13 F Generalized swelling and lymphadenoma

I am presenting a case of a young girl of age 13yr old female, resident of Nalgonda,came to the OPD with chief complaints of 
generalized swelling of the body since 1 month and hematuria since 1 month.

HOPI:
        Patient was apparently asymptomatic 36 days ago, the she develops fever low grade intermittent type, relieved with medications not associated with chills and regors. Vomitings: 4 episodes per day, for 3 days. Contains food particles, non bilious, non projectile, loose stools 3-4 episodes per day, watery not associated with abdominal pain, blood in stools.
     Patient now presents to the OPD with complaints of hematuria since 33 days whole stream of urine red in colour. No burning micturition and frothiness of urine. Then patient develops generalized swelling of body, initially at both lower limbs pedal odema and then abdominal distension and facial puffiness.
No history of sore throat, decreased urine output.
PAST HISTORY:
    No history of similar complaints in the past. Not a K/C/O HTN,DM,TB, Bronchial asthma, CAD,CVD, Epilepsy.
TREATMENT HISTORY:
      Not significant
PERSONAL HISTORY:
   Sleep: Normal
   Appetite: Normal
   Bowel and bladder movements: Normal
   Micturition: Normal
 No Allergies and addictions.
FAMILY HISTORY:
    No significant family history.
MENSTRUAL HISTORY:
  Age of menarche: 11 years
  Menstrual cycle: 5/28.
  LMP: 25/11/22.
 No gynaecological problems.

EXAMINATIONS
    PHYSICAL EXAMINATION:
        A) GENERAL:
               Pallor: Present
             Icterus: Absent
         Cyanosis: Absent
         Clubbing: Absent
Lymphadenopathy: Absent
Odema of foot: Present bilateral.

   Temp: 98.4 °F
  Pulse: 74/ min
    RR: 18/ min
      BP: 120/90
PER ABDOMEN:

Inspection- umbilicus inverted, all quadrants moving equally with respiration , no scars sinuses and engorged veins with visible pulsations

Palpation: soft , non tender
Auscultation: BS heard


CARDIOVASCULAR SYSTEM:

 on inspection : chest is elliptical bilaterally symmetrical 

Palpation: apex beat felt 

All inspectory findings confirmed



RESPIRATORY SYSTEM:

Inspection: 

Shape- elliptical 

B/L symmetrical , 

Both sides moving equally with respiration .

No scars, sinuses, engorged veins, pulsations 


Palpation:

Trachea - central

Expansion of chest is symmetrical. 

Vocal fremitus - normal


Percussion: resonant bilaterally 


Auscultation:

 bilateral air entry present. Normal vesicular breath sounds heard.


CENTRAL NERVOUS SYSTEM:


Patient is Conscious,coherent and cooperative 

Speech- normal

No signs of meningeal irritation. 

Cranial nerves- intact

Sensory system- normal 

Motor system:

Tone- normal

Power- bilaterally 5/5

Reflexes - 

Triceps  +2  +2

Biceps.  + 2  +2

Supinator +2  +2

Knee +2  +2

Ankle +2  +2


PROVISIONAL DIAGNOSIS:

POST INFECTIOUS GLOMERULONEPHRITIS ?SECONDARY TO ECOLI/SALMONELLA/STREPTOCOCCI


INVESTIGATIONS :




Fever chart :




URINE SAMPLE 


ANA PROFILE 

TREATMENT:


17/12/22

SALT AND FLUID RESTRICTION 

Vitals monitoring 4th Hrly


18/12/22


13 year old girl, high school student came to the OPD with history  of fever 36 days ago high grade, continuous type relieved with medication. Vomitings 4 episodes /day, content food particles, non bilious, non projectile. Loose stools 3-4 episodes/day, watery .

No presented with the complains of hematuria since 33 days,  gross hematuria whole stream of urine.Both lower limb  pedal edema since 30 days, pitting type.

No history of sore throat, decreased urine output .



S 


C/o generalised swelling of body



O


Pt is C/C/C


BP:120/90mmHg


PR:74bpm


RR:18cpm


SpO2:98% on RA


Temp :afebrile


CVS:S1S2 +


RS :BAE +


PA-soft no organomegaly


A


POST INFECTIOUS GLOMERULONEPHRITIS SECONDARY TO ECOLI/SALMONELLA/STREPTOCOCCI


P


SALT AND FLUID RESTRICTION 


Vitals monitoring 4th Hrly


19/12/22

13 year old girl, high school student came to the OPD with history  of fever 36 days ago high grade, continuous type relieved with medication. Vomitings 4 episodes /day, content food particles, non bilious, non projectile. Loose stools 3-4 episodes/day, watery .

No presented with the complains of hematuria since 33 days,  gross hematuria whole stream of urine.Both lower limb  pedal edema since 30 days, pitting type.

No history of sore throat, decreased urine output .



S 


C/o generalised swelling of body



O


Pt is C/C/C


BP:110/70mmHg


PR:80bpm


SpO2:98% on RA


Temp :afebrile


CVS:S1S2 +


RS :BAE +


PA-soft no organomegaly


A


POST INFECTIOUS GLOMERULONEPHRITIS ? SECONDARY TO SALMONELLA/STREPTOCOCCI/ECOLI


P


SALT AND FLUID RESTRICTION 


TAB LASIX 40mg PO/BD


Plan for renal biopsy


20/12/22


13 year old girl, high school student came to the OPD with history  of fever 36 days ago high grade, continuous type relieved with medication. Vomitings 4 episodes /day, content food particles, non bilious, non projectile. Loose stools 3-4 episodes/day, watery .

No presented with the complains of hematuria since 33 days,  gross hematuria whole stream of urine.Both lower limb  pedal edema since 30 days, pitting type.

No history of sore throat, decreased urine output .



S 


C/o b/l lower limbs

No shortness of breath



O


Pt is C/C/C


BP:100/80mmHg


PR:72bpm


SpO2:98% on RA


Temp :afebrile


CVS:S1S2 +


RS :BAE +


PA-soft no organomegaly


A


POST INFECTIOUS GLOMERULONEPHRITIS ? SECONDARY TO SALMONELLA/STREPTOCOCCI/ECOLI


ANEMIA OF CHRONIC INFLAMMATION 


P


SALT AND FLUID RESTRICTION 


TAB LASIX 40mg PO/BD


Vitals monitoring 4th Hrly


Plan for renal biopsy today



21/12/22


13 year old girl, high school student came to the OPD with history  of fever 36 days ago high grade, continuous type relieved with medication. Vomitings 4 episodes /day, content food particles, non bilious, non projectile. Loose stools 3-4 episodes/day, watery .

No presented with the complains of hematuria since 33 days,  gross hematuria whole stream of urine.Both lower limb  pedal edema since 30 days, pitting type.

No history of sore throat, decreased urine output .



S 


C/o b/l lower limbs

No shortness of breath



O


Pt is C/C/C


BP:110/80mmHg


PR:72bpm


SpO2:98% on RA


Temp :afebrile


CVS:S1S2 +


RS :BAE +


PA-soft no organomegaly


A


POST INFECTIOUS GLOMERULONEPHRITIS


ANEMIA OF CHRONIC INFLAMMATION 


P


SALT AND FLUID RESTRICTION 


TAB LASIX 40mg PO/BD


Vitals monitoring 4th Hrly


Plan for renal biopsy today






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