Dr Saicharan Kulkarni MD

 Bimonthly test  Q1) 57 year old man with jaundice, pedal edema and abdominal distension since three years and bleeding gums since three days" Chronic liver disease causing hypoalbuminemia and or portal hypertension leading to ascitis.  Cirrhotic ascitic fluid accumulation results from a number of factors broadly defined in terms of hormonal and cytokine dysregulation and related volume overload in the setting of portal hypertension[ 1 ]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664283/ A. Bipedal edema may be due to hypoalbuminemia leading to decreased albumin in turn decreases plasma oncotic pressure causing lymphedema. B. Cellulitis in liver cirrhosis is caused by numerous factors. Increased bacterial translocation from the gut due to altered intestinal immunity and bacterial overgrowth in cirrhotics produces Gram-negative bacteraemia, giving an opportunity for distant invasion by these microorganisms [ 3 ]. This is substantiated by the culture reports in these pa...

 BIWEEKLY ASSESSMENT 1) What is your complete anatomic and etiologic diagnosis from the data available in the patient's online record linked above? (ignore the provisional diagnosis on admission mentioned in the case report) In the context of patient symptoms(pedal edema & SOB& facial puffiness) anatomical diagnosis would be ? Kidney(albuminuria,microscopic hematuria) ?heart(pedal edema) ? Liver(no significant features suggesting hepatic dysfunction) Etiological diagnosis In the background of her diabetes I would suspect the ?early diabetic nephropathic changes which is rapidly progressing I exclude hypertensive nephropathy because it is less likely to manifest with in one year of onset of diabetes • Still considering the ?heart failure because of her pedal edema shortness of breath I would exclude liver involvement because no evidence of hepatic dysfunction 2) What are the reasons for her: Azotemia – may be due to precipitated AKI which I attribute to ?pre renal...