45years old female with bilateral swelling in lower limbs
45years old female came to casuality with
Chief complaints:
Bilateral Swelling in lower limbs
Pain in abdomen
History of presenting illness :
Patient was apparently asymptomatic 20days back later she developed swelling in limbs,right side is more compare to left side in the bilateral lower limbs it is insidious in onset gradually progressive in nature associated with pain while walking,
10 days back she developed pain in the right hypochondrium which was insidious in onset gradually progressive increase in sitting position decrease in laying position she also developed pain in right shoulder
Daily routine :
Patient wakes around 6am and completed her daily routines completes.comoletes her tiffin and goes to work at around 9am.She returns from work around 6 pm in evening and completed dinner by 9:30pm.
Past history :
Not a known case of diabetes, hypertension,asthma ,TB , epilepsy
Treatment history :
No significant treatment history
Personal history
Diet -mixed
Bowel and bladder -regular
Appetite-decreased
Sleep - adequate
Addiction - nill
General examination
Patient was conscious , coherent, cooperative well oriented to time , place person
Pallor- absent
Icterus- absent
cyanosis- absent
Clubbing- absent
Lymphadenopathy - absent
Edema- present pitting type
Vitals
Temperature-afebrile
Respiratory rate - 28cpm
Pulse -76bpm
Bp-120/80mmhg
Systemic examination
CVS-- s1 ,s2 heard no murmurs
• Respiratory system- normal vesicular breath sounds heard
Abdomen- no. . palpable mass , tenderness is present in right hypochondrium
CNS
-Patient is conscious
-Speech -normal
-No signs of meningeal irritation
-SENSORY EXAMINATION,- touch, pain , vibration present
-No muscle wasting seen
Local examination
Inspection:
Swelling : present
Scars : absent
Deformity- absent
Palpation:
Pitting type edema
Temperature - no local rise in temperature
Tenderness - present
Ascites -absent
Investigation
Diagnosis:.
Heart failure??
Chymoerol fort
Follow up :
On 04-072022 after two days of treatment
On 06-07-2022
On 7-07-2022
Treatment giving from 6 -7-2022
*Lasix
*Shelcal
*Chymoral forte
*" DCE 200 mg"
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