35 yr old male with bilateral pedal edema
A 35 year old male with bilateral pedal edema
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A 35 year old male patient who is a daily wage labourer by occupation came to the opd with complaints of bilateral pedal edema since 2 months with was aggrevated from 20 days,abdominal distension from 20 days,and dry cough from 20 days ,facial puffiness from 3 days
Patient was apparently asymptomatic 2 months back then he developed edema of feet which was on and off .From 20 days the edema gradually progressed till knee,which relieves on elevation of limb.From 20 days he was having abdominal distension and dry cough.He got admitted for these complaints in a private hospital. After 3 days he was reffered to highter centres.Then he came to kims for futhur evaluation.
Patient had similar complaints of pedal edema 6 years back.
No h/o HTN/DM/thyroid disorders/fevere/sore throat/asthma
Alcoholic since 12 years 90 ml/day
GENERAL EXAMINATION:
patient is concious ,coherent, cooperative, oriented to time,place,person,moderately built and moderately nourished
Vitals:
Bp:120/70mm hg
PR:95/min
RR:30/min
GRBS:119mg%
No pallor,icterus,cyanosis, clubbing,lympadenopathy,edema of feet.
SYSTEMIC EXAMINATION:
Respiratory system:bilateral air entry present,trachea central,normal vesicular breath sounds heard,no adventious sounds heard
Per abdomen:
shape of the abdomen:distented no tenderness,no local rise of temperature no palpable mass hernial orifices free no free fluid and bruit liver and spleen:not palpable bowel sounds:normally heard
CNS EXAMINATION:
Highter mental functions:
Patient is concoius,coherent,coperative,oriented to time,place,person
Speech is normal in pitch and tone memory :recent and remote memory intact
Cranial nerves:all cranial nerves intact
Motor system:
TONE: UL LL
Rt N N
Lt N N
BULK : UL LL
Rt N N
Lt N N
POWER: UL LL
Rt 4- 3+
Lt 4- 3+
Sensory system:
Fine touch N
Crude touch N
Pain/temp N
Vibration decreased
Joint position N
Propriception
Deep tendon reflexes
Biceps absent absent
Triceps absent absent
Supinator absent absent
Knee absent absent
Ankle absent absent
Cerebellum :no finger nose incordination
Knee heel test:normal
CVS examination:jvp raised,no visible pulsations,palpable heart sounds in plumonary,tricuspid,mitral areas,s1 and s2 heard,p2 is split
Raised jvp video:
https://drive.google.com/folderview?id=1U2stuJTGF7WZe4xzb9A6uG14xzFZ0VgX
Investigations:
Day 1:
20/4/20
2D ECHO VIDEO:
https://drive.google.com/folderview?id=1TSsy_eX1ZCqxjfRAycAJxrgndefbkkRx
Jvp video:
https://drive.google.com/folderview?id=1U64jiDEZPXsKlyD1rMZmucAqKGBIjZcU
PROVISIONAL DIAGNOSIS:
Type 1 pulmonary arterial hypertension
Treatment:
1)inj.lasix 40 mg iv×bd
2)fluid restriction less than 1 lit/day
3)salt restriction less than 4 gm/day
4)daily weight measurement
5)daily abdominal girth measurements
6)strict i/o charting
7)bp,pr monitoring 1 hrly
8)inj.ceftriaxone 1gm /iv/bd
9)tab.pregabaline 75mg od
Patient came to follow up and he presented with pain in both calf muscles dragging type,continuous,without radiating since 2 months Aggravated on walking .Mild pain during day time increased during first half of night and relieved in second half of night
Patient was apparently a symptomatic 3 months back ,he developed Ed’s a of feet (on and off).From 20 days Edelman gradually progressed till knee,which releives on elevation of limb.From 20 days he was having abdominal distension and dry cough
MOTOR SYSTEM EXAMINATION
POWER Rt Lt
Upper limbs Shoulder. flexion-extension 5/5 5/5
Lateral -medial rotation 5/5 5/5
Abduction-adduction 5/5 5/5
Elbow Flexion-extension 5/5 5/5
Wrist Dorsiflexion-palmar flexion 5/5 5/5
Adduction-abduction 5/5 5/5
Lower limbs Hips Flexion-extension 5/5,5/5 4/5
Lat rotation-medial rotation 5/5 5/5
Abduction-addiction 4/5 4/5
Knee Flexion -extension 4/5,4/5 4/5
Ankle Dorsiflexion-plantar flexion 4/5,5/5 4/5
Inversion-eversion 4/5 4/5
TRUNK MUSCLE; Rolling over bed
Pain in the adductor compartment of thigh while rolling
GAIT; wide stance gait
EXAMINATION OF SPINE; Rt Lt
Vibration UL 8sec 8sec
LL 8sec 8 sec