CASE PRESENTATION

MUHAMMAD ZAKWAN ZAINAL 0608-0341

PARTICULARS
Name: Mdm. KSK Age/Sex/Race: 68 yo/Female/Chinese DoA: 26/10/2011 DoC: 27/10/2011

 She was admitted yesterday for weekly IPD She has been having weekly IPD for the past 3 months after being diagnosed with ESRF 2 HPT She is diabetic for the past 30 years; on Insulin BD She is also hypertensive for approx. 20 years; on medication Currently, she has no active complains no symptoms of hyperuraemia or fluid overload Systemic review is unremarkable no fever, no SoB, no chest pain, no UTI symptoms, no URTI symptoms, no alteration in bowel or micturition habits.

 She was first diagnosed with ESRF by Kajang Hospital after having episodes of shortness of breath; worsening for the past 4 months. It is made worsen on movement; she was having SoB after walking about 100m; and she cant climb stairs. It was reduced after she sits down and rest for at least 10 minutes The SoB is also a/w orthopnea she needs 2-3 pillows to sleep, and is also a/w PND However, there is no chest pains, no palpitation, no cough, no fever, no alteration in bowel or micturition habits, no abdominal distention.

PAST MEDICAL HISTORY

DM for the past 30 years
Change to insulin for the past 5 years

HPT for approx 20 years

On medications

PAST SURGICAL HISTORY

1 previous C-Section scar 1 previous surgical scar

DRUGS HISTORY
No known drugs or food allergies On

FAMILY HISTORY
Strong family history of DM and HPT mother and 3 siblings No family history of renal diseases No family history of any malignancies

SOCIAL HISTORY
Not smoking Not drinking

PHYSICAL EXAMINATION
General:
Sallor looking, small built, + conjunctival pallor, no scleral jaundice, + abdomen distended Vital signs is as follows:
PR: 84 bpm; normal rhythm, good volume RR: 16 breaths/minute BP: Temperature: Pain score: Nil

Distal pulses present No stigmata of CLD

ABDOMINAL EXAMINATION
The abdomen is distended, measuring 48 cm;p + fluid thrills Theres a tenchoff catheter inserted at the RIF No dilated veins, no visible peristalsis Palpation:
No tenderness, no mass felt on superficial and deep palpation No hepatosplenomegaly

Auscultation:
Bowel sound present; normal Non renal bruit noted

CARDIOVASCULAR EXAMINATION
The apex beat is displaced, located at 6th intercostal space, mid axillary line No thrills felt Auscultation:
S1 n S2 heard; no additional heart sound noted No murmurs heard

RESPIRATORY EXAMINATION
Inspection normal, no scar, no swelling, no visible vein noted Palpation chest wall movement is symmetry, vocal fremitus is equal both sides Percussion resonant on all the lung zone Auscultation breath sound is equal bilaterally, no crepitation

INVESTIGATION

MANAGEMENT