Manogna 33

This is an online E logbook to discuss our patients' 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 the available global online community of experts intending to solve those patients clinical problems with the collective current best evidence-based inputs. This e-log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box are welcome.  Name:  G Sai Manogna Roll no: 41 I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan. Following is the view of my case : CASE PRESENTATION: A 45 year old female who is a resident of miryalaguda has come to the casualty with the chief

 Duration of posting (12/10/22 to 11/12/22) During units duty: 1. Inserted foley's catether twice 2. Inserted ryle's tube twice 3. Tried ascitic tapping in an abdominal distended patient with ascites present in ICU 4. Took ABG samples and collected venous blood samples for routine investigations Case 1: https://manogna33.blogspot.com/2022/10/chronic-liver-disease-with-akihepato.html My orientation around the case 1. What is the possible cause of his pedal edema? Renal impairment or low output states (Cardiac failure) or acute tubular atrophy 2. What is the cause of nil urine output in this patient Hypotension and hypovolemia are the two most important causes of decreased renal perfusion In this patient, when he came to the casualty his BP recorded was 60/40 mmHg 3. What are the indications for commencing dialysis in this patient a. Urine output <0.3 ml/kg for 24 hours b. Absolute anuria for > 12 hrs c. Multiorgan failure d. Refractory volume overload e. Complications of u

 DIAGNOSIS ACUTE DECOMPENSATED LIVER DISEASE SECONDARY TO ALCOHOL WITH GRADE 2 HEPATIC ENCEPHALOPATHY CASE FINDINGS C/O DRAGGING TYPE OF PAIN OF B/L LOWER LIMBS SINCE EVENING DECREASED URINE OUTPUT SINCE 15 DAYS ABDOMINAL DISCOMFORT SINCE 15 DAYS C/O SWELLING OF BILATERAL LOWER LIMBS SINCE 15 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 15 DAYS AGO AND THEN DEVELOPED SWELLING OF BOTH LOWER LIMBS, INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE, AND ABDOMINAL DISTENSION SINCE 15 DAYS ABDOMINAL DISCOMFORT SINCE 15 DAYS C/O DECREASED URINE OUTPUT SINCE 15 DAYS H/O SEIZURES, 3 EPISODES- ONE IN DEC 2021, JAN 2022, SEP 2022 NOT USED ANY MEDICATION TONIC SEIZURES, UPROLLING OF EYES +, FROTHING FROM MOUTH + POSTURAL CONFUSION + FOR 15 MINUTES SPONTANEOUS URINATION -  SPONTANEOUS DEFECATION - VOMITINGS - LOOSE STOOLS - INCREASED DAYTIME SLEEPINESS SINCE 1 WEEK H/O INCREASED BILIRUBIN LEVELS 1 MONTH BACK HYPERPIGMENTED PATCHES (DIFFUSE) PRESENT OVER THE BODY PAST HISTORY NOT A KNOWN CASE OF HTN, DM, ASTHM