40M PRESENTED WITH PEDAL EDEMA AND FACIAL PUFFINESS

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 40 yr old male presented with chief complaints of pedal edema since 10 days B/L pitting type upto knee

facial puffiness since 2 days 

SOB grade 2 since 10 days

Palpitations present

Post prandial chest pain since 1 week 

HOPI

Pt was apparently asymptomatic 10 days ago then he developed b/l pitting type of pedal edema and sob grade 2 with Palpitations 

No decreased urine output,no groin pain, facial puffiness present 

Post prandial chest pain since 1 week non radiating type

PAST HISTORY

H/o hemorrhoids 5-6 yrs back(passage of blood in stools intermittent)

N/k/c/o DM, CVA, TB, EPILEPSY, HTN


Personal history

Diet mixed 

Appetite normal

Bowel and bladder -regular


GENERAL PHYSICAL EXAMINATION

On examination, patient is conscious, coherent, cooperative

patient is moderately built and moderately nourished

No pallor,icterus, cyanosis, clubbing, lymphadenopathy, edema








VITALS 

temp afebrile

Bp 120/80

Pr 82

Rr 18


SYSTEMIC EXAMINATION:

Abdominal examination:

Inspection 

Umbilicus inverted , No abdominal distention,no visible pulsations,scars and swelling.

Palpation 

 Soft, non tender, no organo megaly.

Auscultation 

Bowel sounds Heard

Cardio vascular examination:

No visible pulsations, scars, engorged veins. No rise in jvp 

Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.

 S1 S2 heard . No murmurs.

Respiratory system :

Shape of chest is elliptical, b/l symmetrical.

Trachea is central. Expansion of chest is symmetrical

 Bilateral Airway Entry - positive

Normal vesicular breath sounds

CNS examination: 

No neurological deficit found.

HMF Intact 


Provisional diagnosis 


Wet Beri beri 

Investigations

Blood urea


Serum creatinine 

LFT 

CUE

PLBS 


PERIPHERAL SMEAR



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