A 36 yeah old male with edema of uvula and throat
A 36 year old male patient watchman by occuption came with the complaints of swelling of tongue and uvula at 4.00 am yesterday
HOPI:
He was apparently asymptomatic 15 years ago before 2007 when he developed generalised swellings in the body which progressed to involve his face and he was admitted to a local hospital for that and tracheotomy was done and referred to kamineni for further management
Since then he had multiple episodes of swelling over the limbs, back, face for which he took hydrocortisone and avil at home and if there was swelling in the face and throat he came to hospital
He used to develop the swelling at a frequency of about 2 times amonth
The swelling is not associated with itching, redness or pain
Patient developed swellings when exposed to smoke /dust/whrn he eats certain foods(fish,brinjal,gongura)
Swelling usually appears 5to 10 hours after exposure to triggers and lasts upto 3 days
In 2016,he developed again an episode of swelling of face and throat for which tracheostomy was done
recent episode was yesterday
Patient woke up to to urinate at 1'0 am during his shift as watchman yesterday then he felt discomfort in his throat and foreign body sensation so he went to check it out what it was in the mirror and he noticed swelling of uvula
The swelling progressed downwards and patient felt like whole of the throat is swollen
He developed sudden onset pain associated with swelling soon after he noticed swelling which progressed gradually to the point where he could not move his head side to side due to pain
His daily routine was not affected much when he has swelling over body and limbs but he used to take leave when he developed edema of face, throat
PAST HISTORY:
No history of diabetes, hypertension, asthma, tuberculosis, epilepsy
TREATMENT HISTORY :
He has been taking hydrocortisone and avail for swelling episodes
SURGICAL HISTORY :
Tracheotomy was done twice
PERSONAL HISTORY :
Diet-mixed
Appetite - normal
Sleep - inadequate because of working as watchman
Bowel and bladder : regular
No addictions
Allergies - he used to develop generalised swellings over the body when he eats fish, mutton, gongura
Or exposed to incense stick, burning garbage, deos
FAMILY HISTORY :
No other family members affected by this condition
GENERAL EXAMINATION:
Patient was conscious, coherent, cooperative and moderately built and well nourished. He was examined in a well lit room
No signs of pallor, Icterus, cyanosis, clubbing, lymphadenopathy
Edema of uvula is seen
Edema of extremities is absent
Vitals:
HR - 120 bpm
BP - 120/90 mmhg
RR - 16 cpm
Afebrile
RESPIRATORY SYSTEM EXAMINATION :
Examination of oral cavity :
No trismus
Examination of oral cavity - lips, gums, teeth, gingivobuccal sulcus, gingivolingual sulcus( upper and lower) ,retromolar trigone, anterior 2/3 of tongue, hardpalate, floor of mouth appear normal
Examination of oropharynx - edema and congestion of anterior pillar, uvula, soft palate, posterior pharyngeal wall
Examination of nose:
Turbinates and mucosa appear normal
Examination of neck - tracheostomy scar and normal neck movements
1.Inspection of chest:
Shape of chest-bilaterally symmetrical
Expansion of chest - appears equal on both sides
Position of trachea - deviated to left
No crowding of ribs
No visible pulsations or engorgement
No visible scars and sinuses
No kyphoscoliosis
2.Palpation of chest :
No tenderness
No local rise of temperature
Bilateral air entry present
Expansion of chest equal on both sides
Apex beat - medial to midclavicular line in 5th intercoastal space
3.Percussion:
Resonant over all areas of chest
4.Auscultation:
normal vesicular breath sounds
Abdominal examination :
Inspection : shape of abdomen is scaphoid, no visible peristalsis
Palpation : soft, nontender ,no organomegaly
Percussion : no free fluid
Auscultation : bowel sounds heard
CVS EXAMINATION :
Inspection : no visible pulsations
Palpation: apex beat felt
Percussion :heart borders normal
Auscultation :S1, S2 heard nothing added murmurs
CNS EXAMINATION :
Conscious
Normal speech
Cranial nerves intact
Normal sensory and motor system
Kernick's sign - normal
No neck stiffness
Reflexes - normal
INVESTIGATIONS:
- Haemoglobin- 13g/dl
- Total Leukocyte count- 13,200 cells/cumm
- Platelet count- 4.6 lakhs/cumm
- Complete Urine examination- no sugars, no albumin present.
- Blood grouping- A positive
- Random Blood Sugar- 115mg/dl
- RFTs-
- Urea- 19
- Creatinine- 1
- Sodium- 140 mEq/L
- Potassium- 4.1 mEq/L
- Chloride- 94 mEq/L
8. Liver Function Tests-
- Total bilirubin- 1.19 mg/dl
- Direct bilirubin- 0.3mg/dl
- AST(SGOT) - 25 IU/L (N 5-40)
- ALP(SGPT) - 145 IU/L (N 44-147)
- ALT- 21 IU/L (N 7-55)
9. C4 complement serum
10.radiography
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