A 80year old male,came to casualty with chief complaints of pain in right lower abdomen since 1 week.

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A 80year old male,resident of kodakandla village,worked at pharmacy in Bombay and got retired,came to casualty with chief complaints of pain in right lower abdomen since 1 week.

HOPI:

Patient was apparent asymptomatic 20days back and then he developed fever which was intermittent,low grade,assosiated with chills and rigor.Temperature got down on taking Dolo 650mg.No diurnal variation.No h/o body pains,headache,vomitings, diarrhea.

One week back he developed pain in right sided lower abdomen,pain was pricking type and aggravated on slight movement and pain relieved temporarily on medication.

Decreased urine output and burning micturation since 5days.

Past history:

No similar complaints in past.

In 2010,he got admitted in NIMS,for urinary tract infection and got treated.

H/o urine incontinence since 2010,uses diapers occassionally.

He is a known case of:

Asthma since 30years,hypertension since 5years and he is on AMLODIPINE-5mg,decreased hearing in left ear since 5-6years and used hearing aid for 1year, not and not using now,h/o recurrent UTI.

Not a known case of TB,Epilepsy.

No history of previous surgeries.

Personal history:

Diet:Mixed

Appetite:Normal

Sleep:He sleeps more in morning and has disturbed sleep at night.

Bowel movements decreased since 3days and was given enema today and he passed stools.

decreased urine output and burning micturation since 5days.

Addictions:consumes alcohol occassionally.

General physical examination:

Patient is conscious,coherent,coperative and well oriented to time,place,person.He is moderately built and nourished.

No signs of pallor,icterus,cyanosis,clubbing,generalised lymphedenopathy,edema.

Vitals:

Temperature:99.6F

PR:86bpm

RS:16cpm

BP:110/70 mmHg

Spo2:98% at room air

GRBS:106mg%

Systemic examination:

CVS:S1,S2 heard,no murmurs.

RS: Bilateral airway present.NVBS Heard

CNS: Memory intact

HMF intact

          TONE : RIGHT    LEFT

        UPPER LIMB. N.             N

           LOWER LIMB. N.        . N

          POWER :. RIGHT.      LEFT

                UPPER LIMB. 4/5         4/5

                LOWER LIMB. 4/5.          4/5

REFLEXES : 

                BICEPS. +++. +++

                TRICEPS +++. +++

                SUPINATOR +. +

                KNEE. +. -

                ANKLE +. -

PLANTAR :. FLEXOR. MUTE

Per abdomen:

INSPECTION:

Shape of abdomen:Distended 

Flanks:Not full 

Umbilicus:Position-center,Shape:normal.

Skin over abdomen:normal.

No engorged veins.

No scars and sinuses.

PALPATION:No local rise of temperature and tenderness is present in right iliac region.

All inspectory findings are confirmed by palpation.

Liver:non tender and non pulsatile,lower border of liver is palpable just below right costal margin.

Spleen:non tender 

Kidney: non tender,felt in right and left lumbar regions moves in respiration.

No other palpable swellings and hernial orifices 

PERCUSSION:

Fluid thrill and shifting dullness absent.

On percussion of liver:dull note is heard at 2nd ICS 

On Percussion of spleen dull note heard and fingers easily passed below left ribs suggesting no spleenomegaly.

AUSCULTATION:

Bowel sounds heard.

Bruit not heard 

No venous hum.

INVESTIGATIONS:

On 7-10-22

On 8-10-22

At 7am 

At 1pm 

On 9-10-22

PROVISIONAL DIAGNOSIS:

Lower Urinary tract infection with urinary incontinence and grade-1 prostatomegaly.

TREATMENT: 

1. TAB. NITROFURANTOIN 100 MG PO/BD

2. INJ. NEOMOL 1 G/IV/SOS (IF TEMP.>101 F)

3. IV FLUIDS NS @ 75 ML/HR

4. INJ. PIPTAZ IV/OD

5. TAB. DOLO 650 MG PO/TID

6. INJ. PAN 40 MG /IV/OD

7. T. TAMSULOSIN 0.4 MG/PO/HS

8. INJ. ZOFER 4 MG/IV/OD 

Proctolytic enema was administered to the patient i/v/o constipation since 5 days.