A 36 Old Male, Cement factory worker by occupation came to the opd with chief complaints of
Abdominal pain since 5days
Right loin pain since 5 days
Vomitings since 5 days
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic one year ago then he developed pain in abdomen one year ago, later he went to the local hotshot diagnoses to have right renal calculi for which he took treatment and got cured
Then he developed pain in abdomen 5days ago, which is sudden in onset, gradually progressive, aggressive on performing daily chores, nights for which he went to local RMP for treatment and got cured
The next day patient developed,Right loin pain since, which is colicky type, sudden in onset, gradually progressive , radiating to right groin
Right loin pain was associated with Vomitings 2-3episodes / day , Non bilious, Content -food particles, Non projectile
Loose stools , 3times / day , clay colored, non foul smelling , Reduced urine output less than 200ml /day and abdominal distension
Shortness of breath grade 3 since 5 days
No h/o fever, Itching, facial puffiness, burning micurituon, painful micurition, Orthopnea , pleuritic chest pain , PND , Cough, cold
PAST HISTORY
Not a known case of Hytertension , diabetes , asthma ,CAD
FAMILY HISTORY
NOT significant
PERSONAL HISTORY
Complaints of loss of appetite since 5days
He is an alcoholic, consumes toddy, whiskey 3times /week , 90ml , content increases during family festivals and gatherings , non smoker
Bowel and bladder movements are irregular
GENERAL EXAMINATION
Patient is conscious, coherent and co operative
Well oriented to time,place,person
VITALS
BP 120/90mm hg
PR 76bpm
RR 28cpm
Spo298% Room air
GRBS 120mg%
Icterus present
No pallor, cyanosis , clubbing , lymphadenopathy
SYSTEMIC EXAMINATION:
Per abdomen
Abdominal distension present
Horizontal umblicus ?
No visible veins,Sinuses
Soft, tenderness present in all quadrants
Murphys punch positive on right side
Fluid thrill?
CVS
S1, S2heard , no murmurs
Respiratory system:
Bae present ?
Breath sounds ?
CNS
NAD
INVESTIGATIONS
USG ABDOMEN 17th June 2022
Impression :
Right distal ureteric calculus causing hydro nephro sis
Right simple renal cortical cyst
Right grade 1RPD Changes
Bilateral pleural effusion
Minimal ascitis
DIAGNOSIS
? POST RENAL AKI SECONDARY TO URETERIC CALCULI WITH UROSEPSIS WITH MODS
TREATMENT GIVEN
1) INJ PIPTAZ 4.5gm/IV/STAT
2)IVF DNS @70ml/ hr
3) INJ PAN 40mg IV/OD
4)TAB UDILIV 300mg/PO/BD
5)SYRUP LACTULOSE 15ml/PO/HS
6)INJ VITk IV/OD
7)INJ BUSCOPAN IV/SOS
