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 C/O VOMITINGS SINCE 3 MONTHS 

SWELLING OF BOTH LOWER LIMBS SINCE 1MONTH.


HOPI:- PATIENT WAS APPARENTLY ASYMPTOMATIC 3 MONTHS BACK. SHE THEN HAD VOMITINGS (2-3 EPISODES/DAY) -ON AND OFF SINCE 3 MONTHS

VOMITINGS - WATERY, NON-PROJECTILE, NON-BILIOUS WITH FOOD PARTICLES AS CONTENTS AND NOT BLOOD STAINED.; HEART BURN OCCASIONALLY. VOMITINGS HAPPEN AFTER TAKING FOOD (NOT DAILY),NO NAUSEA.

-NO C/O PAIN ABDOMEN, LOOSE STOOLS.


C/O CONSTIPATION - PASSES DAILY -HARD STOOLS OR PASSES EVERY ALTERNATE DAY


C/O SWELLING OF BILATERAL LOWER LIMBS -PITTING TYPE, EXTENDING ABOVE ANKLE AND NOT EXTENDING UPTO THE KNEE. AGGREVATED ON WALKING AND RELIEVED (INCOMPLETELY) ON LYING DOWN (INCREASED BY EVENING AND DECREASED BY MORNING).


DECREASED URINE OUTPUT, NO BURNING MICTURITION, NO INVOLUNTARY MICTURITION , PT IS UNABLE TO HOLD THE URINE DURING URGE TO MICTURITION.


C/O SOB - AFTER EATING FOOD, AND AFTER WALKING (GRADE-II)


NO C/O CHEST PAIN, PALPITATIONS, ORTHOPNEA, PND.


C/O LBA-RADIATING TO B/L LOWER LIMBS, NO TINGLING SENSATION. C/O TINGLING OF HANDS AND FEET.


K/C/O HYPERTENSION 7-YEARS ON MEDICATION.

(T. AMLODIPINE 5MG OD)..


NOT A K/C/O TB, EPILEPSY, ASTHMA, CVA, CAD,

THYROID DISORDERS.


PERSONAL HISTORY-


DIET: MIXED


APPETTITE:NORMAL


BOWEL AND BLADDER: REGULAR


SLEEP: ADEQUATE


NO ADDICTIONS


GENERAL EXAMINATION-PATIENT IS CONSCIOUS,COHERENT, COOPERATIVE 


WELL ORIENTED TO TIME, PLACE,PERSON


MODERATLY BUILT AND NOURISHED


VITALS-

TEMPERATURE AFEBRILE

PR 80BPM

BP 110/70 MMHG

RR 18CPM

GRBS 111MG/DL


SYSTEMIC EXAMINATION-


CVS-S1S2 HEARD,NO MURMURS


RS-BAE+,NVBS HEARD


CNS-NFND,HMF INTACT


P/A-SOFT,NON TENDER,NO ORGANOMEGALY


INVESTIGATIONS 

HEMOGRAM 

HB 10.5

TC 11700

NLEM 64/26/02/08

PCV 32.5


2D ECHO

MODERATE AR, MILD MR,MILD TR /PAH

NO RWMA,NO AS/MS SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION,NO PE


USG FINDINGS

E/O MULTIPLE HYOERECHOIC FOCI NOTED IN GALL BLADDER

LARGEST 7MM

E/O 22*17MM EXOPHYTIC CYST NOTED IN UPPER POLE OF LEFT KIDNEY

IMPRESSION

CHOLELITHIASIS

LEFT RENAL CORTICAL CYST

B/L RAISED ECHOGENESITY OF KIDNEYS 


ADVICE AT DISCHARGE


T.ONDANSETRON 4MG PO OD

@8AM

T.PAN 40 MG PO OD @8AM

T.PREGABALIN M 75MG PO OD @2PM

T.BEPLEX FORTE PO OD@8PM

SYP CREMAFFIN 10ML PO HS

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