Diabetic nephropathy with CLD
Patient complaints of headache, maturation Swelling over body, anemia, anorexia, irritable K/c/o DM,HTN Chief Complaints Headache Maturation of urine Swelling over the body Fatigue, generalized waekness Hyperglycemia History DM HTN Medium economic data Vitals B.P 190/100 HR 109 RR 24 Spo2 96% Physical Examination Pitting edema both limbs Diagnosis Diabetic nephropathy with UTI,CLD Management Patient on medical management Please suggest further management and diagnosis and prognosis
Going through the case history and investigations It is a c/o chronic renal failure bcz of DKD Mild BPH is responsible for retention urine Mild cholecystitis or psuedothickening of GB walls CLD with PH and ascitis Kco diabetes and hypertension C /o headache and swelling over body with fatigue and gen weakness and hyperglycemia He is a c/o decompensated heart failure as seen from xray chest and ecg Xray chest suggest cardiomegaly with PAH Secondary to PH and CLD Yes for all this status responsible for DKD as albuminurea and reverse a/g ratio suggest hypoproteinemia and pt has ascitis Rx diuretics with i/o observation Put him on catheter Treat PAH inj pentoxyphyone Improve cardiac output So far CLD and DKD is concerned we need to look for DKA Inj sodabicarb to correct metabolic acidosis Bph too require attention as retention quantity is to be calculated Sos dialysis is to be considered Hba1c is varied abd eAG is not sugnificant still insulin is to be considered plain nph may be started Broadspectrum antibiotics Balance the electrolyte imbalance
Going through the case history and investigations It is a c/o chronic renal failure bcz of DKD Mild BPH is responsible for retention urine Mild cholecystitis or psuedothickening of GB walls CLD with PH and ascitis Kco diabetes and hypertension C /o headache and swelling over body with fatigue and gen weakness and hyperglycemia He is a c/o decompensated heart failure as seen from xray chest and ecg Xray chest suggest cardiomegaly with PAH Secondary to PH and CLD Yes for all this status responsible for DKD as albuminurea and reverse a/g ratio suggest hypoproteinemia and pt has ascitis Rx diuretics with i/o observation Put him on catheter Treat PAH inj pentoxyphyone Improve cardiac output So far CLD and DKD is concerned we need to look for DKA Inj sodabicarb to correct metabolic acidosis Bph too require attention as retention quantity is to be calculated Sos dialysis is to be considered Hba1c is varied abd eAG is not sugnificant still insulin is to be considered plain nph may be started Broadspectrum antibiotics Balance the electrolyte imbalance
Diabetic nephropathy ,CKD, Renal anemia Cirrhosis of liver with portal hypertension. BPH HTN Cardiomegaly , ECG , wrong limb lead placement, low voltage complexes Fluid overload state , cardiac failure ( Kerle B lines, fissural effusion ) Suggest Insulin for sugar control, watch for hypoglycemia Treatment of UTI and CKD Treatment of cirrhosis liver with combination of loop and K sparing diuretics. Careful Albumin infusions Antibiotics for UTI Investigations of anemia, may require Erythropoietin injection . Upper GI endoscopy to rule out bleeding oesophageal varices
? DIBETIC NEPHROPATHY.. WITH.. BRONCHITIS.. NEED'S TO..R/O..COVID-19.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT AS WELL.. MANAGEMENT FOR ..NEPHROPATHY..
1.Decompensated chronic liver disease with portal hypertension and mild -mod ascites with AKI--- GRADE 2 HEPATIC ENCEPHALOPATHY 2.Diabetic nephropathy 3.UTI 4. FLUID OVERLOAD 5.ANEMIA TREATMENT. 1. get 2d echo done check for EF % check for urine output plan for hemodialysis if. required 2.start on IV broad spectrum antibiotics 3.check for electrolytes 4.check for se.ammonia 5. lactulose syrup hs POOR PROGNOSIS
Acute Bronchitis Diabetic nephropathy 1): If patient on insulin then proper dose regulation and monitoring of sugar levels is required in consultation with Diabetologist. 2): Ashwagandha + bala moola+ madhumehantak+ tejovatyadi+ manjistadi+ sudh shilajeet+ udumbar ghan satva: 2 tsp BD A/F 3): Vasantkusmakar ras+ ekangveer ras+ CPV: 1 each BD B/F 4): Udvartanam with vacha churan or manjistadi churan. 5): Dhanyamala dhara. 6): Regular kati exercise to ensure proper blood circulation.
