General Medicine case

NIKITHA TALLAPELLI 

Rollno.163

"A CASE OF 42 yr OLD FEMALE WITH MULTIPLE HEALTH EVENTS SINCE BIRTH"

I have been given the case to solve in an attempt to understand  the topic of patient clinical data analysis to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 

SYMPTOMS:

1.HEADACHE:

2.SWELLING

3.BREATHING DIFFICULTY 

4.SLEEP DISORDER

1.HEADACHE

sudden in onset,very severe.present since  she is 2yrs.Increased attacks of migraine in 24yr,34yr,during menses.

D/D:

sub-arachnoid hemorrhage. 

Investigation:

1.CT,MRI to confirm brain tumor.

2.calculate ICP

3.CSF analysis for infections 

4.Angiography

Treatment:

Triptans

2.SWELLING

swelling is present since 1yr.It is mostly present on face and abdomen

Causes of swelling:

Swelling could be due to hemolytic anemia,oxidative stress, G6PD deficiency which is first and major step in production of NADPH which is required for scavenging free radicles to prevent oxidative stress.

Hemolysis can cause congestive heart failure.Oxidative stress in kidney may lead to ion imbalance resulting in swelling. 

Swelling aggravates on

1.exposure to smoke

2.emotional stress

3.physical activity 

4.sulfa drugs

5.fava beans

She presented with severe jaundice at birth

Inv:

1.hemogram

2.ECG

3.SGPT/SGOT

Treatment:

1.avoid stress

2.serine:increases urination

        3.BREATHING DIFFICULTY 

Patient suffers from breathing difficulty due to G6PD deficiency .In G6PD deficiency muscle ,a lower level of NADPH leads to decrease in  intracellular GSH which increases cell vulnerability to reactive oxygen compounds and free radicles.Heart and skeletal muscles have low levels of catalase and superoxide dismutase and depend on GSH linked reactions for detoxification of reactive oxygen species. 

Aggravating factors:

1.alcohol

2.smoking

3.excessive stress

4.exposure to fungal toxins

Treatment: Ribose given daily increases energy intake of cells

      4.SLEEPING DIFFICULTY 

she has sleeplessness since birth.she used to sleep for 2-4 hrs .

This may be due to G6PD deficiency because impaired production of glycine(inhibitory neurotransmitter)is observed in this deficiency. 

Treatment:

Cimetidine.

L serine

Major problems;

1.polycystic ovarian disease due to which she lost her pregnancy 

2.Bipolar disorder and depression due to which she committed suicide

3.Behect's disease so presented witj oral and genital ulcers.

4.Occational hip and knee pain are also observed.