A 80 year old male brought to casuality with c/o constipation since 20 days (on and off).
Not passing stools and Flatus since 5 days
Shortness of breath since 5 days.
History of presneting illness:
Patient was apparently asymptomatic 3 years back and then he developed pain abdomen in epigastrium localized and not a/w nausea or vomitings aggravated after food intake.
Since 1 year patient complains that he used to wake up in the middle of night and felt breathless for a while. Since 20 days patient history of generalised weakness with loss of appetite and has constipation with small quantity of hard stools. Sinec 5 days patient complains he didn't pass stools and flatus which makes him discomfort associated with pain abdomen.
Personal history:
Patient lost his appetite since 20 days and disturbed sleep.
Addictions: H/o Smoking (Sutta) since 55 years. chronic alcoholic drinks 90ml whiskey daily.
General examination:
Patient consious, coherent, cooperative.
No signs of icterus, clubbing, lymphadenopathy, edema
Signs of pallor.
Vitals:
Temp: afebrile
Pr: 90 bpm
Rr: 20 cpm
Bp: 130/80 mmhg
Spo2: 98%
Grbs- 132 mg/dl
Systematic examination:
CVS: S1 and S2 heard
RS: BAE +
CNS: NAD
P/A: soft , tender.
Fever chart.
Diagnosis:
Constipation 2to ?Uremic gastroparesis with RCA territory Akinesia (?old MI).
Investigations on 10/12/21:
Hemogram:
Hb- 11.5
Tlc- 29,300
Plt count- 1.62
RFT:
Urea- 202
Creatinine- 5.9
Na+- 137
K+- 4.5
Cl-- 90
LFT:
ALP- 437
ALB- 2.8
CUE:
ALB +
RBC - Absent.
ABG:
Ph- 7.473
Pco2- 23.9
So2- 95.6
cHCO3 (P.ST)c- 20.8
cHCO3(p)c- 17.3
Serology- negative.
USG Abdomen
Chest Xray PA VIEW
Investigations on 11/12/21
Hb: 11.7
Tlc: 33,450
Plt count: 2.31
Urea: 204
Na+ : 139
K+ : 4.1
Cl- : 96
Spot urine protein: 1.2
Spot urine Creatinine: 100.6
Spot urine Albumin: 0.11
CUE:
Albumin: +
No sugars
Ec: 2 to 4
Pc: 2 to 4
Investigations on 12/12/21
Hb: 10.9
Tlc: 22,700
Plt count: 1.59
Blood urea: 203
Serum creatinine: 3.4
Na+ : 144
Cl- : 98
K+ : 3.3
Treatment
1. Ivf NS/RL/DNS continuous at 100ml/hr
2. Inj. PAN 40mg IV BD
3. inj. ZOFER 4mg IV/SOS
4. Syp. LACTULOSE 20 ml PO/BD
5. Tab.ECOSPORIN 75 mg PO/OD
6. Tab.CLOPITAB 75 mg PO/OD
7. Tab. ATROVAS 10 mg PO/OD
8. Proctoclysis enema twice daily
9. BP/PR/TEMP monitoring 4th hourly.
