Ascites , CLD

Hello, this is Goli shreya roll no 45,medical student. 

I have been given the assignment to check our ability to connect with and capture patient Centered data  and also the ability to connect with and engage in shared learning with their peers through peer review feedback. 

Below is the link to the questions given to us:-

http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

We have been given 5 questions to assess the ability to connect with and capture patient-centered data and the ability to connect with and engage in shared learning with their peers through peer review feedback.

Question 1

I went through the previous assignment of G Preethi Roll no 43 and breifly reviewed all her answers. Here is my review of her assignment- 

1Q- 

Each case was breifly explained. Cheif complainys, symptoms,diagnosis and Treatment details have been provided. 

She has breifly mentioned about the insights, which must hve been done a little more in detail. 

2Q-

She mentioned that she was not assigned any case and would update it as soon as she gets one. 

3Q- 

case of ACUTE KIDNEY INJURY SECONDARY TO UROSEPSIS was mentioned. 

Case details in breif:- A patient presented with chief complaints of n pedal edema and decreased urine output . The patient was already diagnosed with DM2 .After she diagnosed with acute kidney injury secondary to urosepsis and it got resolved conservatively after dialysis .All the investigations like complete urine examination ,ECG ,Ultrasound is done.ABG Analysis is also done . Bacterial and sensitivity report and Complete Blood Picture is done .The case is very well presented and daily update on her blood and urine analysis is also given .This was treated with the Inj LASIX 40 mg IV/TID and IVF - NS @ UO + 50 ml/hr and other necessary medications were given to relive her symptoms and for the good recovery.

The case details are given in breif. Reports of investigation and relavent pictures of the case are not added. Must have given more detailed information about the case. 

4Q-

 case of HFrEF with ATRIAL FIBRILLATION .

Case in breif -The patient had chief complaints of abdominal distension and shortness of breadth . She is a known case of hypothyroidism since 5 years and she has no history of palpitations ,Pedal edema ,oliguria ,fever cough ,fatigue .She was on thyronorm 100mg OD for hypothyroidism .Her troponin - 1 is negative.The investigations done in the case are complete blood picture ,serum electrolytes HIV 1/2 rapid test ,glycated Hb ,CRP, blood sugar random and 2D echo is also done . By seeing her biochemical report we can say that she is suffering from severe hyperthyroidism possibly relating to her Atrial Fibrillation and attempted for Defibrillation but unfortunately she had passed away.

The case was concisely explained . Overview of the investigations, diagnosis are not mentioned. 

5Q-

Her observations about the online teaching and case taking are well mentioned. She gave her genuine review about the online teaching process . She explained her opinion very well. 

Question 2

It is a case of-

A 70 YEAR OLD MALE WITH SOB AND SWELLING, DISCHARGE FROM RT. LOWER LIMB( CELLULITIS) 

The details of the case are provided in this link-

https://shreyagoli.blogspot.com/2021/07/45-goli-shreya.html

Provisional diagnosis

AKI ON CKD

UREMIC ENCEPHALOPATHY 

LOWER LIMB CELLULITIS 

Question 3

1.AKI:

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

 Insights-

 Histories- personal present and past have been taken in chronological order.Diagnosis and treatment must have been explained a little more. 

 2.Acute on CKD 

Case link-

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

Insights-

  The blog was very clear , and impressive . All the day to day treatment details have been mentioned . History of present illness was clearly given. All the investigation reports have been provided. 

 3.CKD :

Case link- 

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

Insights- 

Case is well presented .Patients date is deidentified . All the the reports are uploaded day wise which helped in easy understanding .

4. Patient with coma and renal failure :

Case link: 

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

Insights- 

Day to day treatment details are mentioned clearly . Pictures are also included , detailed reports have been provided . But history and treatment have been repeated . Log was very impressive . diagnosis should have been more clear. 

5).52 yr old presented with cheif complaints of abdominal distension, constipation ,pedal oedma , hiccups since morning .he is a known case of diabetes.he was a alcoholic.Patient is diagnosed and infective endocarditis wait KI assioasited with alcholic liver diasease with multiple infarcts in the bilateral cerebral and cerebrellar regions .

case link-  

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

Insights - 

 Details of discharge summary and treatment faculty have been provided . Pictures , videos were included . Advice at discharge is also mentioned .But drug history has not been mentioned. 

6)  Patients with acute on CKD :

Case link : 

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

Insights - 

Well presecaswnted blog , important details are highlighted . It was very concise and comprehensive .

