A CASE OF ACUTE URINARY RETENTION UNDER EVALUATION

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A 30 year old male,farmer by occupation resident of Nalgonda came to op And he has

H/o RTA 3 Years ago after which he got implant in right tibia.

H/o RTA 2 years ago, Injury to the same leg and sustained a superficial wound

1 year ago patient developed a small vesicle over left shin of tibia which increased in size with swelling of whole limb, blackish discoloration later multiple vesicles of large size developed over left lower limb,pt visited doctor where they punctured the vesicles and later he developed ulcers over punctured sites,he was operated and debridement was done,since 1 year he was walking, doing his daily chores but not working in farm.

10 days ago he developed cough with blood tinged sputum(hemoptysis),low grade fever with evening rise of temperature.

H/o acute retention of urine 10 days ago,he was able to feel fullness and want to void but couldn't,was put on Foley's outside after which it was removed the next day but he couldn't pass urine and Foley's was replaced.patient was diagnosed to be sputum+ koch's, started on ATT on 1/11/2021

He has normal appetite,takes mixed diet, regular bowel and bladder movements and takes alcohol daily 180 ml since 15 years,smokes 1 pack/day since 15 years.

On examination patient is conscious, coherent, cooperative.

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema.

Vitals:

Temp-98.4 degrees F

BP-120/70 mm hg

PR-78 bpm

RR-18cpm

Spo2:97%

P/A:soft,non tender, slightly distended

No guarding or rigidity.

CVS: S1S2+

RS: bilateral air entry+;clear

CNS:NFD

Provisional diagnosis: 

Acute urinary retention under evaluation,? Potts spine.

Pulmonary koch's on ATT since 10 days

Multiple ulcers secondary to ?TB vasculitis/?berger's disease

INVESTIGATIONS:

HEMOGRAM:

HB-12.1

TLC-16,200

PTC-4.45 Lakhs

Normocytic, normochromic blood picture with leucocytosis

CUE:

Albumin-nil

Sugar-nil

Pus cells-3-4

Epithelial cells-2-3

Red blood cells-2-3

LFT:

TB-1.00

DB-0.18

AST-36

ALT-20

ALP-129

TP-6.6

Albumin-3.0

A/G-0.83

RFT:

urea-17

Creatinine-0.6

Uric acid-5.2

Ca-10.0

P-3.0

Na-137

K-3.0

Cl-98

ECG:

TREATMENT:

1)IVF 2 NS,2RL @100 ML/HR

2)INJ.PAN 40 MG IV/OD

3)ATT X 4 TABS

4)INJ.AUGMENTIN 1.2 GM IV/BD

5)INJ.LASIX 20MG IV/BD

6)SYP.ASCORYL 10 ML PO/BD

7)SYP.CREMAFFIN 15 ML PO/BD

8)BP,PR MONITORING;GRBS 12TH HOURLY

9)STRICT I/O CHARTING