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FATTY LIVER Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells. Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people. Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat. Causes Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following: · Overweight or obesity · Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin · High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes · High levels of fats, particularly triglycerides, in the blood These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver. Symptoms Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include: · Enlarged liver · Fatigue · Pain in the upper right abdomen Possible signs and symptoms of nonalcoholic steatohepatitis and cirrhosis (advanced scarring) include: · Abdominal swelling (ascites) · Enlarged blood vessels just beneath the skin's surface · Enlarged breasts in men · Enlarged spleen · Red palms · Yellowing of the skin and eyes (jaundice) Risk factors A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including: · High cholesterol · High levels of triglycerides in the blood · Metabolic syndrome · Obesity, particularly when fat is concentrated in the abdomen · Polycystic ovary syndrome · Sleep apnea · Type 2 diabetes · Underactive thyroid (hypothyroidism) · Underactive pituitary gland (hypopituitarism) Nonalcoholic steatohepatitis is more likely in these groups: · Older people · People with diabetes · People with body fat concentrated in the abdomen It is difficult to distinguish nonalcoholic fatty liver disease from nonalcoholic steatohepatitis without further testing. Complications The main complication of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is cirrhosis, which is late-stage scarring (fibrosis) in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in nonalcoholic steatohepatitis. As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue. If the process isn't interrupted, cirrhosis can lead to: · Fluid buildup in the abdomen (ascites) · Swelling of veins in your esophagus (esophageal varices), which can rupture and bleed · Confusion, drowsiness and slurred speech (hepatic encephalopathy) · Liver cancer · End-stage liver failure, which means the liver has stopped functioning About 20 percent of people with nonalcoholic steatohepatitis will progress to cirrhosis. HOMOEOPATHIC REMEDIES Homoeopathic remedies are safe remedies for the treatment of fatty liver. Some of the important remedies are given below-- CHELIDONIUM Q- Chelidonium is the top Homeopathic medicine for Fatty Liver treatment. The marked symptom for using this medicine is pain in right upper abdomen and pain under right shoulder. There may also be an enlargement of liver.The person is usually constipated. The stool passes in the form of hard balls. A distended abdomen with nausea and vomiting is also experienced. The patient suffers from excessive weakness. In case of jaundice in a patient with Fatty Liver too, Chelidonium is the best Homeopathic remedy. Desire for very hot drinks and hot food CARDUS MARIANUS Q—.Pain in the liver region . Left lobe is very sensitive. Fullness and soreness with moist skin. Constipation. Stool hard, difficul and knotty. Alternates with diarrhea. Golden colored urine Nausea, vomiting of green acid fluid BOLDO Q- Congestion of liver . Burning weight in liver and stomach. Bitter taste , no appetite LYCOPODIUM CLAVATUM 200- Lycopodium is another remedy of great help for treating Fatty Liver with gastric symptoms and acidity. The patient complains of distension or bloating of abdomen soon after eating anything. The abdomen feels full of gas. Burning belching is also experienced. Even eating a little causes fullness in abdomen. The patient feels heaviness and pain in the right upper part of abdomen. Usually the symptoms get worse towards the evening. Farinaceous food makes the person worse. An unusual craving for sweets and hot drinks in excess may be present. PHOSPHOROUS 200-Phosphorus is the best Homeopathic medicine for patients of Fatty Liver who feel as if the food is coming upwards after eating. This is accompanied by sour belching. Vomiting may also occur in a few cases, along with pain in liver. The stool and flatus are very offensive. The patient feels weak after passing stool. The craving for peculiar things in diet is an important indication for using this medicine in Fatty Liver patients. These peculiar things include ice creams, cold drinks and refreshing items like juices. CALCAREA CARB 30- Calcarea Carb is a very beneficial Homeopathic medicine for mainly obese Fatty Liver patients. The person is fatty, flabby with excess fat in liver and whole abdomen. This Homeopathic remedy successfully helps in burning excess fat in liver.The digestion is very slow in such persons with a long-standing constipation. The abdomen always remains distended. Milk is not suitable for these persons. Desire for boiled eggs or strange things like chalk and pencils. Sensitivity to cold air and excessive sweating on the head. NUX VOMICA 30- Nux Vomica is the best fatty liver remedy in homeopathy when the cause is over consumption of Alcohol . It is prescribed when pain in abdomen begins a few hours after eating, with a feeling of stone in abdomen. Sour or bitter belching accompanies the pain. A very significant symptom for selecting Homeopathic remedy Nux Vomica for Fatty Liver is constipation with an ineffectual urge to pass stool or poop. The stool, however, is insufficient and unsatisfactory. The passing out of stool gives some relief from the pain in abdomen but the urge to pass stool is renewed soon after. The patient craves for fattyfood, spicy food, coffee and alcoholic drinks in diet.
Dr. Azher Ansari5 Likes19 Answers - Login to View the image
A 22 year old female married for 2.5 months presented to ER with fever since 8 days low to moderate grade, intermittent.and yellowish discolouration of sclera and skin since 3/4 days and altered sensorium since 1 day. On examination: Vitals normal Pallor + Icterus +++ Rest GPE wnl Patient deeply comatosed E1V1M1 No neck rigidity no kernigs. Planter b\l flexor Liver just palpable ( span 11.5 cm) On enquiring her husband and mother, there is history of ayurvedic medicine intake for a month bt that too 2 months back for lump in left breast which seems to be a lipomatous 0.5*0.5 cm swelling. Lmp was 1.5 mnth back. History if rats in house is there. No major prev illness Husband told that she developed rashes on day 1 and 2 and as per description were maculopapular but no scars are seen now. LMP 1.5 month back UPT negative. Leptospira igM sent, hbsag hcv awaited. Reat reports attached. Started ceftriaxone , doxycycline, ppi, emset, ivf, lactulose, rt feed. Kindly give your valuable opinion for further plan.
Dr. Rishabh Dixit3 Likes19 Answers - Login to View the image
42M,progressive cough,dyspnea gr4,since 8days, travelled to kerala recently.spo2 84%on nasal 02.HR130,BP110/60,newly ムT2DM.whats possible diagnosis and treatment?
Dr. Sandeep Ghodekar4 Likes26 Answers - Login to View the image
This pt is suffring from liver cirrosis .pul htn..ascitis.. He was coming with the c/o weakness . abd distension..polyurea...b.p 160/100 ,spo2 90./.,pr 104 per mt...chest b/l weezing...rbs ..565mg...wt is the best treatment for this pt
Dr. Bhushan Uniyal9 Likes41 Answers - Login to View the image
Patient Age 40 Yrs Old With History of Chronic Alcoholic With Complaint Absent of Urination & Pain Abdomen.Previously History Of Diagnosis With DM & TB.Here Is I Am Attaching Some Of Reports. Please Suggest Further Management. Thank You.
Dr. Kamal Koushal1 Like11 Answers