A Case of Emphysematous Pylonephritis

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A Case of Emphysematous Pylonephritis

  1. 1. PROF.DR.NOORUL AMEEN PANDICHELVAN M4 UNIT
  2. 2. <ul><li>50 yrs old lady came with </li></ul><ul><li>c/o Breathlessness – 2 days </li></ul><ul><li>sudden onset </li></ul><ul><li>not progressive </li></ul><ul><li>not related with exertion </li></ul><ul><li>h/o Fever – 2 days </li></ul><ul><li>low grade fever </li></ul><ul><li>not associated with chills and rigor </li></ul><ul><li>h/o Cough with sputum production – 2 days </li></ul>
  3. 3. <ul><li>h/o Swelling of both legs </li></ul><ul><li>h/o Decreased urine output </li></ul><ul><li>no h/o Vomiting </li></ul><ul><li>no h/o loose stool </li></ul><ul><li>Past history </li></ul><ul><li>K/C/O – SHT -18 yrs </li></ul><ul><li>DM -18 yrs taking treatment </li></ul><ul><li>pt recovered from DKA 1 wk ago </li></ul>
  4. 4. <ul><li>GENERAL EXAMINATION </li></ul><ul><li>Concious </li></ul><ul><li>Oriented </li></ul><ul><li>Afebrile </li></ul><ul><li>Dyspneic </li></ul><ul><li>Mildly dehydrated </li></ul><ul><li>Pallor </li></ul><ul><li>BPPE </li></ul><ul><li>Not icteric </li></ul><ul><li>No cyanosis ; No clubbing; No LNE </li></ul>
  5. 5. <ul><li>VITALS </li></ul><ul><li>PR 90/min </li></ul><ul><li>BP 130/80 mmhg </li></ul><ul><li>RR 28/min </li></ul><ul><li>CVS S1 S2 Heard </li></ul><ul><li>RS NVBS Heard </li></ul><ul><li>B/L creps </li></ul><ul><li>B/L wheeze </li></ul><ul><li>P/A Soft </li></ul><ul><li>Tender </li></ul><ul><li>No free fluid </li></ul><ul><li>No Organomegaly </li></ul><ul><li>BS Heard </li></ul><ul><li>CNS NFND </li></ul>
  6. 6. <ul><li>PROVISIONAL DIAGNOSIS </li></ul><ul><li>DM2 </li></ul><ul><li>SHT </li></ul><ul><li>SEPSIS </li></ul><ul><li>UTI </li></ul><ul><li>? DKA </li></ul>
  7. 7. <ul><li>INVESTIGATION </li></ul><ul><li>Urine R/E </li></ul><ul><li>Albumin-nil </li></ul><ul><li>Sugar - + </li></ul><ul><li>Deposit 4-6cells/hpf </li></ul><ul><li>Blood </li></ul><ul><li>Urea- 44 FBS – 202 mg/dl </li></ul><ul><li>Cr -0.9 PPBS -306 mg/dl </li></ul><ul><li>Sugar -286 </li></ul><ul><li>Urine </li></ul><ul><li>Ketone – Negative </li></ul><ul><li>24 hr urine proetinuria – 150 mg </li></ul>
  8. 8. <ul><li>Complete Blood Haemogram </li></ul><ul><li>Hb -10.5 </li></ul><ul><li>TC-10500 </li></ul><ul><li>DC-P70;L28;E2 </li></ul><ul><li>ESR 10/20 </li></ul><ul><li>PLC-1.4 LAC </li></ul><ul><li>PCV-27% </li></ul><ul><li>MCV-78 </li></ul><ul><li>MCH-31 </li></ul><ul><li>MCHC-30 </li></ul><ul><li>MP PS /QBC- Negative </li></ul><ul><li>WIDAL –Negative </li></ul><ul><li>MSAT- Negative </li></ul>
  9. 9. <ul><li>Serum electrolytes </li></ul><ul><li>NA- 123 </li></ul><ul><li>K -3.9 </li></ul><ul><li>CL -96 </li></ul><ul><li>HCO3-20 </li></ul><ul><li>ECG - Normal </li></ul><ul><li>CXR - Normal </li></ul><ul><li>ECHO- No regional wall motion abnormality </li></ul><ul><li>EF-73% </li></ul><ul><li>ABG- High anion gap metabolic acidosis </li></ul>
  10. 10. <ul><li>USG ABDOMEN - Increased echo texture in liver </li></ul><ul><li>Cirrhosis </li></ul><ul><li>Splenomegaly </li></ul><ul><li>Lt renal cortical cyst </li></ul><ul><li>Focal hypoechoic leison in upper pole of left kidney </li></ul><ul><li>LFT </li></ul><ul><li>TB-0.8 </li></ul><ul><li>SGOT-36 </li></ul><ul><li>SGPT-31 </li></ul><ul><li>SAP-73 </li></ul><ul><li>TP-5.9 </li></ul><ul><li>ALP-3.2 </li></ul><ul><li>PT-13.2 </li></ul><ul><li>APTT-30.4 </li></ul><ul><li>INR-1.2 </li></ul>
  11. 11. <ul><li>Viral markers </li></ul><ul><li>HBSAG - Negative </li></ul><ul><li>ANTIHCV - Negative </li></ul><ul><li>HIV ELISA - Non reactive </li></ul><ul><li>ANA- Negative </li></ul><ul><li>MGE Opinion: DM2/UTI/CLD/NAFLD </li></ul>
  12. 12. <ul><li>Urine C/S on 16/8/11 </li></ul><ul><li>Pseudomonas growth in culture </li></ul><ul><li>Sensitive to Cephalosporin; GM;Amikacin </li></ul><ul><li>Sputum C/S -No growth </li></ul><ul><li>Blood C/S -No growth </li></ul>
  13. 13. <ul><li>TREATMENT </li></ul><ul><li>Inj. Cefatoxime </li></ul><ul><li>Inj.Insulin </li></ul><ul><li>IVF </li></ul><ul><li>Syp Kcl </li></ul><ul><li>Anti hypertensives </li></ul><ul><li>On 25/8/11 Urine C/S- No Growth </li></ul>
  14. 14. <ul><li>Two days later patient </li></ul><ul><li>c/o fever </li></ul><ul><li>c/o abdominal pain </li></ul><ul><li>temp 102 ^ f </li></ul>
  15. 15. <ul><li>COMPLETE BLOOD HAEMOGRAM </li></ul><ul><li>HB-8.9 </li></ul><ul><li>TC-12100 </li></ul><ul><li>DC-P78;L22 </li></ul><ul><li>ESR-25/69 </li></ul><ul><li>PCV-28 </li></ul><ul><li>MCV-78 </li></ul><ul><li>MCH-31.8 </li></ul><ul><li>MCHC-30 </li></ul><ul><li>PLC-60000 </li></ul><ul><li>Urine C/S 30/8/11 </li></ul><ul><li>E.coli growth in culture </li></ul><ul><li>Sensitive to Cefotaime and Amikacin </li></ul>
  16. 22. <ul><li>DIAGNOSIS </li></ul><ul><li>DM2 </li></ul><ul><li>SHT </li></ul><ul><li>EMPHYSEMATOUS PYELONEPHRITIS </li></ul><ul><li>CLASS 3B </li></ul><ul><li>Pt transferred to Urology </li></ul>

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