70 year male with pedal edema

PRESENTING COMPLAINTS:
C/O Pedal edema since 20 days.
C/O Loss of appetite since 20 days.
C/O Nausea and vomiting since a week.

HOPI:
A 70 year male, artist by profession, resident of Mupparam,Hanmakonda presented to OPD with complaints of non pitting type of Grade II 
Pedal edema since 20days. History of loss of appetite since 20 days. History of nausea and vomiting leading to decreased food intake since a week. 1-2 episodes of Vomiting, which was non projectile, non bilious not associated with abdominal pain. Patient sought for consultation and admitted for further evaluation and management.

PAST ILLNESS:
A 70 year male sought for consultation for recurrent episodes of giddiness and diagnosed with Hypertension 25 years ago (1997); he was on regular antihypertensive medications. He had history of non healing wound over the upper lip for which he sought for consultation and diagnosed with Diabetes Mellitus; he was on Oral hypoglycemic agents since 8 years(2014). He had complaints of severe abdominal pain in right upper quadrant associated with vomiting, for which he sought for consultation and diagnosed with acute cholecystitis and underwent laparoscopic cholecystectomy under GA on December 2017. The patient had complaints of low back ache, joint pains, unable to stand in erect position 4 years ago and he took ayurvedic medication and NAIDS for 6 months. He had complaints of abdominal pain, facial puffiness for which he sought for consultation and diagnosed to be having Chronic Kidney Disease and he was started on only pharmacotherapy since 2018. He had complaints of Decreased appetite since a month.

PERSONAL HISTORY:
Moderately built and nourished.
Adequate Sleep.
Bowel and Bladder are regular.
Smoker: started at the age of 18 and stopped at the age of 46. He smokes 6 beedi's/day.
Occasional Alcoholic: 90ml once in 2-3 weeks.





ECG at presentation:
CHEST XRAY PA VIEW:
2D ECHO: 
INVESTIGATION CHART:
USG ABDOMEN:





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