Case of a 19 years old male with abdominal pain.

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This is the case of a 19 years old boy, who is a student and resident of Nalgonda.

CHIEF COMPLAINTS

The patient presented to the casualty with the chief complaints of loose stools and continuous abdominal pain from 3 days and two episodes of vomiting, the day before admission.

HISTORY OF PRESENTING ILLNESS

The patient was apparently asymptomatic 3 days ago. He had attended a function where he consumed very oily food. From that day he had 5-6 episodes of loose stools every day. Yesterday, the patient went to another hospital where he was diagnosed with acute appendicitis and was told that he would require surgery.

One day ago, the patient had two episodes of vomiting (green in colour- bilious, non-projectile). He had an episode of fever (102 degrees F), one day ago.

The patient presented to the casualty today with complaints of loose stools (5-6 episodes a day) and continuous abdominal pain (increased during defecation).

PAST HISTORY

The patient is not a known case of DM, HTN, Asthma, Epilepsy or TB.

FAMILY HISTORY

No relevant family history.

PERSONAL HISTORY

Diet- normal

Sleep- adequate

Smoking - no

Alcohol - no

Other addictions- the patient is a regular consumer of toddy. He has been consuming toddy from a very young age. He consumes little every day.  He consumed 1 glass of toddy 4 days ago.

VITALS

Patient is conscious, coherent and oriented to time and place.

PR- 89 bpm

BP- 130/80 mm Hg

Temperature - afebrile

SpO2- 99%

GRBS- 115 mg/dl

GENERAL EXAMINATION

Pallor- absent

Icterus- absent

Clubbing- absent

Cyanosis- absent

Lymphoedema- absent

Edema- absent





SYSTEMIC EXAMINATION 

CVS:- 
 S1, S2 heard 
No thrills
No murmurs

 
RESPIRATORY SYSTEM :- 
 BAE+ 
 NVBS heard 

 PER ABDOMEN:-
INSPECTION- Shape of the abdomen- obese
Umbilicus is central and inverted 
No visible engorged veins, scars or sinuses
No visible pulsations
All quadrants are moving appropriately with respiration
No visible peristalsis
PALPATION-
Soft, mild tenderness at the left iliac region 
No hepatomegaly 
No splenomegaly
PERCUSSION-
Liver dullness not obliterated
AUSCULTATION - 
bowel sounds heard

CNS
The patient is conscious and coherent.
Speech is normal.

INVESTIGATIONS

CBP



RFT



LFT



USG



ECG


PROVISIONAL DIAGNOSIS
?GASTROENTERITIS

TREATMENT

Inj PAN 40 mg IV/STAT

Inj ZOFER 4 mg IV/STAT

Inj METRONIDAZOLE 100 ml IV/STAT

IVF- 10 NS @70 ml/hr

         10 RL @70ml/hr

Tab SPOROLAC 2 tab STAT








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