Problem Based Learning Oedema

Group A2

Q1 :

What is your differential diagnosis based on the history given? State reason.

A) Differential diag. based on history. State reasons. 1 ) Congestive heart failure left ventricular failure Reasons patient complains of i) Dyspnoea, ii) Paroxysmal nocturnal dyspnoea, iii) Bilateral swelling of legs from ankle up to the knee History - Hypertension and myocardiac infarction CHF might be a complication of hypertension and MI 2) Chronic renal failure Reasonsi) Manifestations similar to cardiac failure and it might be caused by hypertension. ii) Prolonged use of drugs, iii) Patient complains of poor urinary stream with hesitancy and post void dribbling for the past three years 3) Nephrotic syndrome Reasons Distended abdomen. Oedema present.

4) Liver disease Reasons Distended abdomen and oedema present. 5) Prolonged use of amlodipine Reasons Swelling of the ankle 6) Lymphedema Reasons Caused by infections that might be caused by diabetes mellitus 7) Metastatic cancer Reasons - distended abdomen Causes - Fluid accumulation and effusion when it spreads to the lungs or abdomen due to obstruction of lymphatics and veins as well as serous exudation 8) Benign Prostatic Hyperplasia Reasons - Difficulty in urine voiding and dribbling is present at the end of micturation

Q2 :

What are the possible underlying causes for this diagnosis in this patient
1) Congestive heart failure Causes - Due to hypertension which cause by unhealthy diet and he's an old man (aged). i) Ischemic Heart Disease ii) Hypertension iii) Obesity iv) Diabetes v) Vulvular heart disease 2) Chronic renal failure Causes - Medication side effect - Aspirin (NSAID) i) Diabetes Mellitus ii) Hypertension iii) Glomerulonephritis iv) Prostate obstruction 3) Nephrotic syndrome Causes i) Hypertension ii) Diabetes mellitus iii) Aspirin

4) Liver disease Causes 5) Prolonged use of amlodipine <-- this is a cause by itself Causes i) Hyperglycemia(very rare) ii) Peripheral oedema 6) Lymphedema Causes - Usuallly only cancer causes this

Q3:what other question would you like to ask to further clarify your suspected diagnosis

Suspected diagnosis: Congestive Heart Failure whether the patient have suffered from symptoms below other than the stated sign & symptoms: i) increased urination (due to extra fluid) ii) nausea, decreased appetite, weight loss ( due to accumulation of fluid in liver & intestine) iii) abdominal pain ( due to abdomen distended) iv) Anemia (increase demand of O2 outstrips what the heart can provide) v) tachypnea & increased work of breathing (due to pulmonary edema) vi) wheezing or cardiac asthma vii) Dizziness, confusion viii) cool extremities at rest ( decreased CO) xi) Nocturnal cough x) reduced exercise capability

4)What other differential diagnosis are there for peripheral edema in this patient?

Main causes of peripheral edema 1. Baker Cyst 2.Cellulitis 3.Cirrhosis liver 4.CCF 5.Eosinophilic fascilitis 6.Illiotibial band syndrome 7.Kidney failure 8.Phlebitis 9.Scleroderma Other Causes of Leg Swelling 1.Idiopathic Edema (Swelling of Unknown Cause, typically in women) 2.Leg Vein Obstruction 3.Medications 4.Nephrotic Syndrome 5.Salt Retention 6.Trauma Injury (Contusion, Hematoma)