65 year old man, was a driver in Dubai, hasn't been working the last 10 years, currently residing in nalgonda, presented with the complains of
Generalized weakness since 1 month
Dyspnea on exertion since 1 month
Bilateral lower limb swelling since 1 month
Difficulty in getting up from sitting posture since 1 month
Urinary incontinence since 1 month
Black colored stools since 15 days
Difficulty in walking and sitting without support since 4 days
1 episode of dark colored vomiting 1 day back
He got married when he was 18 years of age, has been working as a driver in Dubai since 25yrs og age. He has got 5 children, 3 daughters and 2 sons.
He was diagnosed with DM 15 years back and HTN 10 years back and has been on regular medications since then ( Telma AM for HTN, Glimi for DM).
He started experiencing difficulty in passing urine since 4 years, he says he could pass urine only on pressure. He was catheterized around 10 times in the last 4 years and was told that he had prostate enlargement and was put on Tab Uromax. Since 1 month he is complaining of urinary incontinence.
Since 1 month he also has been experiencing generalized weakness, easy fatiguability, dyspnea on exertion, he says he gets breathless on walking less than 100m
He has bilateral lower limb swelling which progressed gradually upto his knees.
He says he started finding it difficult to walk and get up from sitting posture since 1 month
He also has been complaining of dark colored stools since 15 days
Since 4 days he is unable to even walk and sit without support
He also tells he had one episode of dark colored non projectile vomiting 1 day back
On examination :
Patient is conscious, coherent, cooperative.
Pallor is present.
Icterus absent
Cyanosis absent
Clubbing absent
Lymphadenopathy absent
Pedal edema absent.
CNS EXAMINATION:
His HMF are intact
Lower limb tone is reduced
Reflexes:
Upper limb
Right left
Biceps 3+ 3+
Triceps 3+ 3+
Supinator 2+ 2+
Knee + +
Ankle + +
Plantars extension
Sensory intact
No spinal tenderness
Cvs: s1,s2 + ,No murmers
Per Abdomen - soft, non tender
Respiratory system: bilateral air entry present,
Normal vesicular breath sounds heard.
1 month back he got an MRI brain, ct chest, usg abdomen done. And his blood picture 1 month back showed a Hb of 7.
They even got a PSA done which was around 9 ng/ml.
PROVISIONAL DIAGNOSIS
Malignant neoplastic lesion in anteropyloric region with metastasis to lymph node, omentum, chest wall.
Grade 3 median lobe hypertrophy(BPH)
Anemia(?Anemia of chronic disease)
Hypoalbuminemia
K/c/o hypertension and diabetes mellitus type 2
TREATMENT:
1.TAB.ECOSPIRIN 75/20 H/S
2. INJ.HAI S/C According to sliding scale
3.TAB.TELMA AM P/O O/D
4.TAB.PANTOP 40MG OD
5.SYP LACTULOSE 10 ML PO H/S
6.PROTEIN POWDER 2 SCOOPS IN 1 GLASS OF MILK. TID
The next plan of management is endoscopy followed by biopsy. But the patient and his attenders were not willing for the same. So we couldn't proceed further.
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