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25F REACTIVE ARTHRITIS

 


25 YR OLD FEMALE WORKS IN PETROL BUNK,RESIDENT OF DHAMARACHARLA CAME TO OPD WITHC/O DIFFICULTY IN WALKING SINCE 4 DAYS

PATIENT WAS APPARENTLY ASYMPTOMATIC UNTIL 10 DAYS AGO THEN HAD C/O FEVER WENT TO LOCAL HOSIPTAL AND TREATED ,AFTER TREATMENT PATIENT HAD C/O LOOSE STOOLS 4-5 EPISODES PER DAY MUCOID , GREENISH COLOUR , NON BLOOD STAINED , NON FOUL SMELLING , LARGE QUANTITY AGGRAVTED ON HAVING FOOD ,WENT TO LOCAL RMP AND GOT TREATED SYMPTOMS SUBSIDED .

SINCE 4 DAYS PATIENT HAD C/O BACK PAIN SUDDEN ONSET F/B NECK PAIN AT CERVICAL REGION , NON RADIATING F/B RIGHT KNEE PAIN AND SWELLING .RIGHT INDEX FINGER PAIN A/W SHOCK LIKE SENSATION .

N/K/C/O DM ,HTN, TB,CVA,CAD,ASTHMA,EPILEPSY,THYROID DISORDERS . GENERAL PHYSICAL EXAMINATION

PATIENT IS CONSCIOUS, COOHERENT, COOPERATIVE

TEMP-98.4F

PR-95BPM BP-110/70MMHG

SPO2 97%RA

GRBS -93

CVS-S1S2 +

RS BAE +, NVBS

P/A SOFT, NON TENDER

CNS E4V5M6

PUPILS - B/L PUPILS REACTIVE

TONE

LT UL- NORMAL LL NORMAL

RT ULNORMAL LT- NORMAL

POWER

LT UL-4/5 LL4/5

RT UL 4/5 LL 3/5

REFLEXES

BICEPS - RT +2, LT +2

TRICEPS RT - LEFT -

SUPINATOR RT+ LT +

KNEE RT +2 LT +2

ANKLE RT + LT +

PLANTARFLEXION RT FLEXION LT FLEXION CRANIAL NERVES -

1-NORMAL

2-NORMAL

3-NORMAL

4-NORMAL

5-NORMAL

6-NORMAL

7-NORMAL

8 -NORMAL

9-NORMAL

10-NORMAL

11-NORMAL

12-NORMAL





COURSE IN THE HOSPITAL

24 YEAR FEMALE CAME TO OPD WITH ABOVE MENTIONED COMPLAINTS, NECESSARY INVESTIGATIONS DONE AND DIAGNOSED WITH REACTIVE ARTHRITIS SECONDARY TO ENTERIC FEVER. ON DAY 2 OF ADMISSION PAINS SUBSIDED. ON DAY 3 OF ADMISSION PATIENT COMPLAINED OF RIGHT KNEE PAIN, AND 2 EPISODES OF LOOSE STOOLS WITH UNDIGESTED FOOD PARTICLES. ON DAY 4 OF ADMISSION PATIENT HAD BILATERAL KNEE PAINS, LOOSE STOOLS SUBSIDED. ON DAY 5 AND 6 PATIENT IS SYMPTOMATICALLY BETTER WITHOUT ANY FEVER SPIKES. PATIENT WAS CONSERVATIVELY MANAGED WITH IV ANTIBIOTICS AND NSAIDS. PATIENT IS HEMODYNAMICALLY BETTER AND PLANNED FOR DISCHARGE.

