1801006158 prefinal A 45 year old female with generalised weakness and pedal edema
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Shivang sharma
2018 batch
Case report -
A 45 year old female ,resident of narkatpally came with the chief complaints of
-- generalised weakness since 15 days
B/l pedal edema since 15 days
HOPI --
Patient was apparently asymptomatic 15 days back then she developed swelling in both lower limbs which was insidious in onset gradually progressive and pitting type , relieved in night (on rest )
It was previously on and off type bt since 2 to3 days it was not relieving on rest also for which she visited hospital and her hemoglobin level was 4.5 gm / dl , later she had blood transfusion,the pedal edema is relieved
She also complains generalised weakness
No h/o of sob , orthopnea,pnd , palpitation, decreased urine out put , and burning micturition
No h/o abdominal distension,pain , itching,erythema
No h/o fever ,vomiting, loose stools, constipation
Past history -
She had similar complaint of generalised weakness 4years back.
K/c/o diabetes since 3days
Not a k/c/o HTN,Asthma, epilepsy , thyroid disorders,TB, CAD
Menstrual history -
Menarche-At the age of 13years
She had regular periods of 5/28
She used 2-3pads/day before but since 3months she has increased blood flow on her 1st day of menses for which she used around 4pads/day(fully soaked).
Marital history -
She got married at the age of 15years
1st child- normal vaginal delivery but died after 3days.
2nd child- normal vaginal delivery but died at the age of 6.
3rd,4th and 5th child through normal vaginal delivery and their current age 23yrs,18yrs and 16yrs.
Personal history -
Diet - mixed
Appetite - decreased
Sleep - adequate
Bowl and bladder movement - regular
No addiction
No allergy
Daily routine -
She used to wake up at 7 am nd do household works , had breakfast at 8 am ,lunch by 2 pm ,dinner by 10 pm and sleep 12 pm , she works in her genral store with her son
Since few months she used to skip meal
Family history - not significant
General examination--
Patient is conscious, coherent and cooperative
Moderately built nd nourished
Pallor - present
Icterus - absent
Cyanosis - absent
Clubbing - absent
Generalised lymphadenopathy - absent
Edema - previously present now resolved
Temp -96.8° F
Blood pressure - 110/70 mmHg
Pulse rate - 89bpm
Respiratory rate - 16 cpm
Systemic examination --
RESPIRATORY examination --
Shape of chest is elliptical
B/L symmetrical
Trachea is central
Expansion of chest symetrical
Bilateral airway entery
Normal vesicular breath sound
No scars ,dilated vein seen
Per abdomen -
Inspection -
Shape - scaphoid
Umbilicus - inverted
Equal symmetrical movement in all the quadrant with respiration
No visible pulsation , peristalsis ,dilated veins
No distension
Palpation -
No local rise of temp
Inspectory findings are confirmed
No hepatomegaly
Spleen not palpable
Percussion -
Liver span - 7 cm
Shifting dullness - absent
Puddle sign - absent
Auscultation - bowl sound heard - 6 sound / minute
Cvs --
Inspection:
There are no chest wall abnormalities
The position of the trachea is central.
Apical impulse is not observed.
There are no other visible pulsations, dilated and engorged veins, surgical scars or sinuses.
Palpation:
Apex beat was localised in the 5th intercostal space 1cm medial to the mid clavicular line
Position of trachea was central
There we no parasternal heave , thrills, tender points.
Auscultation:
Loud S1 and S2
There were no added sounds / murmurs.
CNS -
HIGHER MENTAL FUNCTIONS-
Normal
Memory intact
CRANIAL NERVES :Normal
SENSORY EXAMINATION
Normal sensations felt in all dermatomes
MOTOR EXAMINATION
Normal tone in upper and lower limb
Normal power in upper and lower limb
Normal gait
REFLEXES
Normal, brisk reflexes elicited- biceps, triceps, knee and ankle reflexes elicited
Reflexes video --
CEREBELLAR FUNCTION-
Normal function
No meningeal signs were elicited
Provisional diagnosis -
This is case of 45 year old female having anemia secondary to ?heavy menstrual bleeding
INVESTIGATIONS:
On 7/6/23:
ECG -
USG -
Evidence of few calculi 3-4mm noted in the lower pole of right kidney
Evidence of 5.8x4.8 cm fibroid in the posterior myometrium
Impression:
Borderline spleenomegaly
Right renal calculi
Posterior myometrial fibroid
13 June 2023--
Hb- 5gm/dl
TLC - 5800
MCV - 61.7
MCHC - 23.1
MCH - 14.3
Platelet - 3.0
Serum iron - 31 micro gram / dl
Blood urea - 22 mg/dl
Serum creatinine - 0.6 mg/ dl
Blood grouping - B +ve
Serum ferritin - 2.2ng/ml
Liver function test --
14 June 2023
Fasting Blood sugar -285 mg/dl
Chest x-ray:
15/06/23
2D eco --
Final diagnosis:
This is case of 45 year old female having
Anemia-nutritional(iron deficiency anemia)secondary to ?heavy menstrual bleeding
Denovo DM 2
Right renal calculi
OBG Referral on 13/6/23:
O/E:
45year old P5L3D2 tubectomised with AUB-L with severe anemia
Patient not willing for per speculum and bimanual examination
Advice :
No active gynaecological intervention needed
Blood transfusion of 1unit PRBC was done on 13/6/23
Treatment:-
INJ.IRON SUCROSE 200MG IN 100ML NS IV/OD OVER 1 HOUR.
INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
TAB.METFORMIN 500MG PO/BD
TAB.GLIMIPIRIDE 1MG PO/OD
Why does edema develop in chronicle anemia ??
. It is suggested that the low concentration of haemoglobin in patients with anaemia causes a reduced inhibition of basal endothelium-derived relaxing factor activity and leads to generalised vasodilatation. The consequent low blood pressure may be the stimulus for neurohormonal activation and salt and water retention.
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