56 year old male with bilateral loin pain
A 60 year old male came to casuality on 13th January with complaints of :
Chief complaints:
Pain abdomen and bilateral lower back pain since 20 days
Decreased urine output since 15 days
HOPI:
Patient was apparently asymptomatic 2 years ago then he developed burning micturiturition intermittently. 2 month later he developed pain abdomen and bilateral loin pain. Pain was dragging type, no aggravating or relieving favors.
He then went to a hospital in khammam and was diagnosed with renal stones and was prescribed medication. He didnot use any medication and continued to have loin pain and burning micturiturition.
He developed vomitings and nausea 1year ago every 3 to 4 days immediately after eating and it was foul smelling and greenish in colour
He had 3 episodes of blood in urine on the same day 3 months ago and it disappeared from next day
2 months ago he developed urinary incontinence
20 days back he developed abdominal pain
15 days back he developed fever and decreased urine output
He doesn't have any chronic illness
His appetite decreased since 2 years and he takes less quantity of food than before and sometimes feels nauseous after eating and vomits sometimes
He lost 12 kgs in 2years from 44kgs to 32 kgs
He takes mixed diet
His sleep is disturbed due to pain
He regularly drinks alcohol and toddy since 50 years
Smoking since 40 years
No allergies
GENERAL EXAMINATION :
Patient is moderately built and poorly nourished;conscious,coherent ,cooperative and examined in a well lit room after taking informed consent
Pallor is present
No signs of Icterus, cyanosis, clubbing, lymphadenopathy, edema, Koilonychia
VITALS:
BP - 140/80
PR - 100 bpm
RR - 20 cpm
Afebrile
SYSTEMIC EXAMINATION :
CVS: S1, S2 heard, no murmurs
RESPIRATORY SYSTEM :
Normal vesicular breath sounds are heard
ABDOMEN :
Scaphoid in shape,soft and nontender
Bowel sounds heard
A nephrostomy tube is put on back left side
CNS: NAD
INVESTIGATIONS:
RFT:
Urea - 27.8
Creatinine - 16.3
Na - 139
K - 6.1
Cl- 104
LFT:
Total bilirubin - 0.99
Direct bilirubin - 0.28
AST - 12
ALT -12
ALP - 174
Tp-6. 2
Albumin - 3.5
CUE:
Albumin +
Pus cells - 3.4
RBC - nil
Sugar - nil
ABG:
pH-7.21
pCO2-14.5
pO2-131
spO2-96
HCO3-5.7
APTT-32secs
PT-16 secs
INR-1. 11
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