Bimonthly internal assessment (november)

CASE : 1

1) "55 year old male patient  came with the complaints of Chest pain since 3 days Abdominal distension since 3 days Abdominal pain since 3 days and decreased urine output since 3days and not passed stools since 3days.

https://sreejaboga.blogspot.com/2020/11/is-online-e-log-book-to-discuss-our.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

Gallbladder,pancreas,Rt lung,kidney,thyroid.

Gall stones due to Hypertriglycerdemia

a-acute pancreatitis mostly due to gallstones .

it can be alcohol  also

acute pancreatitis leads to SIRS

Bcz of SIRS exudative pleural effusion on rt side of heart.

AKI due to prerenal cause that is acute pancreatitis

usg abdomen,CXR,sr.amylase,CBP,RFT,

2D echo,TFT,ascitic tap,pt,lipid profile

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

pharmacological  intervention

a IVF

Piptaz,metrozyl-antibiotics

Tramadol-to relieve pain

Zofer-to relieve vomitings and nausea

Lasix

Nebulization with budecort

Non pharmacological intervention-

Stop the alcohol intake

Avoid fatty food

Increase the intake fiber rich food,fuits, vegetables.

Exercise for atleast 30mins .

CASE : 2

2) A 55 year old male, shepherd by occupation, presented to the OPD with the chief complaints of fever (on and off), loss of appetite, headache, body pains, generalized weakness since 2 months, cough since 2 weeks and vomitings and pain abdomen since 2 days. 

https://aakansharaj.blogspot.com/2020/11/55-year-old-male-with-anemia.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

ANATOMICAL LOCATIONS WITH ETIOLOGY:

BONE MARROW

Etiology: Multiple myeloma

KIDNEYS

Etiology: AKI due to multiple myeloma

HEMATOLOGICAL (ANEMIA)

Etiology: secondary to multiple myeloma

LUNGS

Etiology: Tuberculosis (Increased susceptibility to infections)

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

PHARMACOLOGIC :

1.ANTIBIOTICS : For underlying infection (Azithromycin for ?Atypical pneumonia)

2.ATT : For TB

3.SEVELAMER : For hyperphosphatemia

4.FEBUXOSTAT : For hyperuricemia

5.PRBC transfusion for anemia

CASE : 3

3) 51 Year old man with complaints of B/L pitting pedal edema from 5 to 6months,abdominal distension from 2 to 3 days,SOB from 3days.

nithishaavula.blogspot.com/2020/11/51-yr-old-male-with-hfref.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

ANATOMICAL LOCATIONS WITH ETIOLOGY:

HEART (HFrEF - pedal edema , abdominal distention and SOB) :

Etiology: Microvascular dysfunction DM and HTN

CNS (Seizures) 

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Pharmacological interventions

meta analysis with each class of drugs)

Preload reducers

Diuretics

Afterload reducers-ace inhibitors

Rate controlling agents-beta blockers

Antiepileptics for known case of epilepsy

Insulin for glycemic control in diabetes.


Non pharmacological interventions:

Salt and fluid restriction

Individualized salt and fluid restriction can improve signs and symptoms of CHF with no negative effects on thirst, appetite, or QoL in patients with moderate to severe CHF and previous signs of fluid retention

CASE : 4

4) 31 yr old man with B/L pedal edema with scrotal and penile swelling since 2 months

https://nairaditya97.blogspot.com/2020/11/31-yr-old-male-with-bl-pedal-edema-with.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

ANATOMICAL LOCATIONS WITH ETIOLOGY:

HEART FAILURE (pedal edema , penile & scrotal swelling and SOB) :

Etiology: Alcohol causing wet beriberi

AXONAL SENSORY POLYNEUROPATHY:

Etiology: Alcohol

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

pharmacological interventions:

Diuretics

Thiamine

non pharmacological interventions:

Salt and fluid restriction

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