80yr old male with fever and burning micturition.
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A 80 year old male patient came with
Chief complaints :
Fever since 20 days
Weakness of both lower limbs since 15 days
Pain in Rt. lower quadrant of abdomen since 10 days
Decreased urine output since 5 days
Burning sensation while passing urine since 5 days
HOPI :
Patient was apparently asymptomatic 20 days back, then he developed fever since 20 days which is high grade, associated with chills and rigors, no diurnal variation, relieved with medication. He visited the local RMP for the same and got a CUE done and was told by the RMP that he had urine infection. He had weakness of both lower limbs since 15 days(unable to stand and walk on his own). Then, he had pain abdomen in the right lower quadrant of abdomen and in the lower back which had no aggravating and relieving factors. He also had decreased urine output and burning sensation while passing urine since 5 days.
Shortness of Breath present (on and off)
No h/o chest pain
No h/o headache.
Past History :
Patient is a k/c/o Asthma and is not on medication
K/c/o Hypertension since 10 years and is on Amlodipine 5 mg once daily.
H/o renal calculi 10 years back.
K/c/o BPH 10 years back
Hospital admission for 15 days for Decreased urine output and abdominal distension 10 years back. Was told that the Creatinine was raised. Underwent treatment for 6 months.
Decreased hearing since 6 months
Uinary incontinence since 5 years.
Known case of Hepatitis since 10 years.
Not a k/c/o TB, DM, ASTHMA, EPILEPSY
Personal History :
Diet : mixed
Appetite : Decreased
Sleep : Disturbed
Bowel movements : Constipation since 5 days
Bladder movements : Decreased urine output and burning micturition since 5 days
Addictions : Consumes alcohol occasionally
On Examination :
Patient is conscious, coherent and cooperative.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema.
VITALS :
AT THE TIME OF ADMISSION :
TEMP. : 99.6 F
PR : 80 BPM
RR : 16 CPM
BP : 110/70 MM HG
SpO2 (on Room air) : 98%
GRBS : 106 mg%
On Systemic Examination:
CVS : S1, S2 heard
RS : BAE present
P/A : so
Abdomen
Shape:distended
Flanks:full
Umblicus:center position, inverted shape
Skin:scars present,no dilated veins seen.
Movements of abdomen equal with inspiration.
Provisional diagnosis: urinary tract infection
Investigation:
Urine analysis,urine culture
Complete blood picture
Abdomen ultrasound.
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