 7) Case link-

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

Insights- 

Well presented blog . It was clear and comprehensive . Important details have  been highlighted . Necessary links have also been provided .

8.case link- 

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

Insights - It was good and clear,could have been more detailed. Discharge summary is not mentioned .

9) Case link-Patients with AKI :

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

Insights:

Present, past, family history have been mentioned. Pictures of general examination have also been provided. 

10) case link

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

Insights-

Log was Impressive. The information was clear. It is well assisted with pictures. Treatment and diagnosis are well mentioned. All the required investigation reports and details are provided. 

11) case link

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

Insights- 

Log was clear and precise .Day to day treatment have been mentioned. All the necessary details are mentioned. The case summary has also been provided wich helps in easy understanding. 

QUESTION 4

✱Case 1

Diagnosis : AKI  secondary to UTI, associated with Denovo - DM -2 

Treatment : 

1)IVF : -RL  @ UO+ 30ml/hr -NS

2)SALT RESTRICTION  < 2.4gm/day

3)INJ    TAZAR    4.5gm  IV/TID

4)INJ     PANTOP 40mg  IV/OD

5)INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID

✱Case 2

Diagnosis : Hyperuricemia 2° to Renal failure 

Treatment:

• IVF -    NS-0.9%  @100ml/hr

• Inj. Tazar 2.25gm I.V -TID 

• Inj. Lasik 40mg I.V -BD 

✱Case 3

Diagnosis:  Chronic interstitial nephritis secondary to plasma cell dyscariasis

Treatment:   

- T. PAN 40mg /PO / OD

- oral fluids upto 1.5 - 2 lit / day

- Protein - x ( plant based ) 2 tablespoon   in 1 glass of  milk  

✱Case 4 

Diagnosis: DKA with AKI 

Treatment:

Inj. NORAD 2amp in 50ml NS

Inj. PIPTAZ 2.25gm.

Inj. DOPAMINE 2amp in 50ml

Inj. HAI 1ml in 39ml NS

✱Case 5

Diagnosis:INFECTIVE ENDOCARDITIS

Treatment:

1. Inj. Monocef 1gm IV/BD

2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr

3. Procto clysis enema

4. Inj. Pan 40 mg Iv/OD

✱Case 6 

Diagnosis: Renal AKI secondary to urosepsis with b/L hydroureteronephrosis

Treatment: 

Injection PANTOP 40mg IV/OD

Injection PIPTAZ  4.5 stat  and 2.25 gm  IV/ TID

Injection LASIX 40mg IV/BD

Injection optineuron 1AMP in 100ml NS slow IV/OD

✱Case 7

Diagnosis: HFrEF secondary to CAD; CRF

Treatment: 

1. TAB. BISOPROLOL 5mg OD

2.TAB. NITROHART 20/37.5mg 1/2 T/D

3.TAB NICARDIA XL 30mg OD

4.TAB. GLICIAZIDE 80mg BD

5.TAB. NODOSIS 500 mg TD

✱Case 8

Diagnosis: Acute on CKD 

Treatment: 

1. Tab. Augmentin 625 mg ×7 days

2. Tab. Wysolone 40 mg ×10 days.

    30 mg × 10 days 

    20 mg ×10 days

    10 mg ×10 days.

3. Tab . Lasix 20 mg  × 1 month.

✱Case 9

Diagnosis: Alcoholic Hepatitis and aki sec to gastroenteritis

Treatment: 

INJ THIAMINE 100 mg in 100 ml NS slow IV / TID

INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD

INJ LASIX 40 mg  

✱Case 10

Diagnosis: Acute Kidney Injury secondary to Urosepsis

Treatment:

Inj LASIX 40mg (8am- 2pm -8pm)

IVF - NS @ UO + 50 ml/hr

✱Case 11

Diagnosis: pancreatitis in a chronic alcoholic 

Treatment:

IV lasix  40 mg BD .

Tab Nodosis .

IV PIPTAZ 4.5 Gms. BD 

Iv 25%Dextrose. 100 ml BD 

Iv fluids : NS 40 ml /hr.

Question 5 

I have learned many things during the online clinical sessions. I  got a chance to log for a case, the experience was quite helpful for me in understand how the system works. Our assigned interns were very cooperative and helped in making the elogs. General Medicine department has put in lots of efforts to make the online teaching process much more effective and productive. This online experience will definitely make our offline postings easier. This way of learning helped us in getting exposure to different cases , their diagnosis and treatment. I am very thankful to the GM department for their efforts in making our learning process easier and more interesting.