constipation ... paralytic ileus? 85 yrs old male

A 85 years old male patient , who is resident  of akkinapalli, farmer by occupation...stoped working since 4 years... came to the hospital with the chief complaints of 
        . Abdominal pain since 1 year.. increased pain since 5 days 
       . Constipation  since 20 days (on and off ) 
       . Generalized weakness since 20 days 
       . Not passing stools and flatus  since 5 days 
       .  Loss of appetite since 5 days 
       .  Shortness of breath  occasionally  

History of present illness  : 
      
         1 )  The patient was apparently asymptomatic 1 year back ... then he developed  abdominal pain  , localized epigastric.. 
                Aggregated  on taking food 
                Pain is not associated with nausea,  vomiting  
                Duration of pain will be sometime after  food 
        2 )  the patient  didn't consult any doctor , didn't used any medication  till 6 months 
       3 )  6 months back .. he consulted an RMP doctor in chityala.... he suggested some medication to the patient along with some tonics 
            The pain was relieved temporarily  on medication  
     4 )  he continued the medication since 6 months 
     5 ) since 20 days , the pain is not relived on medication and there is on and off of constipation, fever ,burning miturition , then he visited the same RMP  
Then he suggested to visit our hospital  

    6 ) they didn't visit immediately....  as the abdominal pain increased  since 5 days.  
          They came to our hospital 5 days back with the complaints of not passing stools and urine,  increased abdominal pain , loss of appetite. 

History of past illness  : 
                 Similar complaints in the past are not absorbed 
           Not a known case of HTN ,DM , coronary artery disease  

Family history  : 
      Insignificant  family history 
Personal history :  
       Mixed diet 
       Bowel and bladder : constipation since 20 days 
        Loss of appetite  5 days 
        No known Allergies  
         Addictions : alcohol ( regular) 
                               Smoking  
         No known drug allergy  


General examination: 
      
Patient consious, coherent, cooperative.
No signs of , icterus, clubbing, lymphadenopathy, pedal edema , cynosis  
No signs of malnutrition and dehydration  

Signs of pallor  is seen 
       
      
      
Temperature  : afebrile 
Pr: 90 bpm
Rr: 20 cpm
Bp: 130/80 mmhg
Spo2: 98%
Grbs- 132 mg/dl
  

Systemic examination  : 

CVS: S1 and S2 heard
RS: BAE + 
CNS: NAD
P/A: soft , tender

Oral examination  : 
      Bluish discoloration  is seen 
        
 Abdomen examination: 
         Bowel sounds - sluggish 



Provisional diagnosis  : 
Constipation  2 degree  to ? 
Paralytic ileus  ,?  Pre renal AKI ( acute kidney  injury) 


Investigation: 
       on 10/12/21:

Hemogram:
Hb- 11.5
Tlc- 29,300
Plt count- 1.62

RFT:
Urea- 202
Creatinine- 5.9
Na+- 137
K+- 4.5 
Cl-- 90

LFT:
ALP- 437
ALB- 2.8

CUE:
ALB +
RBC - Absent.

ABG:
Ph- 7.473
Pco2- 23.9
So2- 95.6
cHCO3 (P.ST)c- 20.8
cHCO3(p)c- 17.3
Serology- negative.

Investigations on 11/12/21

Hb: 11.7
Tlc: 33,450
Plt count: 2.31

Urea: 204
Na+ : 139
K+ : 4.1
Cl- : 96

Spot urine protein: 1.2
Spot urine Creatinine: 100.6
Spot urine Albumin: 0.11

CUE:
Albumin:  +
No sugars 
Ec: 2 to 4
Pc: 2 to 4

Investigations on 12/12/21

Hb: 10.9
Tlc: 22,700
Plt count: 1.59

Blood urea: 203
Serum creatinine: 3.4

Na+ : 144
Cl- : 98
K+ : 3.3


  Fever chart  : 


Ecg : 
   10/ 12 /21

Ultrasound reports 
On 9 /12 /21 
11/12/21 
USG  abdomen  : 

Chest Xray PA VIEW


Treatment 
1. Ivf NS/RL/DNS continuous at 100ml/hr
2. Inj. PAN 40mg IV BD 
3. inj. ZOFER 4mg IV/SOS
4. Syp. LACTULOSE 20 ml PO/BD
5. Tab.ECOSPORIN 75 mg PO/OD
6. Tab.CLOPITAB 75 mg PO/OD
7. Tab. ATROVAS 10 mg PO/OD
8. Proctoclysis enema twice daily
9. BP/PR/TEMP monitoring 4th hourly

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