A 67year old man with scrotal swelling
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A 67 year old man who is a daily labourer from Nagaramwith complaints of scrotal swelling since 15days, fever and vomitings since 3days and difficulty in micturition
History of presenting illness:
He was apparently asymptomatic 15days back then he developed bilateral scrotal swelling associated with pain and discharge. He also complaints of fever since 3days which is intermittent, high grade with chills. He has vomitings 2episodes a day, non projectile, bilious.
He has dribbling of urine, post residual volume, urgency, thin stream. Stream improves with increased in abdominal pressure.
Past history:
Not a k/c/o Diabetes, hypertension, asthma, epilepsy, CAD , Tuberculosis
Personal history:
He has normal appetite, takes mixed diet, bowel movements are regular, gets adequate sleep. He takes alcohol around 90ml daily. He has been taking alcohol since 10years. He smokes 4 to5 beedi a day. He has been smoking since 10years.
Daily routine:
He wakes up at 6am in the morning.
He gets ready for work, eats breakfast at around 8.30 to 9am and goes to work at 9am. He does his work and takes lunch at 2pm and finishes his work by 5to 6pm and returns home. He eats his dinner at 8pm and goes to sleep at 9pm.
Family history:
No member of the family has similar complaints
General examination:
He is conscious, coherent and cooperative. He is moderately built and moderately nourished.
No pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema.
Vitals:
Temperature
Pulse rate 90bpm
Blood pressure
Respiratory rate 20cpm
SpO2 92%
GRBS 217
Clinical images
Inguinoscrotal examination
Inspection:
There is a bilateral scrotal swelling of size 10*10 cm, the surface appears to be smooth, shiny and excoriated.
Serosanguinous discharge is present.
No scars, sinuses, visible pusations.
Palpation:
There is no local rise of temperature, tenderness is present.
Swelling is present bilaterally, cystic in consistency,
getting above the swelling +
Transillunination +
Systemic examination
Per abdomen
No distension
Soft, non tender
Bowel sounds heard
Respiratory system examination
Bilateral air entry +
Normal vesicular breath sounds heard
Cardiovascular system examination
S1 S2 heart sounds heard, no murmurs
Raised JVP
Central nervous system examination
Higher mental functions intact
Cranial nerves intact
No focal neurological defecits
Provisional diagnosis:
Bilateral hydrocele, post renal AKI?, acute gastritis?
Investigations
USG Inguinoscrotal region
USG Abdomen
ECG
ABG
General surgery consultation
Treatment
IV fluids NS RL @100ml/hr
Inj.PIPTAZ 2.25gm iv stat
Inj.LASIX 20mg iv BD
Inj.OPTINEURON 1amp in 100ml NS iv OD
Inj.PAN 40mg iv OD
Inj.ZOFER 4mg iv BD
Inj.NEOMOL 1gm iv if temperature >102F
Inj.TRAMADOL 1amp in 100ml NS if required
Tab. DOLO 650mg PO QID
Tab.ULTRACET if required
4th hourly BP charting
8th hourly GRBS monitoring
Input/output charting
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