1801006196 CASE PRESENTATION
long case
CHIEF COMPLAINTS:
A 40 year old male resident of Krishnapuram, Nalgonda dist, field assistant by occupation presented with the chief complaints of -
pain abdomen since 6 days
nausea and vomiting since 6 days
abdominal distension since 5 days
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 6 days ago, then he developed abdominal pain in the epigastric region which is squeezing type, constant, radiating to the back and aggravated on doing any activity and relieved on sitting and bending forward.
He had nausea and vomiting which was 8-10 episodes which was non bilious, non projectile and with food as content.
H/o abdominal distension which was sudden in onset and gradually progressive to current size .
No history of fever, shortness of breath, cough , hemoptysis
No h/o orthopnea , pnd , fatigue , palpitations.
No h/o decreased urine output, burning micturition .
PAST HISTORY :
Patient has history of similar complaints of pain abdomen a year ago.
Patient is a known case of diabetes and hypertension since 5 years
No history of asthma, TB, epilepsy and thyroid disorders.
PERSONAL HISTORY:
Appetite : decreased
Diet : mixed
Sleep : disturbed
Bowel and Bladder : regular
Addictions : History of alcohol intake for 5 years
FAMILY HISTORY:
History of diabetes to patient's mother since 14 years
History of diabetes to patient's father since 15 years
GENERAL EXAMINATION :
Patient is conscious, coherent, cooperative and well oriented to time, place and person
Adequately built and Adequately nourished
Pallor - Absent
Icterus - present
Clubbing - Absent
Cyanosis - Absent
Lymphadenopathy -Absent
Pedal Edema - Absent
Vitals :
Temperature - 99 °F
Pulse Rate - 80 bpm regular,normal volume
Blood Pressure - 130/90 mmHg on right arm,supine position
Respiratory Rate - 13 breaths per minute and regular
SYSTEMIC EXAMINATION:
Patient examined in a well lit room, after taking informed consent.
PER ABDOMEN :
Inspection -
Shape - Uniformly Distended
Umbilicus - displaced downwards
Skin - No scars, sinuses, stretch marks, striae, no dilated veins, hernial orifices free
External genitalia - normal
Palpation -
No local rise in temperature and tenderness
Liver not palpable
Spleen not palpable
Kidneys are not palpable
Abdominal Girth - 84 cm
Percussion -
Shifting Dullness - Present
Liver span - Normal
Spleen Percussion - Normal
Auscultation -
Bowel Sounds - heard
No Bruit
CARDIOVASCULAR SYSTEM EXAMINATION :
Inspection -
Chest Wall is Symmetrical
Precordial Bulge is not seen
No dilated veins, scars, sinuses
Apical impulse - Not Seen
Jugular Venous Pulse - Not Raised
Palpation -
Apical Impulse - Felt at 5th Intercostal space in the mid clavicular line
No thrills, no dilated veins
Auscultation -
1st and 2nd sound heard
no added sounds and murmurs
RESPIRATORY SYSTEM EXAMINATION :
Inspection -
Chest is symmetrical
Trachea is midline
No Scars, sinuses, Dilated Veins
All areas move equally and symmetrically with respiration
Palpation -
Trachea is Midline
No tenderness, local rise in temperature
Tactile Vocal Fremitus - Present in all 9 areas
Percussion -
On Percussion - resonant on both sides
Normal vesicular breath sounds are heard
No added sounds
Vocal Resonance in all 9 areas
CENTRAL NERVOUS SYSTEM EXAMINATION :
Higher mental functions:
Patient is conscious,coherent,cooperative,
Speech and language is normal
CRANIAL NERVES:Intact
Sensory system normal
Motor system:
Tone - normal
Bulk - normal
Power - bilaterally 5/5
Deep tendon reflexes
Biceps : ++
Triceps : ++
Supinator: ++
Knee : ++
Ankle : ++
Superficial reflexes - normal
Gait - normal
PROVISIONAL DIAGNOSIS
Ascites secondary to pancreatitis
INVESTIGATIONS
Random blood sugar - 540mg/dl
Hba1c - 7.6%
Ascitic fluid analysis
Protein - 5.1 g/dl
Albumin - 3.3 gm /dl
Amylase - 1055 IU / l
ADA - 15 IU/l
Cell count - 50 cells ( 70% lymphocytes )
Ascitic fluid culture negative
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Ultra sound abdomen
Mild to moderate ascitis is seen
FINAL DIAGNOSIS
Ascites secondary to acute pancreatitis
MANAGEMENT
NPO
IV Fluids - N/S, R/L 125 ml/hr
Inj. PANTOP 40 mg IV BD
Tab. TELMEKIND 40 mg PO OD
GRBS every 4th hourly
Inj TRAMADOL 1 amp IV
Inj, HUMAN ACT RAPID according to grbs levels
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short case
A 14 year old female , resident of nagarjuna sagar came to opd with chief complaint of pain in both the lower limb since 7days
HISTORY OF PRESENT ILLNESS
2012
She was asymtomatic upto age of 3 years, then she developed high grade fever with cough and vomitting for which she was admitted in hospital. She was diagnosed with Sickle cell anaemia. Sickling test positive and Electrophoresis showed HbS. Blood transfusion were given 1packet.
2013
She developed high grade fever, dry cough and cold. She was diagnosed with Bronchopneumonia. X-ray lower lobe consolidation.
2015
She had recurrent episodes of fever, cough , cold i.e Recurrent Bronchopneumonia- 6 episodes in 3years(2012-2015). Urine culture showed Klebsiella growth.
Blood transfusion till date 4 times.
2016
She developed fever, pain abdomen , myalgia and arthralgia. She improved on medications and thus was discharged.
2019
She came with stomach pain and vomitting. She was diagnosed with Acute pancreatitis.
2023 Jan
Blood Transfusion done
Diagnosed to have cholelithiasis
2023 March
She was apparently asymptomatic 7 days back then she developed pain in left ankle for which she took TAB.ULTRACET and since 4day she developed pain in both knee and then she developed tenderness in the calf muscles it is of throbbing type in nature
She complaints of right lower leg pain from knee to ankle, dragging type, continuous, not relieved on medication associated with swelling below right knee over shin of tibia ,no aggravating and reliving factors.
She had 2 episodes of fever after admitting in hospital moderate grade,no diurnal variation , not associated with chills and rigors ,releived on medication.
No history of chest pain,shortness of breath,palpitations.
No history epigastric pain, vomitting
No history of headache, seizures,altered mental status
BIRTH HISTORY
She is second born child of parents married of 3rd degree consanguinity in 2009. All trimesters were uneventful. She was delivered through Cesarean section because of delayed labour pain with birth weight of 3kg.
Immunized till date.
PAST HISTORY
She is a known case of sickle cell anemia
History of bronchopnemonia
History of 8 PICU admissions
History of blood transfusion (20 times till now) last transfusion was done in jan 2023
No History of asthama,thyroid,Tuberculosis, Hypertension, Diabetes,Epilepsy
No history of bone pain with localized swelling in past
No history of any surgery.
PERSONAL HISTORY
Diet-mixed
Appetite-normal
Sleep-adequate
Bowel and bladder movements are regular
No allergies
No addictions
Not attained menarche
FAMILY HISTORY
3rd degree consanguinious marriage
No known affected relatives
PEDIGREE CHART
Icterus present
Mild edema of shin tibia
No cyanosis ,clubbing,lymphadenopathy
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