General medicine(4)

45 years old female came to OPD complaints of loss of appetite, vomiting and itching all over the since seven days.

October 22,2022

Chief complaint: patient complaints of loss of appetite and vomitings and itching all over the body since seven days.
-patient was apparently asymptomatic 4 years back and developed right loin pain and fever for which she visit NIMS and she also complaints of vomitings single episode immediately after taking food.

History of present illness: 
-no fever
-no headache
-pain abdomen
-chest pain 
-no loss of appetite since seven days.

History of past Illness: 
-n/k/c/o- htn,DM,asthma,and cad

Treatment history:
-no diabetes
-no htn
-no cad
-no asthma
-no TB
-no known history of taking antibiotics and chemo therapy, radiotherapy,blood transfusion
Surgeries undergone: right nephrectomy.

Personal history
-married
-occupation: farmer
-appetite: lost
-mixed diet
-bowel and bladder: regular
-micturition: normal
- no known allergies
-no addictione
Family history :
No other family member had similar complaints
Menstrual history:
Age of menarche: 13 years
Menstrual cycle: 30/3
-no any other gynaecological problems
Physical examination: 
-no pallor
-no cyanosis
-no icterus
-no lymphadenopathy
-no clubbing of fingers and toes
-no pedal edema
-no malnutrition
-no dehydration
Vitals:
Temperature: afebrile
Pulse rate: 84bpm
Respiratory rate:16cycles/min
BP: 120/80mmhg

Systemic examination: 
-Cvs: no thrills and cardiac murmurs
-Cardiac sounds- s1,s2 positive
-Respiratory system: no dyspnea,no -wheeze.
-Position of trachea- central
-Breath sounds: vesicular 
-abdomen- shape of the abdomen scaphoid, no tenderness,no palpable mass, hernial orifice normal, no free fluid
-liver and spleen - not palpable
-bowel sounds- present
--Cns: level of consciousness- conscious
-speech: normal
-signs of meningitis: no neck stiffness
                                     no kernigs sign
Provisional diagnosis: nephropathy
Investigations;












Treatment:
Tablets: lasix 40mg
                Nodosis
                 Shelcal
                 Orofer
Inj: iron 200mg iv(every alternate day)



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