General medicine E log 1

 A 40 YR OLD MALE CAME WITH COMPLAINTS OF  CHEST PAIN, SOB, APPETITE AND WEIGHT LOSS

June 06, 2022

Hi, I am Aziza Ferdose 3rd sem medical student. this is an online elog book to discuss our patients health data after taking his consent.This also reflects my patient centered online learning portfolio.

A 40 year old male painter by occupation resident of bhongir came to casualty with cheif complaints of 

Shortness of breath

Chest pain

Appetite and weight loss

HISTORY OF PRESENT ILLNESS:

The patient was asymptomatic 10 days back then developed loss of appetite ,weight loss, and shortness of breath .

 Shortness of breadth insidious on onset and gradually progressive.sob with grading of MMRC-3 ( grade 1 to 3 in three days ) aggrevated on lying down and walking  and relieved on sitting. Patient unable to sleep at night because of sob.

chest pain since 1 month intermittent and gradually progressive. Dull aching pain localised to left chest region. no radiation. aggrevated 4 days back and with onset of sob episodes.

No fever, coughing,vomiting,wheezing

Difficulty in swallowing since 7 days leading to weight loss 

PAST HISTORY

Diabetes since 3 yrs was taking oral medications

No similar complaints in past

Not a known case of asthma, TB, epilepsy, cardiac disease, hypertension 

PRESENT HISTORY

Diet : mixed

Appetite reduced

Sleep disturbed due to pain but normalised after treatment

Patient stopped smoking 2 years back ( started 4 yrs back) and stopped drinking 1 and a half year back ( started 7 and a half year back )

No allergies 

FAMILY HISTORY

Mother is diabetic and has the problem of sob

VITALS 

Fever :afebrile 

Pulse: 82bpm

Respiratory rate: 24 cpm

Blood pressure: 104/78 mm Hg

GENERAL EXAMINATION

Patient is concious, coherent, cooperative

No signs of pallor, icterus, cyanosis, lymphadenopathy, clubbing, oedema

SYSTEMIC EXAMINATION

Respiratory:

Inspection:

no swellings

B/L symmetrical chest 

skin normal 

no sinuses 

no drooping of shoulder

supraclavicular and infraclavicular hollowness seen

Palpation:

no local raise of temparature

no tenderness

trachea central in position 

Percussion:

Dull lung sounds

liver dullness from right fifth ICS

cardiac dullness 

Auscultation:

BAE +

UBS

left SSA, ISA , Absent breadth sounds

left ISA

INVESTIGATIONS 

X-RAY

ECG

 CHEST EXAMINATION FINDINGS

examination of moderate pleural effusion with thick septation noted in left pleural space

examination of air sonogram with minimal air fluid in right pleural space

CVS: s1 s2 heard 

NEEDLE THORACOCENTESIS

PROVISIONAL DIAGNOSIS

 Left Moderate pleural effusion and Right lung consolidation

TREATMENT

oxygen inhalation nasal

inj. Augmentin 1.2gmIV

inj. pan 40mgIV

Tab. pcm 650mg ( if temp high)

syrup ascoril 2tsp

tab azee 500mg

tab glimiperide 1 mg , metformin 500mg

high protein diet 

GRBS monitoring

monitor vitals 

FOLLOW UP 7/6/22

Patient is and concious and cooperative

Investigations done :

X-ray

Bronchoscopy

Ultrasouund of chest

taking the medications as prescribed

Monitoring vitals

GRBS 7 point monitoring

FOLLOW UP 8/6/22

Patient discharged 

QUESTIONS

WHERE IS THE ANATOMICAL POSITION OF THE PATIENTS PROBLEM ?

The condition is pleural effusion that is build up of fluid in the patients pleural cavity

Pleural cavity is a fluid filled space that surrounds the lungs. It is fond in the thorax, separating the lungs from its surrounding structures. The pleural cavity is bounded by a double layered serous membrane called pleura.

Pleura is formed by inner visceral layer and outer parietal layer. Between this two membranous layers is a small amount of serous fluid held within the pleural cavity. This lubricated cavity allows the lungs to move freely during breathing.

WHY IS THE PATIENT HAVING THIS PROBLEM ? ( microanatomical anatomical pathogenesis and macro social environmental factors inflencing it) 

MICROANATOMICAL PATHOPHYSIOOGY

The patient was treated on antibiotic 

The bacteria enter the pleural cavity and bacterial and bacterial degradation products can be detected in the effusion. Due to phagocytosis of the bacterial metabolism and neutrophils, lactic acid would increase, pleural effusion ph and glucose would decrease and the lactic dehydrogenase would be elevated.

The patient was also diabetic since 3 years 

If a person has type 2 diabetes, you have decreased lung function compared with people who don’t have diabetes. Lung function is a measure of how well you’re breathing. It also refers to how well your lungs deliver oxygen to your body. If you have type 2 diabetes, you tend to have 3% to 10% lower lung volumes than adults who do not have the disease.

Generally, reduced lung function won’t interfere with your daily life. However, it could cause issues if you are obese, smoke, or have lung disease. Poor lung function can also be a problem if you have heart failure or kidney failure, two diabetes complications.

Having diabetes doesn’t necessarily mean you have bad lung function. Some studies show that lung function gets worse as blood glucose levels increase. The longer you’ve lived with diabetes, the worse your lung function may be.

In some studies, people who developed diabetes had low lung function to begin with. This has led some experts to wonder if poor lung health might contribute to diabetes. However, this idea hasn’t been proven.

Reference : https://www.healthgrades.com/right-care/diabetes/how-diabetes-affects-your-lungs

MACRO SOCIAL ENVIRONMENTAL EVENTS INFLUENCING IT 

The probable cause may be smoking and alcohol which led to pleural effussion 

Smoking is not a direct cause of pleural effusion. However, tobacco use is associated with a number of other health conditions such as lung cancer and kidney disease, both of which can lead to pleural effusion. In this sense, smoking can be considered a risk factor for pleural effusion, rather than a direct cause.

 Pleural thickening was seen in right lung

 One of the main causes of pleural thickening is exposure to and the inhalation of asbestos dust and fibres.

Asbestos is a naturally occurring mineral that was widely used in construction and other industries until the late 1990s. It was commonly used to insulate and fire proof buildings, particularly in ceiling tiles, pipe insulation, boilers and spray coatings used on ceilings and walls.

People who worked in industries where asbestos was regularly used are at a higher risk if developing pleural thickening. These jobs include, but are not limited to:

Carpentors and fitters

Heating and ventilation engineers

Factory workers

Painter 

( The patient is a painter ) 

PHARMACOLOGICAL INTERVENTIONS

Oxygen inhalation 

inj. Augmentin 1.2gmIV

inj. pan 40mgIV

Tab. pcm 650mg ( if temp high)

syrup ascoril 2tsp

tab azee 500mg

tab glimiperide 1 mg , metformin 500mg

NON PHARMACOLOGICAL INTERVENTIONS 

X ray 

Ultrasound chest

Needle thoracocentesis 

2D echo

GRBS 7 point monitoring 

Bed rest 

Physician presence