Case of a 38 years old man with pain abdomen.

October 15, 2022

Case of a 38 years old man with pain abdomen.

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This is the case of 38 years old man, a Civil engineer by profession and resident of West Bengal.

CHIEF COMPLAINT

The patient has the chief complaint of

Pain in the stomach from 5 years (not present from 7 days)

Pain in both legs from 6 months

Blood in stools from childhood.

HISTORY OF PRESENTING ILLNESS

The patient was apparently asymptomatic 5 years ago, when he started experiencing pain in the abdomen. The pain would occur suddenly ,in episodes ( once a month). The pain was in the centre of the abdomen( epigastric area) radiating to the right flank and behind to the back, dragging in nature. It would be so severe that he would have to bend while walking even short distances. The pain would aggravate after consuming alcohol and fat-rich food, and relieved after getting admitted to the hospital(for 2-3 days), where he was given painkillers I.V. Initially the pain was not associated with vomiting. Every episode is associated with fever ( about 99 degrees Fahrenheit).

For the past 1 year, the patient gets episodes ( once in 2 months ) of vomiting followed by pain in the abdomen (similar to the episodes above ). The vomiting is non-bilous. It has a strange smell ( as described by the patient ) and is associated with retching. The episodes were associated with increased weakness and giddiness.

The patient had an episode 15 days ago , where he had multiple episodes of vomiting after consuming anything, it was not associated with pain.The vomiting would not stop after taking oral medication, thus the patient had to go to the hospital.

For the past 6 months, the patient has been experiencing pain continuously every day, that would not get relieved on taking oral medication.

He also complains of losing at least 10 kg of weight in the past 6 months.

In August 2022 ,the patient had an episode of pain and vomiting, for which he was admitted to a hospital. A CT of abdomen was performed and a lump was found in the pancreas. On further investigation, it was found that the lump was not cancerous. The patient was given symptomatic treatment and discharged when he was stable.

On Sep 6 2022, the patient got admitted to a hospital after another episode of pain and vomiting. The patient was in the hospital for 12 days. He had multiple episodes of vomiting that would not get relieved on taking oral medication . A USG was done and the patient was diagnosed with acute pancreatitis. He was prescribed medication and was asked to follow a restricted diet . The patient has had no pain for the past 7 days.

The patient also complains of constipation and per rectal bleeding from childhood.

From the past 6 months, the patient also complains of severe pain in both the legs ( in the calf region ), below the knee . The pain would start while sleeping or sitting for a long time. It is muscular in nature. The pain would get reduced by massaging the area. The pain is so severe that he is not able to sleep. He does not get the pain while walking. It is not associated with any changes in the overlying skin or swelling or muscle cramps.

The patient also complains of dyspepsia from childhood, which would get relieved by taking medication.

3/12/2022( By Dr Saptarshi)

Ist incident: Left knee pain-

One wk ago while parking his bike in the garage his left knee collided with a collapsible gate. He didn't feel much pain at that time, no swelling or abrasion. But, while trying to walk/climb stairs/do any kind of movement or put pressure in the left knee he experiences a sharp localised pain in the rt side of patella. Pain experienced only during movement or when palpated.

Intensity same.

2nd incident: 1 yr ago during a RTA (his bike collided with toto) he injured his rt knee, rt elbow, rt hip and head injury (bleeding, no stitches). Recovered with first-aid and medications. After 3 months noticed his rt knee and rt elbow jt are tender and also swelled up. His rt hip jt non tender, only swelled up. Dr. did knee jt aspiration (pink color fluid aspirated) and bandaged. Was told he will be alright after 3 days. No treatment was done for the elbow or hip. But after removing the bandage, he saw again fluid had accumulated (knee swelled up and painful). He because of busy schedule ( as a planner in bridge construction) did not visit any Dr. He had to walk on an uneven surface in the construction site. He noticed his knee swelling and pain had reduced within 15 days. Since then no pain in rt knee.

For the past 9 months c/o rt elbow pain and inflammation (can palpate a soft moveable lump in the elbow jt.) A dull, achy pain felt on putting pressure, so difficulty in resting elbow on hard surface or writing. Progressively worsening.

For the past 9 months he noticed 2 palpable non tender lumps in the rt hip jt.

HISTORY OF PAST ILLNESS

The patient had one episode of high BP , which the doctor said was due to stress.

Known case of haemorrhoids from the age of 12 years old.

One episode of jaundice when he was 12 years old.

Not a known case of DM,HTN, asthma, TB, Thyroid condition, CVD, or Epilepsy.

FAMILY HISTORY

Father- Known case of heart block. Has a pacemaker.

Mother- Was diagnosed with Leptospirosis after which she passed away.

PERSONAL HISTORY

The patient is prone to stress.

DIET- Mixed