A 75years male resident of Guntur dadmitted with chief complaint of scrotal swelling since 3 days and reduced urine output since 1 day Known case of heart failure with preserved ejection fraction
A 75years male resident of Guntur dadmitted with chief complaint of scrotal swelling since 3 days and reduced urine output since 1 day
Known case of heart failure with preserved ejection fraction
Chief complaints
A 75years male resident of admitted with chief complaint of scrotal swelling since 3 days and reduced urine output since 1 day
History of present illness
Known case of heart failure with preserved ejection fraction with anemia
Chronic kidney disease 4 stage secondary to diabetic nephropathy
Known case of diabetes mellitus type 2
SOB grade 2
Pedal edema with pitting type since 2 months
No history of trauma,fever.
Generalised edema since 3 months
History of decreased urine output since 1 day
No history of nausea, vomiting,constipation,loose stools .
History of past illness
Known case of type 2 diabetes mellitus since 10 yrs
Medication :
Not a know case of HTN,THYROID,CAD,CVA,TB,epilepsy
No previous surgery
PERSONAL HISTORY
Married
Occupation works as labourer
Diet:mixed
Appetite:normal
Bowel movement:regular
Micturation:abnormal decreased output since 1 day
Sleep:normal
No known allergies
HABITS
alcohol:regular since 40 yrs
Tobacco: Chutta 10 per day since 40 yrs
FAMILY HISTORY
Not significant
GENERAL EXAMINATION
No pallor
No icterus
No cyanosis
No clubbing of fingers
No lymphadenopathy
pedal odema
REFLEXES
Biceps :++
Triceps :++
Supinator :++
Knee :++
Ankle :++
CERBEILAR SIGNS
Finger nose in coordination
Knee heel in coordination
SYSTEMATIC EXAMINATION:
B. CARDIO VASCULAR SYSTEM
1. Thrills No
2. Cardiac Sounds
3. Cardiac murmurs No
C. RESPIRATORY SYSTEM
1. Dyspnoea - no
2. Wheeze - No
3. Position of Trachea - Central
4. Breath Sounds -
5. Adventilious Sounds -
D. ABDOMEN
1. Shape of abdomen -Obese
2. Tenderness - No
3. Palpable mass - No
4. Hernial Orifices Normal
5. Free Fluid : No
6. Bruits No
7. Liver - Not palpable
8. Spleen - Not palpable
9. Bowel sounds -Yes
10.Genitals normal
CENTRAL NERVOUS SYSTEM
1.level of conscious:conscious and covert
2.speech:normal
3.sign of menningeal irritation
Neck stiffness no
Kerning sign no
4.Cranial nerve normal
5.Motor system normal
6.sensory system normal
7.Glasgow Scale normal
SCROTAL REGION
on inspection
Swelling of scrotal area of about size 15*10 cm
Involves whole of scrotum including penis
Skin over the swelling distended
Surface appeared to be smooth
Discharge positive
Blebs positive
No visible pulsation
No visible cough impulse
On palpation
No local rise of temperature
No tenderness
Soft in consistency
Pitting edema positive
No reducible
Investigation
USG-abdomen
Complete Blood Picture
Liver function test
Renal function test
PROVISONAL DIAGNOSIS
scrotal wall edema with congestive heart failure
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