36 year old male with angioedema

 36 year old male with angioedema

Viharika Vupputuri 
Roll no- 144


This is an online e log book to discuss our patient identified health data shared after taking his/her guardian signed informed consent. 

Here we discuss our individual patient problems through a series of inputs from available global online community of experts with a aim to solve those patients clinical problem with collective current best evidence based inputs.

This blog also reflects my patient centered online learning portfolio and valuable inputs on the comments box is welcome.

I have been given this case to solve in an attempts to understand the topic of patient clinical data analysis, to develop my competency in reading and comprehending clinical data including history, clinical finding, investigation.

CASE PRESENTATION


 A 36 yr old male patient who is a watchman in a government hospital was admitted at 4AM on 12/01/2022 in the OPD with the chief complaints of 
1) Discomfort of the throat since 3-4 hrs
2) Swelling and pain in the throat

HISTORY OF PRESENTING ILLNESS


Patient was working asusual and then he developed swelling in the throat at 1AM in the morning of 12/01/2022.

Then he went to check himself in the mirror to examine and noticed swelling of throat.

Patient noticed that the swelling started at  uvula and progressed down till the whole throat is involved.
 
The swelling presented by the patient is sudden in onset and gradually progressive in nature since morning.

Pain is sudden in onset and gradually progressive in nature.

Patient was not able to turn his neck side to side.


PAST HISTORY


Patient had similar complaints in the past.

He was apparently asymptomatic 15 years back then he developed first episode of swelling in the throat associated with pain so he went to a local hospital and was referred to our hospital where tracheostomy was done.

He also had history of multiple swellings over the body which persists for atleast 3 days after using hydrocortisone.

It is not associated with redness, itching and irritation.

Swelling occurred in specific site would rapidly progress throughout the body.

This occurs atleast 2 times a month which is intermittent and random.

Swelling would occur on the face, trunk, upper and lower limb. Common site is face and limbs.

Then he developed 2nd episode in 2016 with complaints of swelling of base of tongue and uvula and tracheostomy was done.

He was not able to regularly work due to these symptoms.

Patient is not a known case of diabetes, hypertension, asthma, epilepsy, tuberculosis.

ALLERGIC HISTORY

Food allergy - Fish, Meat(mutton), leafy vegetable (gongura), brinjal.
Smell - perfume, garbage, sanitizer and smoke.
Pollutants.

PERSONAL HISTORY

Diet - Mixed 
Appetite - Normal
Bowel and bladder - Regular
Sleep - Inadequate
No Addictions

FAMILY HISTORY

Not significant.

TREATMENT HISTORY

Takes avil and hydrocortisone injections whenever swelling occurs.

SURGICAL HISTORY


Undergone tracheostomy 2 times.





GENERAL EXAMINATION

Patient is conscious, coherent and cooperative and is well oriented to time, place and person.

He is well nourished and moderately built.

Pallor - Absent
Icterus - Absent
Clubbing - Absent
Cyanosis - Absent
Lymphadenopathy - Absent
Edema - Absent







VITALS

Pulse rate - 120bpm
Respiratory rate - 16cpm
BP - 120/91 mmHg
Temperature - Afebrile

SYSTEMIC EXAMINATION 

EXAMINATION OF NOSE AND ORAL CAVITY

No Trismus.

Examination of oral cavity - lips, teeth,buccal mucosa and gums. 
Anterior 2/3rd of tongue, hard palate and floor of the mouth appears normal.

Examination of oral pharynx - congestion and oedema of anterior pillar, uvula and soft palate. Posterior pharyngeal wall appears congested.





Examination of nose - turbinates and mucosa appears normal 

RESPIRATORY SYSTEM


Examination of trachea - normal neck movements and tracheostomy scar seen.

Inspection 

Shape of the chest - Bilaterally symmetrical.
Position of trachea - deviated to left side.
Crowding of ribs - Absent.
Expansion of chest - equal on both sides.
No visible pulsations.

Palpation

No tenderness
No local rise of temperature.
Bilateral air entry.
Apex beat - Heard.


Percussion - resonant in all areas

Auscultation - normal vesicular breath sound
 

CVS

S1,S2 are heard.
No murmurs heard








ABDOMEN

Scaphoid shaped abdomen
No tenderness and palpable mass
No free fluid
Auscultation - bowel sounds heard
Liver - Not palpable
Spleen - Not palpable





CNS EXAMINATION

 
Conscious 
Normal speech
Cervical nerves - intact
Normal sensory and motor system
Neck stiffness - absent
Reflexes - normal

INVESTIGATIONS


















PROVISIONAL DIAGNOSIS


Hereditary angioneurotic edema.

TREATMENT

1) Inj. hydrocortisone
2) Nebulization with adrenaline
3) Inj. avil i.v
4) Check BP, PR, RR, SPO2 - 2nd hrly.




















 











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