A 55yr old male patient came for dialysis

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CHEIF COMPLAINTS- 

C/o bilateral lower limb swelling since 8 months 

C/o bilateral lower limb pain since 8 months

HISTORY OF PRESENT ILLNESS-

Patient was apparently normal 8 months ago then he developed bilateral lower limb pain for which he took medications and also developed bilateral lower limb swelling which is insidious in onset, gradually progressive with no aggravating and relieving factors 

HISTORY OF PAST ILLNESS-

Known case of DM since 5 yrs 

Not a known case of HTN, TB, epilepsy, CVA, CAD

Underwent 8 sessions of hemodialysis in outside hospital 8months ago.

TREATMENT HISTORY- 

Pt was on treatment for diabetes since 4 years

PERSONAL HISTORY- 

Appetite- Normal

Non-vegetarian 

Bowels- regular

Micturition - normal

Addictions-

Alcohol- regular 15yrs ago 

Tobacco- normal

Drug abuse- amber 

Beetle nuts- No

FAMILY HISTORY-

Not significant 

PHYSICAL EXAMINATION-

GENERAL EXAMINATION-

Pallor-No

Icterus-No

Clubbing-No

Cyanosis-No

Lymphadenopathy- No

Oedema- present (Grade 1) pitting type

Temperature-98.4

SYSTEMIC EXAMINATION-

CVS-

Cardiac sounds- s1 and s2 heard

Cardiac murmurs- absent 

RESPIRATORY SYSTEM-

Dyspnoea- No

Wheeze- No

Position of trachea- central 

Breath sounds- vesicular 

ABDOMEN-

Shape of abdomen- obese

Tenderness- not present

Palpable mass-not present

Hernial orifices- Normal

Free fluid- not present 

Liver- not palpable

Spleen- not palpable 

Bowel sounds- present 

CNS-

Level of consciousness-conscious

Speech- normal

INVESTIGATIONS-

PROVISIONAL DIAGNOSIS-Chronic kidney disease on maintainance hemodialysis.