Investigation

Blood Urea 11 mg/dl 42-12 mg/dlSerum Creatinine 0.8 mg/dl 1.1-0.6 mg/dlSERUM ELECTROLYTES (Na, K, C l) 27-03-2024 12:55:PM

SODIUM 111 mmol/L 145-136 mmol/L POTASSIUM 3.3 mmol/L 5.1-3.5 mmol/L CHLORIDE 84 mmol/L 98-107 mmol/L

LIVER FUNCTION TEST (LFT) 27-03-2024 12:55:PM Total Bilurubin 0.99 mg/dl 1-0 mg/dl

Direct Bilurubin 0.28 mg/dl 0.2-0.0 mg/dl

SGOT(AST) 17 IU/L 31-0 IU/L

SGPT(ALT) 15 IU/L 34-0 IU/L

ALKALINE PHOSPHATASE 84 IU/L 98-42 IU/L

TOTAL PROTEINS 4.2 gm/dl 8.3-6.4 gm/dl

ALBUMIN 2.14 gm/dl 5.2-3.5 gm/dl

A/G RATIO 1.04

COMPLETE URINE EXAMINATION (CUE) 27-03-2024 12:55:PM COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN Nil

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 2-3

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent OTHERS Nil

HIV - NEGATIVE

HBsAg-RAPID 27-03-2024 12:55:PM Negative

Anti HCV Antibodies - RAPID 27-03-2024 12:55:PM Non Reactive

BLOOD UREA 27-03-2024 10:56:PM 16 mg/dl 42-12 mg/dl

SERUM CREATININE 27-03-2024 10:56:PM 0.8 mg/dl 1.1-0.6 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 27-03-2024 10:56:PM SODIUM 137 mmol/L 145-136 mmol/L

POTASSIUM 4.0 mmol/L 5.1-3.5 mmol/L

CHLORIDE 103 mmol/L 98-107 mmol/L

STOOL FOR OCCULT BLOOD 27-03-2024 10:56:PM Negative (-ve) CRP - + POSITIVE

ESR - 40MM

RBS - 78MG/DL

HEMOGRAM-27/3/24

HB-7.6GM/DL

TLC -9000 CELLS/CUMM

PLATELET COUNT - 2.8 LAKH/CUMM NORMOCYTIC NORMOCHROMIC ANEMIA. HEMOGRAM ON 28/3/24:

HB-9.4GM/DL

TLC -8,200CELLS/CUMM

PLATELET COUNT - 3.5 LAKH/CUMM NORMOCYTIC NORMOCHROMIC ANEMIA. HEMOGRAM ON 29/3/24:

HB-9.9GM/DL

TLC -12,400CELLS/CUMM

PLATELET COUNT - 4.5 LAKH/CUMM

NORMOCYTIC NORMOCHROMIC ANEMIA WITH LEUCOCYTOSIS PERIPHERAL SMEAR:

RBC : Normocytic normochromic few microcytes

WBC : With in normal limits

PLATELET : Adequate

IMP : Normocytic normochromic anemia

RECTIC COUNT:1.0%

SERUM LDH:130IU/L

SR.IRON:

USG ABDOMEN AND PELVIS -

NO SONOLOGICAL ABNORMALITY DETECTED Treatment Given(Enter only Generic Name) INJ.MONOCEF 1GM IV/BD X 4 DAYS INJ.NEOMOL 1G IV/SOS

TAB.NAPROXEN 250MG PO/TID 1-1-1 TAB.ULTRACET 1/2 TAB PO/QID 1/2-1/2-1/2-1/2 TAB.PAN 40 MG PO / OD 1-0-0 TAB.REJUNEX-CD3 PO/OD 0-1-0 TAB.SPOROLAC -DS PO/TID 1-1-1

DOROLAC - Z SACHET PO/BD 1-0-1

Advice at Discharge

TAB TAXIM 200MG PO/TID 1-1-1 X 2 DAYS

TAB INDOCAP SR 75MG PO/OD 1-0-0 X 2 DAYS TAB.NAPROXEN 250MG PO/TID 1-1-1 X 5DAYS TAB.PAN D PO / OD 1-0-0 X 5DAYS TAB.REJUNEX-C03 PO/OD 0-1-0 X 15DAYS

TAB SPORLAC DS 1TAB PO/TID 1-1-1 X 2 DAYS DOROLAC - 2 SACHET PO/BD 1-0-1 X 2 DAYS



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