Internship E log - BHARGAVI

    Diagnosis: ? RAPIDLY PROGRESSIVE GLOMERULO NEPHRITIS 

 A 24year old teacher from Nalgonda came with c/o Difficulty in swallowing (since 10days) Joint pains (10days) Fever (5days) She was apparently asymptomatic 2 years back,  On 5th December 2018 she developed multiple joint pains, fever with chills and rigor, she went to physician and took some medications which relieved her symptoms. After 3weeks she had similar complaints and took same medication. From then the she had mild joint pains but can do her daily activities.  In june 2019 her parents planned her marriage but she developed Rash behind the right ear and over the face also had joint pains, low grade fever  so she underwent antibody tests and found out ANA positive on 26/6/2019. ( ANA: 4.04 ; Anti dsDNA 2.33) She’s on medication for SLE for 1month On 24/7/19 she had generalized body pains and articualar pain for which she took 1 month medication and discontinued as she had hair fall due to that medications.  until 22/5/2020 she did not use any medications. But had mild joint pain

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.  A 60year old lady came to casuality with chief complaints of Facial puffiness since 3 days Swelling of legs since 3 days. Reduced urine output since 2 days Patient was apparently asymptomatic 3 days back then she developed facial puffiness, swelling of both the legs upto knee which is aggravated on walking without any relieving factors along with it she also had swelling of both the hands upto forearm. The following day her urine output is reduced to very minimal amou

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.  A 54 year old Toddy tree climber came to opd with chief complaints of  1. Swelling of both the legs since 15 days 2. chest pain since 10days  3. Facial puffiness since 10days 4. Difficulty in breathing since 7days Patient was apparently asymptomatic 15days back then he developed bilateral pitting type of pedal edema extending Upto knees. He had on and off symptoms of Chest discomfort and pain since 10days. He also developed facial puffiness 10 days back which temporari

 

  CASE 1: 1) Patient develops hypoalbuminemia due to liver pathology as liver helps in albumin synthesis. Oncotic pressure is reduced leading to accumulation of fluid. So patient developed Ascites due to loss of starling forces 2) a) The pedal edema may also be explained by the hypoalbunemia hypothesis. But it can also be explained in terms of increased pressure in the abdomen in gross ascitis which may have caused obstruction to the lymphatic vessels and causing pedal edema (this is mostly supported for unilateral pedal edema)  b) in case of pedal edema there is stretching of skin and cracking up this may alter the defence mechanisms of skin. pathogens lodge and may develop infections, cellulitis of the leg. c)  At the same time due to increased stretching of the skin the upper epidermis gets separated and leads to accumulation of fluid there, which is the reason for blebs.  d)  When there is excessive stretching there will be more pressure which may lead to pressure necrosis and caus