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A 65 year old woman presented to the hospital with the complaints of-
nausea since 20 days
pain abdomen since 20 days
vomiting since 20 days
HISTORY OF PRESENT ILLNESS :
Patient was apparently asymptomatic before 20 days. there was a suddenly onset of stomach pain and vomiting.
vomiting was non projectile in nature, non bilious, containing food particles.
She went to a hospital in Nalgonda few days back and was told that she had kidney problem and She was referred to Kamineni and has been admitted here for 11 days.
In the span of 11 days, she underwent dialysis thrice. The patient was also diagnosed to be anemic. Blood transfusion was done once.
Past history :There is no history of Tuberculosis, Diabetes Mellitus, Hypertension. The patient diet is mixed , but she has been an obligatory vegetarian since the onset of her stomach pain. Her appetite fell with the onset of stomach pain.
General examination :
On viewing, the patient is well built and is slightly malnourished. The patient also complained of disturbed sleep. After onset of pain, the patient has been experiencing constipation. There is no family history of this problem, and apparently, there was no such issue prevalent in the surrounding area.
On examination there
no pedal edema,
no clubbing
no cyanosis,
no generalised lymphadenopathy
pallor +
temperature -98°F
BP - 120/80mmhg
pulse 92 bpm
Systemic examination :
CVS :
S1S2 HEARD
NO THRILLS AND MURMURS
Respiratory system examination
NVB+
BAE +.
Perabdomen :
abdomen is soft
non tender
There was resolving hyponatremia in the patient. Her urea was 123 mg/dl (normal range- 17-50mg/dl), her creatinine level was 5.7 mg/dl (normal range- 0.6-1.2mg/dl). In the bacterial culture of urine, plenty of pus cells are seen. Ecoli> 10^5 cfu/ml was isolated. There is neutrophilic leukocytosis seen in hemogram. The patient was later diagnosed with renal calculi (nephrolithiasis).
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