BIOMONTHLY ASSIGNMENT JULY roll no:86 M Siddu
1) Ans:I had choosen the assignment of roll no. 85
https://varshithmorampudi.blogspot.com/2021/07/morampudi-varshith_3.html?m=1
My Review:I think varshith had done a great job in completing the assignment.
*His elog was so clear that ,just by looking at his elog one can get a clear picture of patient's condition.
*And it would have been better if he added images of patient in his elog.That would help in getting clear clinical correlation.
*And also he had missed to add the test reports of various laboratory tests.
*on the whole I would like to appriciate him for his work.
2) Ans: Till now I didn't got a chance to make a elog. And I will do it as soon as I will get a chance to do it.
And to be frank Iam eagerly waiting to interact with patients.And to learn clinical skills.
3)Ans:Patient with coma and renal failure :
My Review:
The patient had come with complaints of fever and backache with diarrhoea. On arrival at the hospital, she had succumbed to a cardiac arrest for which CPR was administered.lab findings like complete blood picture,LFTs and RFTs where ordered which showed increased levels of urea and creatinine and later, she was put on dialysis.Later USG was done which revealed an enlarged kidney and gradually her haemoglobin levels had come down as a consequence of kidney injury . Due to her persistent vegetative state and no improvement in her coma scale an MRI was ordered which confirmed that there's Septic shock due to hypoxemia. Also the bed sores were due to a hospital acquired infection which cannot be healed by the patient herself because she's a known diabetic,hence the degeneration and necrosis of tissue at the site(this was confirmed because a simlar infection had occured in her little finger in the past, and as treatment the infection site was removed). Hence, timely care and repeated change of dressing was done to relieve her of the pain. But there is poor prognosis and hence she was discharged.
My Review:
This is a case of Multiple myeloma(uncommon type).
The patient had a history of muscle aches, generalised muscle weakness, nausea and vomiting, she had lost her appetite.
General exam and lab investigations revealed anemia(low hemoglobin and pallor)
Anemia is due to impaired iron utilisation as seen in the lab investigations(high ferritin levels and low serum iron levels).The impaired utilisation could be due to cytokine induced upregulation of hepcidin.
Right wrist joint pain And Xray of chest:
Showing the involvement of osteoclasts activity(osteoporosis)in the bones due to malignancy of bone marrow cells bone marrow aspiration analysisThe diagnosis was done and treated accordingly in a short span of time.
Patients with AKI :
My review:
This is a direct case of alcoholic hepatitis with gastroenteritis.The history pertaining to this case is accurate and the lab investigations ordered have also provided a ground proof diagnosis of the said condition.
Patients with acute on CKD :
My Review:
The patient had undergone TURP transurethral resection of prostate in the past due to prostamegaly. But his RFTs where still in a critical state. The Complete blood picture and ABG analysis were ordered which showed a common profile(to that of a normal individual). X ray of the abdomen was done which revealed urinary bladder thickening and hydroureteronephrosis.Hydroureteronephrosis is defined as a dilatation of the renal pelvis, calyces and ureter caused by the obstruction to free flow of urine from the kidney, leading to progressive atrophy of the renal cortex.Also the patient's urine contained pus cells which was indicative of sepsis in the urinary tract.Hence all of the parameters used for coming to a conclusive diagnosis seem to be valid.
4) Ans:Acute kidney injury (AKI):
AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body. AKI can also affect other organs such as the brain, heart, and lungs. Acute kidney injury is common in patients who are in the hospital, in intensive care units, and especially in older adults.
Signs and symptoms of acute kidney injury differ depending on the cause and may include:
Too little urine leaving the body
Swelling in legs, ankles, and around the eyes
Fatigue or tiredness
Shortness of breath
Confusion
Nausea
Seizures or coma in severe cases
Chest pain or pressure
Treatment for AKI :
-usually requires you to stay in a hospital. Most people with acute kidney injury are already in the hospital for another reason.
In more serious cases, dialysis may be needed to help replace kidney function until your kidneys recover. The main goal of your healthcare provider is to treat what is causing your acute kidney injury.
The best ways to lower your chances of having kidney damage and to save kidney function are to prevent acute kidney injury or to find and treat it as early as possible.
-Chronic kidney disease (CKD):
characterized by a gradual loss of kidney function over time.
Heart disease is the major cause of death for all people with CKD.
Glomerular filtration rate (GFR) is the best estimate of kidney function.
Hypertension causes CKD and CKD causes hypertension.
Persistent proteinuria (protein in the urine) means CKD is present.
High risk groups include those with diabetes, hypertension and family history of kidney failure. The two main causes of chronic kidney disease are diabetes and high blood pressure which are responsible for up to two-thirds of the cases
symptoms:
feel more tired and have less energy
have trouble concentrating
have a poor appetite
have trouble sleeping
have muscle cramping at night
have swollen feet and ankles
have puffiness around your eyes, especially in the morning
have dry, itchy skin
need to urinate more often, especially at night.
Treatment:
-Damage to your kidneys is usually permanent. Although the damage cannot be fixed, you can take steps to keep your kidneys as healthy as possible for as long as possible. You may even be able to stop the damage from getting worse.
Control your blood sugar if you have diabetes.
Keep a healthy blood pressure.
Follow a low-salt, low-fat diet.
Exercise at least 30 minutes on most days of the week.
Keep a healthy weight.
Do not smoke or use tobacco
Acute on Chronic Kidney Disease :
Patients with chronic kidney disease (CKD), as evidenced by a low eGFR or presence of proteinuria, are at higher risk for developing AKI, a condition known as acute on chronic renal failure (ACRF). CKD is a strong risk factor for cardiovascular events, and patients with CKD are at particular mortality risk if they develop ACRF.
The clinical features of ACRF are similar to those in patients with de novo AKI
Patients with ACRF can be profoundly acidemic (pH less than 7.1). In patients without severe volume overload, acidemia can be treated with intravenous sodium bicarbonate. In patients in whom sodium bicarbonate or similar base cannot be given, renal replacement therapy is indicated.
5)Ans:
The pandemic has been too hard on us, making learning online ; which was a daunting task at first.
*We had dreamt of attending our clinical postings offline and experience something which we haven't before.
But i'd be lying if i had said that the online postings weren't helpful.
*It was quite a challenge for us to connect with patients on phone,but with the guidance of our HOD sir, pgs and interns of the general medicine department it was seemlessly taken care of.
The clinical postings in the morning and discussions of the cases in the afternoon has helped me to get a better perspective of the said case.
I would like to thank Dr.Rakesh Biswas Sir for helping us to learn during this tough time.
And I would also like to thank pavan kumar sir for clearing my doubts and engaging us to work better for learning clinical skills.
Thank you..
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