hospital in view of  decreased platelet count and Right kidney pyelonephritis.

PAST HISTORY:

She is a known case of Hypertension since 1 year and on regular medication ( AMLONG -AT 5/50mg OD) 
Not a k/c/o DM, Asthma, TB, epilepsy

PERSONAL HISTORY:

A 45 year old lady farmer by labourer who takes mixed diet, had loss of appetite, abnormal Bowel movement(increased loose stools since 2 days) , abnormal micturition( burning micturition) and consumes alcohol occasionally since 20 years. 

FAMILY HISTORY:
No significant family history

GENERAL EXAMINATION:
Patient is conscious, coherent and cooperative

No Pallor, Icterus, Cyanosis, Clubbing, koilonychia, lymphadenopathy.
pedal edema is seen.

VITALS: 
Temperature: 98.6 degree F, PR - 86bpm, BP - 110/70mm of Hg( left arm in sitting position) , RR - 18cpm.

CVS: S1 S2 + , No murmurs

RS: BAE+ , NVBS+

CNS: No motor or sensory deficits

PER ABDOMEN: Obese, tender(diffuse), Bowel sounds present.

INVESTIGATIONS:

Hemogram @ 24/08/21




CUE @ 24/08/21

Urine dipstick showing proteinuria





Urine dipstick showing measuring of specific gravity


Urine sample @ 24/08/21 ; 5:00 PM



LFT

RFT




USG @ 24/08/21



ECG @ 24/08/21


CHEST XRAY @ 24/08/21

XRAY KUB @ 24/08/21




PROVISIONAL DIAGNOSIS: 

DENGUE ASSOCIATED WITH THROMBOCYTOPENIA
? RIGHT PYELONEPHRITIS

TREATMENT GIVEN:

DAY 1:




DISCUSSION:

1) Is rise in ALP due to gall bladder edema ( due to increased permeability in dengue) or other gall bladder pathology?

2) Is dark coloured urine due to the cause that causing rise in direct bilirubin or any pathology in genitourinary tract?
























































































































































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