75Y M CAME WITH C/O FEVER COUGH SINCE 2 DAYS, BLOOD IN STOOLS AND VOMITING

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C/O FEVER , COUGH SINCE 2 DAYS 

C/O BLOOD IN STOOLS, VOMITING FROM 10/1/24 MORNING

HOPI; 

PATIENT WAS APPARENTLY AYMPTOMATIC TODAY MORNING THEN HE DEVELOPED VOMITING BLACKISH IN COLOR AND1 EPISODE WATERY, DARK COLOURED STOOL WITH BLOOD AROUND 10 ML. FEVER SINCE 2 DAYS LOW GRADE NOT ASSOCIATED WITH CHILLS AND RIGORS, COUGH SINCE 2 DAYS ASSOCIATED WITH SPUTUM, MUCOID, WHITISH IN COLOR

NO H/O TENDERNESS,

NO H/O LOOSE STOOLS

NO H/O ABDOMINAL PAIN

PAST HISTORY:

H/O SIMILAR COMPLAINTS IN THE PAST 6 YEARS AGO

K/C/O DUODENAL ULCER GRADE III

K/C/O CHRONIC CHOLECYSTITIS WITH CHOLECYSTODUODENAL FISTULA S/P CHOLECYSTECTOMY 4 YRS AGO

N/K/C/O HTN, DM, EPILEPSY, CVA, CAD, THYROID DISORDES, ASTHMA

PERSONAL HISTORY:

DIET:MIXED

SLEEP:ADEQUATE

BOWEL AND BLADDER:REGULAR

ADDICTIONS:NO

APPETITE:NORMAL

GENERAL EXAMINATION:

PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE,WELL ORIENTED TO TIME,PLACE AND PERSON.

NO PALLOR,ICTERUS CYANOSIS,CLUBING,LYMPHADENOPATHY,EDEMA.

VITALS:

TEMPERATURE:98.6

BP:120/50 MM HG

PR:82 BPM

RR:18 CPM

SYSTEMIC EXAMINATION:

CVS:S1,S2 HEARD NO MURMURS.

RS:BAE +,NO MURMURS

PER ABDOMEN:SOFT,NON TENDER,NO ORGANOMEGALY

CNS:NO FOCAL NEUROLOGICAL DEFICITS.

INVESTIGATION:

Name  Value  Range	Name  Value  Range
RFT   10-01-2024 06:22:PM  UREA 90 mg/dl 50-17 mg/dl  CREATININE 1.6 mg/dl 1.3-0.8 mg/dl  URIC ACID 3.6 mg/dl 7.2-3.5 mg/dl  CALCIUM 10.0 mg/dl 10.2-8.6 mg/dl  PHOSPHOROUS 3.6 mg/dl 4.5-2.5 mg/dl  SODIUM 133 mEq/L 145-136 mEq/L  POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L  CHLORIDE 96 mEq/L 98-107 mEq/L	LIVER FUNCTION TEST (LFT)   10-01-2024 06:22:PM  Total Bilurubin 0.81 mg/dl 1-0 mg/dl  Direct Bilurubin 0.19 mg/dl 0.2-0.0 mg/dl  SGOT(AST) 11 IU/L 35-0 IU/L  SGPT(ALT) 10 IU/L 45-0 IU/L  ALKALINE PHOSPHATE 272 IU/L 119-56 IU/L  TOTAL PROTEINS 6.3 gm/dl 8.3-6.4 gm/dl  ALBUMIN 2.81 gm/dl 4.6-3.2 gm/dl  A/G RATIO 0.81
COMPLETE URINE EXAMINATION (CUE)   10-01-2024 06:22:PM  COLOUR Pale yellow    APPEARANCE Clear    REACTION Acidic    SP.GRAVITY 1.010    ALBUMIN Trace    SUGAR Nil    BILE SALTS Nil    BILE PIGMENTS Nil    PUS CELLS 3-4    EPITHELIAL CELLS 2-3    RED BLOOD CELLS Nil    CRYSTALS Nil    CASTS Nil    AMORPHOUS DEPOSITS Absent    OTHERS Nil	HBsAg-RAPID   10-01-2024 06:22:PM Negative
Anti HCV Antibodies - RAPID   10-01-2024 06:22:PM Non Reactive	ABG   12-01-2024 03:12:AM  PH 6.76    PCO2 22.4    PO2 216    HCO3 3.0    St.HCO3 3.8    BEB -27.8    BEecf -28.2    TCO2 8.2    O2 Sat 93.0    O2 Count 5.2

