A 70 year old male with facial puffiness and pedal edema

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A 70 Year old man who was a toddy tree climber,resident of chirala came to casuality 2 days back with chief complaints of  pedal edema and facial puffiness from the past 15 to 20 days back 

HOPI : Patient was apparently alright 3 years back ,one day he developed generalized body weakness which is intermittent in nature,so from then he is not climbing the trees

He daily wakes up at 6 am in the morning ,completes his daily routine,brushing teeth etc  and drinks tea , eat breakfast by 9 am then he sits in the corridor , talks with neighbours and family members, at about 12 to 12: 30 pm he starts eating lunch and sleep for about 2 to 3 hrs in the afternoon, he wakes up by 4 : 00 pm and go for walk near his residence  and come back eat dinner by 7 to 7: 30 pm.after having dinner he goes to bed.

20 days back patient and attenders noticed pedal edema and facial puffiness there is no H/O  chest pain,palpitations,SOB, orthopnea

patient complains of burning micturition since 2 days

  vomitings since 2 days which is insidious in onset,gradually progressive,5 episodes,non projectile, associated with nausea

it is non bilious,consist of food particles and water,not  blood stained,not foul smelling

No h/o abdominal pain ,fever,cold,malena.

h/o intermittent cough aggravated by smoking from 7 days.

h/o hemorrhoid from 10 years

bleeding p/r since 1 year,h/o hard stools ,constipation ,bleed during passing stools ,minimal quantity.

past history: not a k/c/o dm,htn,asthma,epilepsy,CAD

personal History: he takes mixed diet,good appetite, bowel and bladder movements not  regular 

he gives h/o hard stools

sleep adequate

addictions takes alcohol regularly

90 ml per day ,smokes 20 beedis per day

Family history:

 No significant family history

GENERAL PHYSICAL EXAMINATION

patient is conscious, coherent,cooperative well oriented to time place person

he is moderately built and nourished

pallor present

 icterus,clubbing,cyanosis absent

edema present 

no lymphadenopathy

vitals at time of admission: 

TEMPERATURE: afebrile

BP:140/70 mm Hg

RR: 18 cpm

PR:76 bpm

systemic examination: 

CNS : NO focal neurological deficits

CVS :  visible apex impulse,no scars ,sinuses,dilated veins 

apex beat is palpable

RS: shape of chest - Normal

trachea appears to be central

chest is b/l symmetrical

BAE+ Normal vesicular breath sounds present ,no adventitial sounds 

P/A : abdomen appears to be normal flat shape, all quadrants move equally with respiration,umblicus is central ,no visible masses,dilated veins ,normal skin ,no scars ,sinuses,hernial orifices

no local rise of temperature,tenderness,guarding,rigidity

no organomegaly,soft and non tender

14/9/22:

15/9/22

17/9

18/9/22

Diagnosis: severe anemia secondary to bleeding P/R,fissure,malignancy?

Treatment: inj iron sucrose 200 mg in 100 ml NS iv/od

syrup cremafin 30 ml /od

inj lasix 40 mg /i.v /od

inj zofer iv/Tid

monitor vitals and inform sos.