Name:G. Jagadeesh.                                                    DATE:24/07/2021.

Roll No:37.

3rd semester

Hi,

E log is a platform for patient -Centered case in learnings medicine . Hope this will be informative .

Q ) 1.

This is a peer review of the previous assignment by Tejaswi enduri (36) .

https://tejaswienduri.blogspot.com/ 

Q1) She have did a marvellous job in choosing and examining different cases (10) . She gave an overview onthe treatment and graded them. she had also looked into symptomatology and explained the treatement.

Q2)she had did a case on TRANSVERSE MYELITIS.

Chief complaint provided isnpain on passive movement of the hip.

The patient was asymptomatic 3days back.

she was not able to walk last night.And she had no history of DM,HTN,CAD,Asthma,TB,epilepsy.no simi;ar complaints in past.Has no known allergies and addictions.

there is no specific treatement history.Upon general examination she was found to be no pallor,icterus,cyanosis,clubbing,lymphadenopathy.

Vitals were normal except temperature was afebrile.

tests done are

SERUM ELECTROLYTES.
















MRI SCAN.
Treatement was good by managing the drugs list.

Q3)
She took a case of ALCOHOLIC CIRRHOSIS.
Actually he is a known case of alcoholic cirrhosis since one year.But suddenly started developing fever 14 days back.
Actually due to consumption of more alcohol it is converted into acetaldehyde by an enzyme alcohol dehydrogenase this acetaldehyde can again be metabolised by aldehyde dehydrogenase which is unfortunately not present in indian genes so leads to accumulation of acetaldehyde in liver sinusoids and leads to degeneration of hepatocytes .(HEPATIC NECROSIS).As a healing process there is activation of fibroblasts leading to fibrous tissue deposition which in turn lands up in CIRRHOSIS.
INVESTIGATIONS DONE ARE.

1)HbA1c

2) APTT
 

                                         

                                                              3)SERUM ELECTROLYTES 




4)BLOOD UREA AND CREATININE

5 )ECG 
   

6)LFT
 7) BLEEDING TIME AND CLOTTING TIME 

8)PROTHROMBIN TIME 
9)USG 
Liver function test and prothrombin time shows us that the liver is not functioning properly.
Because there is increased levels of bilirubin ,and enzyme panel of liver is also disturbed.
where again prothrombin time is increased but this is not a perfect test because prothrombin time can be increased in vit k deficiency also.
coming to the treatement it was nicely explained by her.
Q5)
She has given her genuine reasons due to this pandemic.
Q2)
I have not yet done any case on CKD.
Q3)

http://srinaini25.blogspot.com/2021/07/
She had did a case on CHRONIC KIDNEY DISEASE.
Generally the patient presents with pain in his right or left flank.As a chief complaint.
the patient was also suffered from jaundice 3 years ago which cured based on plant treatement.And he is not a known case of DM,HTN,TB,CVA,Epilepsy.
general examination was done and is found to be normal.
vitals were also normal but temperature was afebrile.
systemic examination done and normal but abdomen was obese non tender no free fluid.

INVESTIGATIONS DONE ARE. 

ECG, RFT, CUE, Hemogram, ABG , Serum electrolytes, Blood urea ,USG Abdomen ,LFT

                                        

  13/7/21                                          USGABDOMEN AND PELVIS




CUE,ABG,S/E


                                ECG

BLOOD UREA


SERUM CREATININE

COMPLETE BLOOD PICTURE

SERUM URIC ACID

URINE CULTURE


BLOOD CULTURE

SERUM ELECTROLYTES


                                      

                                                            PHOSPHORUS


                                                         SERUM CALCIUM

Colour dopler -2D Echo


Tests done on 17/7/2021

CBP
MRI-SPINE 
Investigations done on 19/7/21
CBP

INVESTIGATIONS DONE ON 21/7/21
Pelvis-AP view
Bacterial culture report 
CBP

INVESTIGATIONS DONE ON 22/7/21
Hemogram 
Blood urea level is so much high which should have been maintained by normal kidneys.
Hb level was decreased may be due to loss of Hb through kidneys.
The main thing is there is decreased creatinine clearence.
CREATININE
Creatinine is an endogenous athreshold substance for kidney which should be excreated in urine.creatinine is formed by LOHMANN REACTION.
 
The creatine formed here undergo some spontaneous reactions which leads to formation of CREATININE.
EXCREATION OF CREATININE.
Creatinine is cleared from plasma by GFR.and there is also some secreation by tubules into the lumen and creatini ne excreation takes place.so if there is problem with creatinine clearence then we can expect renal failure.
Treatement and prophylactic treatemebt was given and it is nice.
https://krupalatha54.blogspot.com/2021/07/
she had presented a case on CKD.it was good but there are no perfect reports posted in log book.but the treatement was good based on investigation done.
LFT says that bilirubin levels are increased , enzyme panel is also disturbed 
RFT says that UREA,URIC ACID and CREATININE LEVELS are abnormal indicating renal failure.
treatement is good and satisifactory.
Now at present the patient have shifted to ORTHOPAEDIC DEPARTMENT.
https://ananyapulikandala106.blogspot.com/2021/06
She had presented a case on diabetes with breathlessness.
the patient was also suffering from fever and diarrhoea.
the patient is diabetic since 4 years.
General examination and systemic examination was found to be normal.
VITALS
fluctuation of BP.
temperature was afebrile.
INVESTIGATIONS DONE ARE

Abdominal examination :
  • Soft 
  • Non tender
  • No palpable masses 
Cns examination :
  • Unconscious / altered 
  • Speech no response
  • No signs of meningeal irritation
  • GCS (coma scale) :E 3 V 4 M 5 ( before arrest ) 
  • After arrest E 1 V T M1 
  1. Yesterday also same GCS 
  2. Today E1 V T M4
 
Provisional diagnosis:  DKA with AKI ( ? Pre renal) 
USG(25/06/21) - Pyelonephritis. 
 


Laboratory investigations :
ABG analysis:Day 1







Day 2)
ABG analysis

Complete blood picture 

 Liver function tests:

Kidney function tests :
Based on the above results, she was put on dialysis by afternoon 2pm. 
Day 3 









 
Day 4



Day 5
Post dialysis reports



Hb Is less.

Increased level of creatinine and uric acid.


Day 6 and 7
Bed sores

BP 150/80mmHg
PR 89c/m
Ventilator was disconnected
SpO2  98% on oxygen mask.
GCS  E4 V1 M4 
No change in treatment.



HE also have diabetes ketoacidosis.


LFT says that bilirubin levels are increased , enzyme panel is also disturbed 
RFT says that UREA,URIC ACID and CREATININE LEVELS are abnormal indicating renal failure.
treatement is good and satisifactory.
Now at present the patient have shifted to ORTHOPAEDIC DEPARTMENT.
https://kavyasamudrala.blogspot.com/2021/05/
 the case is diabetic nepropathy.
History was taken good .
General examination and systemic examination were normal.
VITALS
Temperature is afebrile and other were normal.
INVESTIGATIONS DONRE ARE.
















17June 2021







21June









25June









28 June





















  14 April to 27 April 2021












                   21 May 2021       


























Temperature charting



                            
  Urine bag with plenty of pus cells on 22nd may 2021









       Urine bag on 31 May 2021 ( After treatment)








Xray

 



                       NCCT KUB




 (Normal KUB for reference)










              

             HYDRONEPHROSIS


        



Investigations done are good and treatement was also good.
Q5)
The online learning is not that satisifactory.

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