General medicine elog 1

 General medicine elog 1

Hi , I am Anamika Maiti ,3rd semester student.  This is an online elog book to discuss our patients health data after taking his consent.  This also reflects my patient centered online learning portfolio.


A 40 year old male with pleural effusion

A 40 year old male patient painter by profession,came to the OPD with the Chief complaints=  Shortness of breath for 3 days, appetite loss, weight loss since 10 days.He is complaining of chest pain since 4 days.The patient was admitted 2 days ago. 

History of presenting illness=
    patient was asymptomatic 10 days back, lost appetite and weight, developed shortness of breath 3 days back. Patient was unable to sleep at night due to SOB. Patient cannot breathe properly without oxygen mask.No history of fever, vomiting, coughing, wheezing.

Past history=
     diabetes Mellitus since 3 years(initially used to take insulin but now on medication). No complaints of sob in the past.

Personal history=
   Addictions: stopped smoking since past 2 year.

  Was alcoholic for 7½ years and stopped drinking since past ¹½ year.

  Appetite is reduced.

 Sleep disturbed due to sob.

diet=Mixed
Did not take covid vaccine.

Family history= No

General examination=
     conscious, coherent, cooperative.
     no signs of pallor, ictreus, cyanosis, clubbing, lymphadenopathy

Vitals= fever(afibrile),
       pulse-82bpm,
       respiratory rate-48cpm,
       bp-107/78mmhg


Physical examination

ECG

X-RAY

NEEDLE THORACOCENTESIS 

Systemic examination =
Respiratory system
Inspection :
  no swellings
  Skin normal
  Bilateral symmetrical chest
  No sinuses
  No dropping of shoulder
  Supraclavicular and infraclavicular hollowness seen

Palpation:
No local raise of temperature
No tenderness
Trachea central in position

Percussion:
  Liver dullness from right 5th intercostal space
  Cardiac dullness

Auscultation:
  BAE+
UBS
Left SSA,ISA,Absent breath sounds

TREATMENT
Oxygen inhalation nasal
Inj. Augmentin 1.2 mlV
Inj. Pan 40 mgIV
Tab Pcm 650 mg (if high temperature)
Syrup ascoril 2 tsp
Tab azee 500 mg
Tab glimiperide 1mg , metformin  500 mg
High protein diet

Follow up: patient wss taken for X-ray, bronchoscopy and ultrasound .

USG showed pleural thickening.

The patient is continuing the same medications.

GRBS monitoring Vitals.

Patient is conscious, cooperative. 

The patient was discharged on the 5th day.

(The pictures shown below are taken from google images!)

Where is anatomical location of this patient's problem?

 Macroanatomy

The anatomical location of the patient's problem is in the lungs.

 Pleural effusion is the collection of abnormal amount of fluid in the pleural space.

The pleura are thin membranes that line the lungs and the inside of the chest cavity.

The pleural cavity, also known as the intrapleural space, contains pleural fluid secreted by the mesothelial cells. 

The fluid allows the layers to glide over each other as the lungs inflate and deflate during respiration.

Why is the patient having this problem? 

   Microanatomical pathogenesis 

Bacterial infections:

The bacteria enter the pleural cavity and bacterial and bacterial degradation products can be detected in the effusion. Due to phagocytosis of the bacterial metabolism and neutrophils, lactic acid would increase, pleural effusion ph and glucose would decrease and the lactic dehydrogenase would be elevated. 

Macro-social environmental events influencing it:

Smoking (pleural thickening)

Alcoholic

Asbestos present in paints. 

What are we doing about it? 

Pharmacological interventions

Oxygen inhalation nasal
Inj. Augmentin 1.2 mlV
Inj. Pan 40 mgIV
Tab Pcm 650 mg (if high temperature)
Syrup ascoril 2 tsp
Tab azee 500 mg
Tab glimiperide 1mg , metformin  500 mg

Non pharmacological interventions

DIAGNOSTIC 

Chest radiographs 

Ultrasound of chest

ECG

Needle Thoracocentesis 

Bronchoscopy 

2D echo

GRBS 7 point monitoring 

Commonly performed tests on the pleural fluid to determine etiology are a measurement of fluid pH, fluid protein, albumin and LDH, fluid glucose, fluid triglyceride, fluid cell count differential, fluid gram stain and culture, and fluid cytology. Exudates are characterized by elevated protein, elevated LDH .

THERAPEUTIC

High protein diet

Bed rest

Controlled breathing techniques 

Physician presence