Skip to main content

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



Comments

Post a Comment

Popular posts from this blog

Participatory medicine

 Reflecting on my experiences as a patient advocate and a physician, I’ve seen both the strengths and the shortcomings of participatory medicine in action. Each patient’s journey has been unique, with moments of progress and empowerment, but also instances of struggle, especially when navigating issues like privacy, confidentiality, and security. The Good One of the most rewarding aspects of participatory medicine is seeing patients and their families become actively involved in care. For example, in the case of the 65-year-old man with chronic vomiting, there was a clear effort to include the patient in discussions about his symptoms and potential diagnoses. This active participation helped foster trust and engagement, even though the diagnostic journey was long. In chronic conditions like HFpEF and CKD, I’ve seen how educating patients about their disease helps them feel more in control. It’s encouraging to witness patients taking ownership of their health by asking questions and...
Post a Comment
Read more

30M WEIGHTLOSS

  A 30-year-old male presented with a history of progressive weight loss over the past year. Symptoms commenced in November 2022 with severe abdominal pain and vomiting, initially attributed to roadside food consumption. Recurrent monthly episodes of abdominal pain, bloating, and vomiting/loose stools persisted until April. Diagnostic workup, including abdominal scan, CBP, ESR, CRP, TTG antibody, LFT, RFT, sputum for AFB, chest X-ray, Quantiferon Gold for TB, and Montoux test, yielded normal results except for elevated CRP. Ayurvedic treatment resulted in symptom improvement, but weight loss persisted. From November 2022 to April 2023, he lost 10 kgs and maintained stability at 48 kgs thereafter. CRP levels correlated with symptom exacerbations, decreasing post-treatment. Presently, he experiences diminished appetite, eating only twice daily, despite previously consuming 4-5 meals. Daily schedule and eating patterns outlined. . [27/11/23, 10:31:59] ~ A: ‎~ A created this group ‎[28...
Post a Comment
Read more

Cases 1-16

  Case 1 https://himajav.blogspot.com/2023/08/53f-metabolic-syndrome.html 53 year old female housewife by occupation resident of coochbihar admitted with complains of generalised weakness since 6 years The patient's medical history reveals that she was asymptomatic until six years ago when she presented with weight loss, xerostomia, and anorexia. She sought medical attention at a local medical facility, where she was diagnosed with Diabetes mellitus and subsequently initiated on oral hypoglycemic agents. Around four years ago, the patient began experiencing generalized asthenia and easy fatigability, leading to the diagnosis of both Hypertension and hypothyroidism. Approximately four years ago, the patient complained of cervical discomfort, prompting a diagnostic consideration of cervical spondylosis. This condition was managed with a course of physiotherapy. Currently, the patient reports intermittent occurrences of generalized asthenia, easy fatigability, and xerostomia. She also...
Post a Comment
Read more