80 Yr Old Male Patient with Abdominal Pain.


80 year old male brought to casuality with c/o  
1.Pain Abdomen since 5 days. 
2.Not passing stools and Flatus since 5 days 
3.Shortness of breath since 5 days.

# History of presenting illness:
Patient was apparently asymptomatic 3 years back and then he developed pain abdomen in epigastrium localized and not a/w nausea or vomitings aggravated after food intake.
Since 1 year patient complains that he used to wake up in the middle of night and felt breathless for a while. Since 5 days patient has a history of generalised weakness with loss of appetite and has constipation with small quantity of hard stools. Sinec 5 days patient complains he didn't pass stools and flatus which makes him discomfort associated with pain abdomen.
#Past history:-
No h/o Dm, Htn, epilepsy, TB
No h/o previous surgeries. 

# Personal history:
Patient lost his appetite since 20 days and disturbed sleep.

Addictions: H/o Smoking (Sutta) since 55 years. chronic alcoholic drinks 90ml whiskey daily.


# General examination:

Patient consious, coherent, cooperative.
No signs of icterus, clubbing, lymphadenopathy, edema, pallor - present. 
Vitals: 
Temp: afebrile
Pr: 90 bpm
Rr: 20 cpm
Bp: 130/80 mmhg
Spo2: 98%
Grbs- 132 mg/dl
Systematic examination:
CVS: S1 and S2 heard
RS: BAE + 
CNS: NAD
P/A: soft ,non tender.
#DIAGNOSIS:-
Constipation 2°to Uremic gastroparesis. ? 
Pre renal AKI 2°to dehydration? 
Heart failure with mid range ejection fraction(49%). 
#INVESTIGATIONS:-
*Hemogram:
Hb- 11.5
Tlc- 29,300
Plt count- 1.62

*RFT:
Urea- 202
Creatinine- 5.9
Na+- 137
K+- 4.5 
Cl-- 90

*LFT:
ALP- 437
ALB- 2.8

*CUE:
ALB +
RBC - Absent.

*ABG:
Ph- 7.473
Pco2- 23.9
So2- 95.6
cHCO3 (P.ST)c- 20.8
cHCO3(p)c- 17.3
Serology- negative.
*X-RAY :-
XRAY -ABD and PELVIS. 

USG:-


ON 11-12-2021
Hb: 11.7
Tlc: 33,450
Plt count: 2.31

Urea: 204
Na+ : 139
K+ : 4.1
Cl- : 96

Spot urine protein: 1.2
Spot urine Creatinine: 100.6
Spot urine Albumin: 0.11

CUE:
Albumin: +
No sugars 
Ec: 2 to 4
Pc: 2 to 4

ON -12-12-2021. 

Hb: 10.9
Tlc: 22,700
Plt count: 1.59

Blood urea: 203
Serum creatinine: 3.4

Na+ : 144
Cl- : 98
K+ : 3.3


ON 16-12-2021

HB:- 11gm/dl
Total wbc :- 10400cells /cumm
neutrophills :- 82%
lymphocytes :-10%
esinophills :- 3%
monocytes:- 5%
Basophils:-0%
Platelet:-1.55 lakhs /cumm
 Blood urea :-80mg/dl
serum creatinine:-1mg/dl
Na+ :- 140meq/l
K+:- 3.8 meq/l
cl+:- 94meq/l
Treatment :-
1. Ivf NS/RL/DNS continuous at 100ml/hr
2. Inj. PAN 40mg IV BD 
3. inj. ZOFER 4mg IV/SOS
4. Syp. LACTULOSE 20 ml PO/BD
5. Tab.ECOSPORIN 75 mg PO/OD
6. Tab.CLOPITAB 75 mg PO/OD
7. Tab. ATROVAS 10 mg PO/OD
8. Proctoclysis enema twice daily
9. BP/PR/TEMP monitoring 4th hourly









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