HEMOGRAM :

HB 7.4GM/DL

TC 19700

N/L/E/M/B- 75/20/3/2/0

PCV 23.8

MCV 78.8

RBC COUNT 3.0 MILLION/CUMM

PLATELET COUNT: 3.5 LAKHS/CUMM

USG ABDOMEN :

B/L RENAL CORTICAL CYSTS

RAISED ECHOGENECITY RIGHT KIDNEY

GRADE 1 RPD CHANGES OF LEFT KIDNEY

CHOLEDOCHOLITHIASIS WITH SLUDGE

MILD IHBRD

PNEUMOBILIA

SUGGESTIVE FOR CECT ABDOMEN

2D ECHO

NO RWMA,MILD LVH

MILD TO MODERATE AR,SCLEROTIC AR

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION +

IVC SIZE 0.9 CMS[COLLAPSING]

EF -58%

 DX:

IMMEDIATE CAUSE :

ACUTE INFERIOR WALL MYOCARDIAL INFARCTION

SEVERE METABOLIC ACIDOSIS

ANTECEDENT CAUSE :

HEMATEMESIS SECONDARY TO GASTRIC ULCER WITH BLEEDING PER  RECTUM WITH IRON DEFICIENCY ANEMIA

S/P CHOLECYSTECTOMY WITH PRIMARY DUODENAL REPAIR WITH OMENTOPEXY WITH

ATYPICAL OPTIC NEURITIS OF LEFT EYE

DENOVO TYPE II DIABETES MELLITUS

PNEUMOBILIA

TREATMENT:

INJ PIPTAZ 2.25G IVTID

INJ ZOFER 4 MG IV TID

IV FLUIDS NS,DNS 50 ML /HR

INJ PAN 80 MG IV/INFUSION

TAB MONTAK LC PO H/S

TAB PULMOCLEAR BD

NEB IPRAVENT 8TH HRLY ; BUDECORT 12TH HRLY

DEATH SUMMARY:

A 75 YEAR OLD RESIDENT OF NALGONDA CAME TO CASUALITY ON 10/1/24 AT 5:30 PM WITH COMPLAINT OF FEVER AND COUGHING  SINCE 2 DAYS AND BLOOD IN STOOLS AND BLOOD IN VOMITUS SINCE MORNING

VITALS AT THE TIME OF ADMISSION

PR 82 BPM,BP 120/80 MMHG, SPO2 98% ON RA, GRBS 220MG/DL

PATIENT WAS SHIFTED FROM CAUSALITY TO ICU AND INJ PAN INFUSION WAS STARTED AND IV ANTIBIOTICS WERE ALSO STARTED IN VIEW OF RAISED TLC AND FEVER SPIKE,ES

DURING HOSPITAL STAY PATIENT HAD MALENA AND BLEEDING PER RECTUM. SURGERY REFERRAL WAS KEPT I/V/O BLEEDING PER RECTUM AND USG SHOWING PNEUMOBILIA AND CHOLEDOCHLOLITHIASIS. PR EXAMINATION SHOWED ANAL FISSURE AND SUGGESTED UPPER GI ENDOSCOPY

AT 2:30 AM PATIENT WAS UNRESPONSIVE AND ECG SHOWED ST ELEVATION IN II,III,AVF AND INTUBATED I/V/O LOW GCS AND FALLING SATURATION AND NON RECORDABLE BP AND CONNECTED TO MECHANICAL VENTILATOR ACMV - VC MODE PEEP 5 FIO2 100%

DEATH SUMMARY:

AT 3;20 AM CPR WAS STARTED I/V/O NON RECORDABLE BP, BRADYCARDIA

30 MINS OF CPR  WAS DONE AND COULD NOT BE REVIVED AND DECLARED DEATH AT 4:10AM ON 12/01/2024

CAUSE OF DEATH:

IMMEDIATE CAUSE 

INTERIOR WALL MI

SEVERE METABOLIC ACIDOSIS

ANTECEDENT CAUSE

1.HEMATEMESIS SECONDARY TO GASTRIC ULCER WITH BLEEDING PER RECTUM WITH IRON DEFICIENCY ANEMIA

S/P CHOLECYSTECTOMY WITH PRIMARY DUODENAL REPAIR WITH OMENTOPEXY

2.PNEUMOBILIA