A 42 year old female with multiple health issues.

V.Priyanka

Rollno.176

    

     I have been given this case to slove in attempt and to understand the topic of patient clinical data analysis to develop my competency in reading and comprehending clinical data including history,clinical findings,investigations and come up with treatment plan .

Entire real patient clinical problems in this link herehttps://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with-17.html?m=1

Following is my analysis of the patient problem .

Problems are

1.swelling of face and abdomen

2.sleep disturbances

3.oliguria

4.rashes

5.headaches(migraine with aura)

6.fatigue

 

1.Swelling of face and abdomen:she was  diagnosed as G6PD deficiency which causes hemolytic anemia ie hemolysis of RBC may cause right heart failure which may be cause of SOB and swelling.

Swelling of face may be caused due to renal failure .This deficiency causes decreased generation of NADPH and ATP which causes oxidative stress.t

These patients may have neonatal jaundice.Hiatus hernia may cause SOB.

Aggravating factors:fava beans,antimalaria drugs.

INVESTIGATIONS DONE-

1.LFT-AST,ALT levels increased

2 ECG-left atrial enlargement,right heart enlargement

3.Echocardiography

4.Recommended:LDHlevels,serumhaptoglobulin levels,peripheral blood smear.

TREATMENT:given cimetidine,ribose,

Recommended-blood transfusion,Oxygen therapy.

SLEEP DISTURBANCES:G6PD deficiency cause impaired generation of glycine which causes impairement in serotonin level so there are sleep disturbance s.This may be due to AMPD1 deficiency as adenosine inhibitory neurotransmitter is defective.

INVESTIGATIONS:EEG

TREATMENT:LSerine induces sleep,cimetidine.

OLIGURIA:due to G6PD deficiency  there is  oxidative stress causing kidney damage (reduced production of NADPH &ATP may lead to loss of ions and decreased urine production ).it may be due to WNK1 gene mutation,kidney infections.

INVESTIGATIONS:CUE,USG

RASHES:she was diagnosed  as behcets syndrome which is an autoimmune disorder which causes vasculitis ,rashes ,blurred vision .

INVESTIGATIONS :Parthergy test,OCT,skin prick.

HEADACHES:migraine with aura is associated with left sided numbness,left sided spinning movement,memory loss,vision loss.

Differential diagnosis:

Meningitis,encephalitis.

Brain tumors

Vestibular disorders 

Cerebellar disorders

Stroke.

Investigations :EEG,MRI,CT,CSF analaysis.

Treatment:given -triptamines

Recommended- stay in dark room, avoid stress.

Drugs which triggers the condition and triptans ,acetamionphen,ergots.

FATIGUE:due to G6PD deficiency causes decreased production of ATP .so there is fatigue .

Aggravated on exertion and stress.

Treatment :ribose which generates ATP.

OTHER PROBLEMS :PCOD,Fractures,loss of hair,excessive growth of hair on body ,osteoarthritis anhygrosis (due to WNK1 gene mutation).