70Y/F WITH C/O LOOSE STOOLS AND LOW BACK ACHE
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70Y/F WITH C/O LOOSE STOOLS AND LOW BACK ACHE
A 70yr old female came with c/o loose stools since 10days
vomitings 10 days ago (2episodes)
C/o low back ache
C/o blebs over Rt lower limb a/w Swelling
since 20 days
Pt was apparently asymptomatic 15yrs back
15 yrs back- H/o fever- on checkup found to be Hypertensive
10yrs ago- C/o joint pains- initially in distal small joints then to elbow and now multiple joints are involved (pt doesn't remember the sequence of involvement of joints after that)
8yrs back- joint pains aggravated for which she started on Tab.ACECLOFENAC, Tab.OMNACORTIL 5mg OD - using daily- tappered in between but as she developed joint pains again she restarted Tab.Omnacortil 5mg OD.
4yrs ago- underwent tooth extraction
H/o slip and fall- operated for Rt tibial # (implant insitu)
3yrs ago- H/o fever,was admitted in our hospital was told to have some renal problem (no records available) later was discharged ?UTI ?PYELONEPHRITIS
1yr ago- C/o facial puffiness,generalized weakness, on and off B/l pedal edema, still having multiple joint pains
5months back- C/o Rt DIP,PIP,wrist joint pain with restriction of movements
10 days ago- C/o blebs over dorsal aspect of Rt foot later formed scab a/w swelling of Rt lower limb which regressed now
C/o low back ache a/w 5-6 episodes of loose stools/day ,large volume, watery consistency
H/o 2 episodes of vomitings 10 days ago not a/w pain abdomen,fever, burning micturation, cough,sob
No C/o chest pain,palpitations, giddiness,sweating
Bowel and Bladder movements-regular
K/c/o HTN since 15 yrs, on T.TELMA H (80/12.5) OD
H/o chronic NSAID abuse, steroid abuse for multiple joint pains
N/k/c/o DM,CVA
H/o reduced appetite since 1yr
Menopause at 40yrs ago
Vitals @ admission :
Temp-96.6 F
PR-110 bpm
BP-100/70 mmHg (not on antiHTN since 4 days)
RR-16/min
SPO2- 98@RA
GRBS- 87mg/dl
On examination:
No pallor/Icterus/cyanosis/clubbing/Generalized lymphadenopathy
Pedal edema +
Cushingoid appearance of face, dry skin, no purple appearance of striae
L/E :
Rt DIP, PIP and wrist - tenderness +, painful ROM+
Rt and Lt elbow - normal
B/L shoulders - pain on movement
Lower limbs-
Rt LL- Rt knee deformity +, Rt ankle externally rotated
Lt LL- normal, no ROM
S/E:
CVS- S1 S2 heard, no murmurs
R/S- BAE+
P/A- soft, nontender,BS +
CNS-
conscious
Cranial nerves- intact
Sensory system- normal
Motor system- normal
Reflexes
Rt Lt
Biceps 3+ 2+
Triceps 3+ 1+
Supinator 2+ 1+
Knee - -
Ankle - -
Plantar withdrawal withdrawal
Provisional diagnosis-
1. ACUTE GASTROENTERITIS (?Small bowel)
2. ASSYMETRIC POLYARTHRITIS
3. ?IATROGENIC CUSHINGS
4. ANEMIA UNDER EVALUATION (? IDA,? Anemia of Chronic diarrhea)
5. ?AKI on ?CKD (secondary to NSAID abuse)
Investigations:
Treatment:
1) IVF - 2 NS, 2 RL @100ml/hr
2)ORS sachet in 1 lit of water-200ml after each stool
3)Tab.PREDNISOLONE 5mg PO OD
4)Tab.ULTRACET 1/2 tab QID
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