50yr old female came for dialysis

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

4 th - 5/12/22

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS AGO THEN SHE DEVELOPED FEVER WHICH IS LOW GRADE CONTINOUS NOT ASSOCIATED WITH CHILLS AND RIGORS NOT RELIEVED WITH MEDICATIONS

H/O OF VOMITING[5-6 EPISODES] NON PROJECTILE NON BILIOUS FOOD AS CONTENT 

C/O SOB SINCE 10 DAYS GRADE 3

BURNING MICTURATION 

HISTORY OF LOSS OF WEIGHT SINCE 4 MONTHS 

VITALS:

Temperature 97.4F

Pulse rate 101 BPM

Respiratory rate 16cpm

Blood pressure 120/80 mmHg

SpO2 96%

GBRS 102mg%

PERSONAL HISTORY:

SHE WAS A DAILY WAGE WORKER WHO STOPPED GOING TO WORK SINCE 1 YEAR BECAUSE SHE WAS FEELING VERY WEAK.

SLEEP IS INADEQUATE 

DIET IS MIXED

APPETITE-DECREASED

DECREASED URINE OUTPUT SINCE 1 MONTH

BOWEL FUNCTIONS ARE NORMAL

FAMILY HISTORY:

NOT SIGNIFICANT 

MENSTRUAL HISTORY:

NULLIPAROUS 

AGE OF MARRIAGE: 15 YEARS

SYSTEMIC EXAMINATION:

CVS : 

On palpation ‐

• Apex beat was felt in the left 5th intercostal space medial to the mid clavicular line on left side.

• JVP was normal 

• No precordial bulge 

• No parasternal heave

On auscultation ‐ S1, S2 heard , no murmurs 

RS :

On inspection ‐

• Chest is bilaterally symmetrical 

• Expansion of chest: Equal on both sides

• Position of trachea: Central

• No visible scars, sinuses, pulsations

On palpation : 

• Expansion of chest was equal on both sides. 

• Position of trachea: Central

• Tactile Vocal Fremitus: resonant note was felt.

On percussion: all lung areas were resonant 

On auscultation : 

• Bilateral air entry was present, normal vesicular breath sounds were heard. 

• Vocal resonance: resonant in all areas

P/A : soft, non tender, no organomegaly, no distension, bowel sounds heard.

CNS : The patient is well oriented to time, place, person.

Higher mental functions are intact.

Cranial nerve examination :‐

All cranial nerves are intact and functioning. 

Motor System Examination :‐

• Normal bulk in upper and lower limbs

• Normal tone in upper and lower limbs

• Normal power in upper and lower limbs

• Gait is normal 

. Reflexes are normal .

Sensory System Examination :‐

Normal sensations are felt in all the dermatomes.

No cerebellar signs .

No meningeal signs.

investigations 

21/11/22

research from an article 

Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival

Krishna Patel, Nathan R. Foster, [...], and Aminah Jatoi

Purpose

Hydronephrosis is a frequently observed but understudied complication in patients with cervical cancer. To better characterize hydronephrosis in cervical cancer patients, the current study sought (1) to describe hydronephrosis-associated morbidity and (2) to analyze the prognostic effect of hydronephrosis in patients with a broad range of cancer stages over time.

Results

Two hundred seventy-nine cervical cancer patients with a median age of 49 years and a range of cancer stages were included. Sixty-five patients (23 %) were diagnosed with hydronephrosis at some point during their disease course. In univariate analyses, hydronephrosis was associated with advanced cancer stage (p<0.0001), squamous histology (p=0.0079), and nonsurgical cancer treatment (p=0.0039). In multivariate analyses, stage and tumor histology were associated with hydronephrosis. All but one patient underwent stent placement or urinary diversion; hydronephrosis-related morbidity included pain, urinary tract infections, nausea and vomiting, renal failure, and urinary tract bleeding. In landmark univariate survival analyses, hydronephrosis was associated with worse survival at all time points. In landmark multivariate analyses (adjusted for patient age, stage, cancer treatment, and tumor histology), hydronephrosis was associated with a trend toward worse survival over time (hazard ratios ranged from 1.47 to 4.69).

Conclusion

Hydronephrosis in cervical cancer patients is associated with notable morbidity. It is also associated with trends toward worse survival—even if it occurs after the original cancer diagnosis.

Hydronephrosis develops when a blockage in the renal collecting system leads to distention of the renal calyces. Women with cervical cancer often develop this complication as a result of tumor or lymph node encroachment, inflammation, or scarring at the pelvic rim. In an effort to relieve obstructive symptoms, patients can undergo stent placement or urinary diversion procedures [1–8]. In addition, cervical cancer is often treated with nephrotoxic drugs, which are sometimes dose-modified or omitted when hydronephrosis is associated with renal insufficiency [8]. Such dose changes can compromise cancer treatment and potentially lead to compromised clinical outcomes, thus emphasizing the importance of studying hydronephrosis in patients with cervical cancer. Furthermore, this complication has been associated with pain related to inflammation of the  and surrounding structures.

Hydronephrosis develops when a blockage in the renal collecting system leads to distention of the renal calyces. Women with cervical cancer often develop this complication as a result of tumor or lymph node encroachment, inflammation, or scarring at the pelvic rim. In an effort to relieve obstructive symptoms, patients can under.go stent placement or urinary diversion procedures [1–8]. In addition, cervical cancer is often treated with nephrotoxic drugs, which are sometimes dose-modified or omitted when hydronephrosis is associated with renal insufficiency [8]. Such dose changes can compromise cancer treatment and potentially lead to compromised clinical outcomes, thus emphasizing the importance of studying hydronephrosis in patients with cervical cancer. Furthermore, this complication has been associated with pain related to inflammation of the kidney and surrounding structures.

Hydronephrosis develops when a blockage in the renal collecting system leads to distention of the renal calyces. Women with cervical cancer often develop this complication as a result of tumor or lymph node encroachment, inflammation, or scarring at the pelvic rim. In an effort to relieve obstructive symptoms, patients can undergo stent placement or urinary diversion procedures [1–8]. In addition, cervical cancer is often treated with nephrotoxic drugs, which are sometimes dose-modified or omitted when hydronephrosis is associated with renal insufficiency [8]. Such dose changes can compromise cancer treatment and potentially lead to compromised clinical outcomes, thus emphasizing the importance of studying hydronephrosis in patients with cervical cancer. Furthermore, this complication has been associated with pain related to inflammation of the kidney and surrounding structures.

Patient taking some treatment in Hyderabad radio/ chemotherapy ?