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A 70 year old ,labourer by occupation came with chief complaints of
1)decreased urine output since 20days
2)burning micturition since 20 days
3)urgency and hesitency of micturition since 20 days
4)mass per abdomen since 15 days
The patient was apparently asymptomatic 20 days back ,then she noticed a decrease in her urine output , burning micturition,urgency and hesitency of micturition ,so she visited local hospital and investigations were done
She denies h/o fever, loin pain, hematuria.
PAST HISTORY
She was hysterectomised 18 years back for fibroid uterus.
Not a k/c/o T2DM,HTN,asthma , epilepsy,TB
PERSONAL HISTORY
Diet - mixed
Appetite - normal
Sleep- adequate
Bowel movements- normal
General physical examination
Pt is conscious, coherent, cooperative,
Vitals-
Temp- afebrile
Bp-90/50 mm hg
Pr- 86 bpm
Rr-20 cpm
Spo2- 98% on RA
Systemic examination
RS- bae+, nvbs
Cvs-S1 S2 +
P/A - distended,tenderness + a hard mass of size 12x8 cm palpable in the suprapubic region.
Cns- nad
X RAY ERECT ABDOMEN
OBG REFERRAL
UROLOGY REFERRAL
DIAGNOSIS
UROSEPSIS secondary to b/l hydro ureteronephrosis with Bladder calculi with AKI with UTI.
PLAN OF TREATMENT
Tab.NITROFURANTOIN 100 MG OD
Tab.OROFER XT PO OD
Tab. NODOSIS 500 MG PO BD
Tab.SHELCAL PO OD
Tab. LASIX 20 MG PO BD
3-2-22
S: Suprapubic bulge and tenderness +
O :
O/E pt c/c/c
Afebrile
BP - 120/90 mmhg
PR - 83bpm
Cvs- s1s2 heard
RS - BAE+
P/A - tenderness noted in lower abdomen
A: Urosepsis
Postrenal AKI with B/L hydroureteronephrosis secondary to bladder calculi
Plan :
Tab. NITROFURANTOIN 100mg po/bd
Tab.OROFER-XT po/od
Tab.LASIX 20 mg po/bd
Tab. MVT po/od
Tab. PAN 40 mg po/od
Tab. PCM 650 mg po/od
Planned for OPEN CYSTOLITHOTOMY on 4/5 feb
Review PAC to be done today with Hemogram and RFT
HEMOGRAM
Hb: 7.3
TLC: 35700
N/L/E/M: 80/10/2/8
Plt: 4.5 lakh
RFT
Urea: 78 mg/dl
Creatinine: 2.2 mg/dl
Uric acid: 6.8 mg/dl
Na+ :122
K+ :3.7
Cl- :88
Day
S: Suprapubic bulge and tenderness +
O :
O/E pt c/c/c
Afebrile
BP - 90/60mmhg
PR - 70 bpm
Cvs- s1s2 heard
RS - BAE+
P/A - tenderness noted in lower abdomen
A: Urosepsis
Postrenal AKI with B/L hydroureteronephrosis secondary to bladder caliculi.
Recent Hemogram
Hb: 9.4
Tlc: 31500
N/L/E/M: 85/5/6/4
Plt: 4.75
RFT
Urea: 99
Creatinine: 2.3
Na+: 132
K+: 4.0
Cl-: 97
Plan :
Tab. NITROFURANTOIN 100mg po/bd
Tab.OROFER-XT po/od
Tab.LASIX 20 mg po/bd
Tab. MVT po/od
Tab. PAN 40 mg po/od
Tab. PCM 650 mg po/od
Planned for OPEN CYSTOLITHOTOMY
6-2-22
S: Suprapubic bulge and tenderness +
O :
O/E pt c/c/c
Afebrile
BP - 100/70mmhg
PR - 78bpm
Cvs- s1s2 heard
RS - BAE+
P/A - tenderness noted in lower abdomen
A: Urosepsis
Postrenal AKI with B/L hydroureteronephrosis secondary to bladder caliculi
Plan :
Tab. NITROFURANTOIN 100mg po/bd
Tab.OROFER-XT po/od
Tab.LASIX 20 mg po/bd
Tab. MVT po/od
Tab. PAN 40 mg po/od
Tab. PCM 650 mg po/od
Planned for OPEN CYSTOLITHOTOMY
Posted for surgery but stoped because of possibility of bradycardia while operating and 20 ml pus aspiratted for culture
7-2-22
S: Suprapubic bulge and tenderness +
O :
O/E pt c/c/c
Afebrile
BP - 110/70mmhg
PR - 82 bpm
Cvs- s1s2 heard
RS - BAE+
P/A - tenderness noted in lower abdomen
A: Urosepsis
Postrenal AKI with B/L hydroureteronephrosis secondary to bladder caliculi
Plan :
Tab. NITROFURANTOIN 100mg po/bd
Tab.OROFER-XT po/od
Tab. MVT po/od
Tab. PCM 650 mg po/od
Planned for OPEN CYSTOLITHOTOMY
Posted for surgery but stoped because of possibility of bradycardia while operating and 20 ml pus aspiratted for culture
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