Concluded Case


A 36 years old female patient, complaining č mastagia, breast lump, erythema, pain abdo. pain at right hypochondriac region , dysuria, poor stream, intense pain in back of the stomach, blood in urine č burning mituration, dyspareuria. O/E BP 140/ 90mmHg Pulse 108 bpm R/R 16 bpm Abdo.distended B/S normal CVS s1 & s2 P Chest B/L clear


Concluded answer
Pt is having two issues A. Rt kidney stone with haematuria abd burning sensation of micturation. As the stone is situated in upper zone of rt kidney there is no chance of hydronephrosis if at all occurs it may be hydro calyx or dilation of calyx but as there is heamaturia and burning sensation of micturation Go for urine for culture and sensitivity test and full @course of antibiotic may be given if even then haematuria persists then you will have to think for removal of stone . Fibroadenosis or fibro cystic disease if breast, aetiology not known but hormone particularly oestrogen has got role particularly during cycle when there is changes of label of oestrogen there is changes in the breast tissue and firms cystic feeling of breast , multiple in numbes feels like cord. During cycle there is some feeling tightness if brest with pain .they are benign in nature. Many a time it remains asymptomatic but sometimes there is heaviness of breast and pain also Mammography to see the structural changes USG witllmor information No specific treatment is there Breast support or tight bra to use Cap Vit E ,400 mg dality to continue Oral contraceptive pill to start from 5 th day of cycle to cont for 21;days then to wait for withdrawal bleeding and to cont for 3 cycles Some like to use Tab Danazol Sometime USG guided aspiration of the cyst or excision cyst may be helpful .
All Answers
Two issues 1 renal calculi with hematuria 2 fibroadenosis breast b/l Complaints narrated are confined to renal system hence first attend the same There is obstructive calculus causing hydronephrosis and hematuria Do routine urine. Hydrotherapy with inj lasix and inj Ceftriaxozone Once pt comes out of it second issue is to be addressed adv fnac and biopsy to confirm malignancy and to plan further mx
Thanx dr Mahananda Angel and 3 others

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Bilateral fibroadenosis with bilateral significant axillary lymphadenitis A mammography should be done to rule out malignancy of breast considering bilateral lymphadenitis. A F.N.A.C of axillary lymph node will be diagnostic . Right renal nephrolithiasis a 5.5 mm calculus can pass spontaneously with conservative treatment on warstone, plenty of oral fluids and restriction on dietary oxalates. Considering dysuria , dyspareunia and hematuria,- it looks like UTI . Tab nitrofurantoin 100 mg B.D for 2 weeks . Tab flavoxate B.D for 2 weeks. For Mastalgia 1.Primosa cap.- evening primrose oil O.D for 3 months 2.Cap flexid - flaxseed oil capsules 1 cap O.D for 2 months
B/L Fibroadenoma with axillary lymphadenitis. Needs further investigation and evaluation to conclude or rule out any eventually in breasts and axillary lymphnodes. Conservative treatment till reports complied. Antibiotics,analgesic, antacids and urine alkalizer.orally or IM. Multivitamin and antioxidant orally. Reassurance and counciling required.
Thanks Dr Pushkar Bhomia

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Rt Renal calculus with uti Bilateral Fibroadenoma with bilateral axillary lymphadenopathy Forced diuresis with antibiotics for small renal calculus and uti . Urine culture and sensitivity. Biopsy for lymph node and Adenoma FNAC and CA125
B /L Fibroadenosis B/L Axillary lymphadenopathy Right side Renal calculi Ad FNAC of lymphnode & Adenomas Ad CBNAAT to R/O tuberculosis Fibroadenectomy both sides PCNL rt side
Patient is having renal stone with B/L fibroadenosis with B/L axillary LN. go for FNAC of LN. with conservative management. Tab nitroferition 100mg BD tab pantop 40 mg OD tab layer D TDS Tab cystone 2 tab TDS Tab lasix TDS ALL FOR 5 days Syp alkacip 2tsp TDS 7 days Tab Evion 400mg BD tab primosa 1gm OD For 15 days. Wait for FNAC report to come. Then proceed according.
Breast evaluation needs to be done - lump size? Character? Axillary status? For 36yrs old , we will get a ultrasound of both breasts done, depending on the report of further evaluation is required then Mammogram/ MRI is to be done.
Valuable opinion
Breast and Axilla LN- FNAC . Control BP. Renal calculi with UTI: Tab Loxof 500- ODPC 7 day's. Syrup Potrate MB 6- 10 ml TDPC 1 month. 4-5 litres water/day Tab Drotin DS-1 tab BDPC 5 days. Blood for FBG PPBG.
Rt renal calculi with rt breast abscess with lt breast fibroadenosis abscess for culture and sensitivity lt breast core biopsy HP renal calculi rt breast abscess lt breast fibroadenosis dd malignancy
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Thank you doctor
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