prostatic adenocarcinoma

A 70 yr old male came to hospital with cheif compliants of severe burning micturition and fever since 1 month

History of present illness:-

Patient was apparantly asymptomatic 6 months ago then developed burning micturition with decreased urine output which worsened since one month. The pt also developed fever since one month which is of high grade, insidious in onset and relieved upon taking dolo-650. He had pedal edema one month ago ,which is  bilateral, of pitting type upto the ankles which got relieved when he used medication. He also developed loss of appetite since one month and has significant weight loss.

Drug history

He is using paracetamol regularly for his fever, since 1 month.

Past history:-He is not a c/o Diabetes mellitus, Hypertension ,asthma, TB, Epilepsy

Personal history:-

Diet: Mixed

Appetite: decreased since 1 month

Bowel and bladder: Regular 

Micturition: decreased urine output(usg showed BPH)

Allergies: drinks toddy (rarely)

Family history:

No history of Diabetes mellitus,Hypertension,heart disease or stroke,tuberculosis,cancer

General examination

patient was consious,coherent and cooperative and examined in a well lit room.

VITALS:

Pulse rate: 98 bpm

Respiratory rate: 18/min

BP: 130/80 mmHg

Temperature: 98.4F

GRBS: 131mg%

SPO2: 98% at room air

            

Pallor: absent

Icterus: absent

Clubbing: absent

Cyanosis: absent

Lymphadenopathy : enlarged lymph nodes in the left anterior side of the neck(matted)

Edema of feet: present, upto ankle, pitting type.

Malnutrition :present

Dehydration :mild

Systemic examination

CVS

• S1 and S2 heard
• No thrills
• No murmurs

Respiratory System

• Vesicular breath sounds heard
• Trachea is in central position
• No wheezing
• No Dyspnoea

Abdomen

• Scaphoid shaped abdomen
• No tenderness
• No palpable mass, no organomegaly
• Bowel sounds are heard

CNS

• Conscious and normal speech
• Normal gait
• Cranial nerves normal
• sensory system normal
• Motor system normal
• No signs of meningeal irritation.

INVESTIGATIONS:

CBP

HEMOGRAM

CUE

Blood parasite:-

Culture:

1. Urine

ULTRA SOUND

FNAC of the lymphnode in the neck:-

Slides:

PROVISIONAL DIAGNOSIS

Obstructive uropathy ?AKI

Post renal Benign prostate hyperplasia

? adenocarcinoma

TREATMENT 

Fluid correction <2l/day

salt restriction with <2g/day

 ivf 1๏ ns @30ml/HR

Inj.Lassix 40mg iv/bd

IO CHARTING

TAB.Ondansetron MD/PO/TID

TAB.Nodosis 500mg/PO/BD

Inj.Meropenem 500mg/IV/BD