55 yr old male with chronic kidney disease on maintenance hemodialysis

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Chief complaints

55yr old male farmer by occupation came to medicine opd with the chief complaints of

- Decreased urine output since 15 days 

- bilateral pedal oedema since 1 month 

- Irregular bowel ( constipation) since 15 days

History of present illness 

Patient was apparently asymptomatic 12 years ago then developed  renal disease which was diagnosed with loin pain , after then he went to hospital and dianosed as renal disease which progressed even after medication 

After that due to failing of kidney he had undergone for dialysis in 2016 ( 6 yrs ago) .

Daily Routine : 

Wakes up at 5am and goes to field.

Comes home at 8am and has rice for breakfast. Returns to work at 9am.

1pm - lunch

2-6 pm - work

6pm - home

8pm - dinner

past history 

no history of diabetes mellitus,  

history of hypertension since 4 years

no history of palpitations, chest pain, shortness of breath 

no history of paroxysmal nocturnal dyspnea, and orthopnea

history of dialysis from 2016 

history of low-grade fever on medication 

PERSONAL HISTORY: 

• Diet - mixed
• Appetite- normal
• Sleep - disturbed
• Bowel - irregular (constipation) since 15 days
• Bladder - oliguria since 15 days , no burning micturition, feeling of incomplete voiding. 
• Allergies- none
• Addictions- regular alcolic (70ml a day)

FAMILY HISTORY:

Not significant 

GENERAL EXAMINATION: 

Patient is conscious, coherent and co-operative.

Examined in a well lit room.

Moderately built and nourished

Icterus - absent

Pedal edema - present - bilateral pitting type

   No pallor, cyanosis, clubbing, lymphoedenopathy.               

Vitals : 

Temperature- afebrile

Respiratory rate - 16cpm

Pulse rate - 101 bpm

BP - 120/80 mm Hg.

SYSTEMIC EXAMINATION: 

CVS : S1 S2 heard, no murmurs

Respiratory system : normal vesicular breath sounds heard.

Abdominal examination: 

INSPECTION : 

      Shape of abdomen- scaphoid

no tender

no palpable mass

hernial orifices - normal 

free fluid - no

bruits - yes

• Umblicus - normal 
• Movements of abdominal wall - moves with respiration
• No scars, sinuses, distended veins, striae.

PALPATION : 

Local rise of temperature present.

Tenderness present - not present 

Rigidity absent 

Fluid thrill negative

Liver not palpable 

Spleen not palpable 

Kidneys not palpable 

Lymph nodes not palpable 

CNS EXAMINATION: 

Conscious 

Speech normal

No signs of meningeal irritation 

Cranial nerves: normal

Sensory system: normal

Motor system: normal

Reflexes:      Right.           Left. 

Biceps.         ++.                 ++

Triceps.         ++.                 ++

Supinator      ++.                  ++

Knee.              ++.                 ++

Ankle              ++.                  ++

Gait: normal

INVESTIGATIONS: 

Serology: 

HIV - negative 

HCV - negative 

HBsAg - negative 

PROVISIONAL DIAGNOSIS:

Chronic kidney disease on maintenance hemodialysis