RIGHT SIDED EMPYEMA WITH ANEMIA WITH AKI

March 25, 2022

RIGHT SIDED EMPYEMA WITH ANEMIA WITH AKI

C/o fever 20 days back

C/o loose stools since 10 days

C/o cough since 10days

C/o burning sensation in chest since 10 days

C/o Sob since 5 days

HOPI:

Patient was apparently asymptomatic 20 days back then he developed fever- low grade, insidious in onset, gradually progressive, more during night not associated with chills/ rigors for 10 days, relieved with medication.

10 days back he developed loose stools, 4-5 episodes per day, watery in consistency, non blood stained. He also developed non productive cough, which was more during night and on lying down, associated with burn sensation in the chest.

5 days back he developed productive cough associated with (grade lll - lV) Sob. Sob not associated with orthopnea/PND, increased on excertion and lying down, decreased in sitting position, relieved on taking rest

Loss of appetite present

Loss of weight present

No c/o palpitations, Headache, burning micturition, nausea/vomiting

PAST HISTORY:

No h/o similar complaints in the past

Pt had observed occasional gum bleeding during brushing his teeth

No h/o petechiae, hemoptysis, hematuria, hemorrhoids

No h/o TB

N/K/C/O HTN, DM, Epilepsy, Ischaemic heart diseases.

H/o bilateral leg ulcers since 10 yesrs appeared with history of shoe bite, aggravates and relieves spontaneously over months associated with intermittent pus discharge.

FAMILY HISTORY:

TB Contact (+)

His brother was diagnosed for TB 1 year ago, and was treated.

PERSONAL HISTORY:

Diet- mixed

Appetite- Normal

Bowel - regular

Micturition- normal

Addiction- 120ml alcohol/day since 7 years

Tobacco chewing 1pac/week since 4 years

EXAMINATION:

Pallor(+), Icterus/ Cyanosis/ Clubbing/ koilonychia/ lymphadenopathy/ edema (-)

Temperature- Afebrile

Bp- 90/60 mmhg

Pr- 98bpm, regular, normal volume

Rr- 18 cpm

Spo2- 98% @RA

CVS- S1S2 Heard, pansystolic murmur (+)

P/A - soft, nontender, BS(+), Mild splenomegaly (+)

RS-

INSPECTION:

Shape of chest - elliptical

B/L asymmetrical chest

Trachea deviated to left

Expansion of chest reduced on right site

RR - 24cpm

Accessory muscles of respiration in use - yes

No droping of shoulders

No supraclavicular/ infraclavicular hollowed

No crowding of ribs

No wasting of muscles

Spino-clavicular distance reduced on right side

Apical impulse could not be seen

PALPITATION:

No loacal rise of temperature

No tenderness

All inspectory findings confirmed

Trachea deviated to left side

Chest movements reduced on right side

Apex beat @ 5 ICS lateral to mid clavicular line

Tactile vocal fremity - reduced

PERCUSSION:

Direct- Dull on right side

Indirect- Dull on right side

AUSCULTATION:

BAE (+)

Absent breath sounds in right side- all areas

L/E - B/L lower limbs:

No active complaints over left foot and ankle

Right lower limb- 20× 8 cm, irregular shaped ulcer(+) o er dorsum of right foot and ankle, irregular margins, pale edges, slough(+) with areas of healed skin around margins, no surrounding edema/erythema. No li.b edema.

Floor- no granulation, green slough(+), minimal serous discharge (+).

Skin upto below knee- darkened, dry with healed patches

Mild tenderness (+), edges indurated, No loacal rise of temperature

Base induration(+), hard. Depth 1-2 mm

Surrounding skin- noramal sensations, temperature

Peripheral pulses- feeble

No palpable popliteal/inguinal lymphnodes.

INVESTIGATIONS: