??buddchari syndrome
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Here is a case i have seen:
A 32 year old woman from WB came with c/o of weakness , decreased appetite ,distension of abdomen and weight loss since 9 months
Patient was apparently asymptomatic 10years ago
In 2010 she got married which was non consanguineous and conceived spontaneously with in 1 year of marriage but when she was 7 month pregnant she slipped and fell down and had bleeding per vagueness ,when taken to near by hospital doctor declared intrauterine death at 7 months of gestation.she was depressed with low mood ,decreased interest in work ,disturbed sleep ,decreased appetite for about 1 month then gradually she got adjusted and became normal .
2012 to 2015 she was Taken treatment as she was unable to conceive .
In 2019 She conceived and delivered a baby girl 9 months after normal lscs was done ,3 to 4 days later after delivery they noticed distension of abdomen which increased gradually and they took treatment (urine output decreased )6 months back ?paracentesis was done .
Since delivery Pt feels weak ,she is doing household works but experiencing easy fatiguability .
She is saying that she is not interested in talking with people or watching tv. According to patient sleep latency is 1 1/2 -2 hrs .After initiation of sleep she is able to maintain sleep .
Pt says that she is feeling hungry but wherever she eats /drinks she is having loose stools .
There was even Loss of libido.
According to patient she lost 10 kg in past 9 months
No history of usage of OCP in between
In 2018 years back history of pedal edema: lasted two to three months subsided on its own
During second preganancy History of slip and fall on floor at 4th to 5th month gestation for a followed by bleeding PV.
yellowish discoloration of eyes since 3 to 4 months
no complaints of pedal edema
history of fever since 2 days high grade
no history of vomitings, loose stools,h/o occasional cough,c/o generalized itching+
no history of cold, burning micturation
Not a k/c/o Diabetes ,hypertension, CAD ,asthma ,TB, epilepsy.
No addictions like alcohol ,tobacco, betel leaf .
On 10/12/2020
General examination
Pt Is conscious and coherent with mildly nourished and thin built.
Pallor +
Mild Bilateral pitting edema up to ankle was present
There was no cyanosis ,clubbing ,lymphadenopathy ,
Temp Was 105F
BP 100/70 mmhg
SPO2 98 %on Room air
PR 127bpm
RR:20 cpm
Grbs : 88mg/dl
CVS s1s2+, no murmurs
RS BAE+ And no added sounds
P/A
Inspection :
Abdomen was distended ,engorged veins +,umbilicus everted
Palpating : liver palpable below R.coastal margin, consistency was hard
Spleen palpable below left coastal margin ,free fluid +,shifting dullness +
Percussion : liver span was 16 cms
Auscultation : bowel sounds present
Day 1-11/12/2020
Patient was referrred to surgery because of pain in the breast ( she stopped feeding her child since 2 days )
Were she Was said to have galactocele and advised to express the milk .
Patient was then taken gynaecologist opinion I/V/O breast engorgement she was advised to express the milk ,hot fomentation and Tab cabergoline (2 tabs )
Patient was taken to psychiatry I/v/o post partum depression and For IUD 10 years
Treatment
Day 1 11/12/2020
1.Tab.aldactone 50mg OD
2.warm fomentation to bilateral breast and breast milk extraction
3tepid sponging done.
Day 2
1.Tab Aldactone 50mg OD
2.Hot fomentation to b/l breasts and breast milk extraction.
3.tepid sponging done
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