Kshithi ambati

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Case presentation: 66yr old male patient who is watchman by occupation and resident of suryapet came to general medicine opd with complaints of generalised weakness from one week and involuntary movements of right upper and lower limbs from 3days. HOPI:  Patient was apparently asymptomatic one week back then developed generalised weakness which is predominant in lower limbs associated with difficulty in walking, standing with support,difficulty in rolling on the bed fr

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Case presentation: A 26 year old female patient who is a house wife and resident of kalampalli came to general medicine opd with complaints of  c/o bilateral pedal edema since 21days. The patient was apparently asymptomatic one month back later she had LSCS for her first pregnancy and gave birth to  a baby who was kept in NICU for a day and then declared dead due to birth asphyxia. Then she noticed bilateral pedal edema pitting type which is insidious in onset graduall

 CASE 1 A1 As per the history given by the patient cirrhosis of the liver maybe the cause of ascites due to chronic alcoholism from 40yrs A2 Due to decreased synthesis of albumin because of the cirrhosis of liver the oncotic pressure is decreased thereby causing bilateral edema. A3 The increased levels of ammonia in liver failure patients causes damage to the neurons causing hepatic encephalopathy the reason for asterixis in this patient  The treatment given is lactulose so that it excretes ammonia  A4 high protein diet like eggs should be given Fluid should be restricted  Antiseptic dressing for the ulcers Syp lactulose Slow iv fluids for hydration INJ thiamine as he is chronic alcoholic CASE 2 A1 ATT were stopped because of the deranged LFT which maybe due to chronic alcoholism or the hepatotoxic drugs such as isoniazid or rifampicin A2 Bilateral infiltrations noted in the chest xray  Consolidations are also seen  A3 Improper functioning of the liver which causes portal hypertension