39 yrs,male,c/o bilateral pedal edema since 10 days,?constipation in his words,passing stool with mild effort but not straining,he is 5.6 ft height,weight 85 kg,no significant past history,he has sitting job at paan shop,almost from 7am to 11.30, BP normal,cvs,RS normal,stemmers sign positive, bilateral tightness below knee,plz discuss



We can summarise the case like T2DM Normotensive Obese Lymphedema Sedentary lifestyle. Constipation ( as per the patient ). Is there any h/o Fever ??? We need to suspect the following reasons for pedal oedema. 1) Lymphedema ??? Filarial Positive Stemmer's sign goes well with lymphedema. 2) Sedentary lifestyle This also might be one of the reasons for pedal oedema. But in general this would be pitting type of oedema. 3) Hypothyroidism Pedal oedema Obesity Constipation are in favour of hypothyroidism. The patient needs some investigations like FPG (repeat please) 2 hrPG HbA1c TFT ECG CBP,ESR CUE Fasting Lipid Profile Micral . Vascular Doppler both lower limbs. USG Abdomen As far as management is concerned. Stress more on LSM & TLC. Pending the results no drug for DM temporarily as LSM & TLC would serve the purpose. Foot end elevation Ask him to walk for 5 mts for every one hour. Hot fomentation twice daily for feet. Hypothyroidism and Filarial lymphedema are in the battle now. Let's wait for the results and come to a conclusion. We decide whether he needs treatment for DM based on the reports. All the best dear Vijay

lovely approach Sir .thanks.

View 8 other replies

till then symptomatic treatment only for constipation....u may give him tab.punarnava mandur 2 tab TDS for three days then BD,tab.chandraprabhawati 2tab tds for 5 days then BD,powder softovac or trifgol 2TSF HS with Luke warm water

yes,punarnava mandur is an excellent medicine.

Widal test ,Smear for MP USG abdomen. urine sample for Routine culture and sensitivity. Fasting lipid profile as he is over weight & sedentary lifestyle person. DVT should be considered & investigation are must.

sir no h/o fever

Dear Vijay Gupta, Is the oedema pitting or non pitting ??? Blood sugar levels given as 154 mg/dl, but not able to see whether Fasting or Post lunch ??? What is ESR ??? kindly clarify Vijay.

sir it is non pitting,it is 154 mg/dl is fasting,ESR could not be done due to insufficient sample,thanx

View 1 other reply

do thyroid profile(ft3,ft4,TSH), Usg abdomen. family history, mosses sign, Homan sign (DVT), for symptomatic can give T.lasix 40 1od (if pt. not affordable fr further management)

Sir. I have seen Pt without fever Malaria positive & Typhoid position only some times headache & pain whole body. Deep vain thrombosis ? Chickengunia in Mumbai ?

yes agree sir,even i saw falciparum without fever,DVT is one of the dd i agree,since 2-3 years in mumbai chikengunia is rare,and in specefic pockets

Very nice explanation by Dr. Mohan. Agree with Dr. Prabhu, except no diuretics until the final diagnoses is made.

Thanks Dr Parvez, but I never made a mention of Diuretics.

View 1 other reply

This is a very good case, with Stemmer's sign positive, let's discuss, after you give me the details please.

a pan vala has to stand in his shop-from morning to night as he is obase and continous standing -might have caused the insufficiency in venous suppply-and causing oedemaone quarry Dr Vijahbhai ,10 days pedal oedema- how can b non putting ? -he c/o bilateral tightness below knee-is it not bcaz of venous return insufficient causing oedema?

he is sitting almost for 12 to 14 hours and not standing,there is no pitting edma

thromboangitis obliterance start frusemide and after b/l colour Doppler report decide the further Mx. leg elevation and crepe bandage application.sometimes calcium phosphate deposition also shows tightness in legs.rule out other orthopaedic situations.

Load more answers

Cases that would interest you