Shailesh Patil

  CASE 1 Question 1) pain in the epigastric region differentials Gastric ulcers Inferior wall MI Acute pancreatitis (Boaring kind of pain) 2)sob- acidosis due to renal failure          ? Ards secondary to sepsis/pancreatitis           Pleural effusion due to acute pancreatitis            3)decreased urine output-pre renal Aki secondary to volume loss(oliguric) 3rd space loss due to pancreatitis Sepsis induced aki 4) abdominal distention with constipation and nausea Secondary to paralytic ileus Treatment 1) Antibiotics  imipenem, ciprofloxacin, ofloxacin, ceftriaxone, cefotaxime, ceftizoxime, cefotiam, piperacillin, mezlozillin, metronidazole and tazobactam were detected in pancreatic tissue at concentrations exceeding the MICs of most of the relevant bacteria A first controlled clinical study with prophylactic imipenem in patients with severe acute pancreatitis showed a reduction in the rate of sep...

 TOPIC: A STUDY ON ASSOCIATION BETWEEN ULTRASONOGRAPHIC VISCERAL FAT THICKNESS AND CARDIOVASCULAR RISK IN TYPE 2 DIABETES MELLITUS AND THEIR GLUCOSE CONTROL PROBLEM STATEMENT: 1] Currently  the  number  of  cases  of  diabetes  worldwide  is  estimated  to be  around  150  million.  India  leads  then  world  with  the  largest  number  of  diabetic subjects  earning  the  dubious  distinction  of  being  the  “diabetic  capital  of  the world”. Complications of diabetes can only be prevented by timely and regular glucose control that includes proper use of OHA's / insulin therapy / lifestyle modifications 2] Obesity  has  induced  many  public  health  problems  related  to diseases, including glucose intolerance, hypertension, hyperinsulinemia,  dyslipidemia  and...

 CASE1 Q1 Reason for this patients ascites        The most common cause of Ascites is       Cirrhosis of liver        risk factors in this patient :       1. Chronic alcoholism since 40 years       2. Truncal obesity           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092576/ Regular alcohol abuse causing cirrhosis causes portal hypertension leading to increased hydrostatic pressure causing fluid accumulation hence Ascites  Q2  Bilateral pedal oedema which is of pitting type is due to decrease in the albumin level trends due to course of the disease and long standing cirrhosis causing decrease in the production of proteins causing decrease in the oncotic pressure leading to accumulation of fluid. Ulcerations are due his limited self practising manoeuvres done in inappropriate conditions such as  : improper dressing of the wound, not maintainin...

 54 year old man, with Hotel Business in Cherlapally since 10 years came to Kamineni hospital with C/O decreased appetite since 2 months after dialysis at kamineni C/O dyspnea grade 3 since 2 monthS C/O generalised weakness since 2 months C/O decreased appetite  C/O seizures (GCTS) on 23rd September 2020 in night ( MEDICATION TAKEN) O/E No fever spikes. Complaints of drowsiness since yesterday BP: 90/60 mmhg PR : 82 bpm RR: 22   CVS : S1 S2 heard no murmurs RS: BAE+ Coarse crepts heard diffusely present CBP:  Hb - 8.6 g/Dl TC - 8800  RBC - 2.95 ( Normocytic Hypochromic ) PC - 40,000 GRBS- 148 mg/Dl RFT: Urea : 101 creat: 4 uric acid : 5.1 Ca :8.2 P : 2.2 Na: 134 K: 4.5 Cl: 99 ABG: pH : 7.4 pCO2: 20.8 pO2: 121 HCO3 : 14 BEB- 8.3 BEecf : 9.4 SpO2 : 97.7% PAST HISTORY- Patient is an alcoholic since 10-15 years. Half bottle daily Epileptic since 6 years , monthly one episode (Epitoin - still continues) Admitted in Gandhi hospital 3 years back for that Diabetic ...

 26/M btech,completed 3yrs back non alcoholic and a non smoker , developed vomitings 4-5episodes on23rd December: yellow colored,non bilious,non blood stained contained foodparticles/water. Then after patient used to have vomitings every day 2-3episodes or at times multiple episodes for  one &half month i.e till feb 11th    After 15days of onset of vomitings i.e in January patient went to Suryapet hospital and there for the first time he was said to have high bp-170mmhg and brain imaging was done .Used anti hypertensive drugs for 10days and stopped On February 12th he presented with : 1-multiple episodes of vomitings a day before,2-he noticed decreased urine output since January  3- intermittent shortness of breath on walking for long distance 4-spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep His creatinine was 15mg/dl On February 13th he was referred to NIMS  i/v/o renal biopsy.There...

1) anatomical diagnosis -? Kidney ? Cardiac??         Liver???                                                                        Etiological diagnosis -  ?? Nephrotic syndrome secondary to the diabetic nephropathy  or CKD.      2)Reasons for I) Azotemia : impaired renal excretion of urea and creatinine secondary to CKD.  II) Anemia : decreased erythropoietin.  III Hypoalbunemia: capillary basement membrane and podocytes damage. IV)  acidosis: acidification of urine is lost.                                       3) Rationale : syp potchlor was given because of the hypokalemia.. Inj. NaHCO3 was given because of metabolic acidosis ..Insulin and a...