Stab injury L frank >> CHF

Case discussion

FX 6444
Sex : Woman Age : 59 years Address : Nakhornratchasima Occupation : -

History
Chief complaint Dyspnea on exertion 2 years PTA

History
Present illness
20 years PTA, the patient was robbed and stabbed at left frank. She underwent emergent exploratory laparotomy.

History
Present illness
She was not sure about the operative procedure. She knew that Splenectomy was done.

History
Present illness
2 years PTA, she complained about dyspnea on exertion and edema of her legs. The doctor said that she had cardiomegaly.

History
Present illness
2 years PTA, she complained about dyspnea on exertion and edema of her legs. The doctor said that she had cardiomegaly.

History
Present illness
The ultrasound and CT scan of abdomen showed that

History
HCV cirrhosis No drug allergy

Physical examination
Middle aged woman BT 36.8 PR 78 RR 20 BP 130/80 HEENT : pink conjunctiva, anicteric sclera Lungs : normal breath sound Heart : audible s1 s2, no murmur Ext : no edema

Physical examination
Abdomen

Murmur +ve

CBC+plt
Hb 13

Bun 10.4 Cr 0.7 Na 141 K 3.9

Hct 39 WBC 4200 Plt 162000 PMN 36

L 48

HCo3 35 Cl 103 UA Sp.gr 1.010 WBC 2-3 pH 6 RBC -

8/3/2012

15/12/2011

15/12/2011

18/6/2011

18/6/2011

18/6/2011

18/6/2011

18/6/2011

Progression
The ultrasound and CT scan of abdomen showed that she had A-V shunting of Leftt renal A&V.

Progression
She was treated by
1. Failed renal angioplasty (Feb 2010) 2. successful closure renal AVF (March 2011) 3. Angiogram (May 2011F/u) - residual renal AV fistula

Progression
Finally, the cardiologist sent her for surgical closure renal AVF.

What should we do for this patient ?