57 year old male with abdominal pain

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This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.


AFEEFA FARZANA ,8th SEMESTER

Roll no:09

This is a case of 57 year old male , resident of nalgonda district ,daily wage labourer 

CHIEF COMPLAINTS:

Abdominal pain since 9 days 


SEQUENCE OF EVENTS:

Patient was apparently asymptomatic 9 days ago then he developed fever which lasted for one day on 25 June 2022 associated with chills and rigors and subsided with medication and

 on that day evening he developed epigastric pain which was radiating to both the flanks,sudden in onset,gradually progressive stabbing type of pain ,pain aggravated on eating food

He also complained of shortness of breath grade 3 on the same day which was relieved

No history of nausea and vomiting,diarrhoea

DAILY ROUTINE:

He wakes up at 4:00am and completes his daily activities.He goes to work at 5:00am and does watering in the field and come back home at 8:00 am have breakfast and goes back to work ,he does different work daily ,depending on the work he gets that day and come back home in the evening by 7:00 pm. He consumes alcohol daily before eating dinner and then eats food and sleep

EVENTS LEADING TO THE PRESENT DAY:

The patient as usual woke up and went to work. He said his work that day was spraying fruits with some chemicals. He came home around at 11 am that day to have food. He had rice and dahl and developed fever insidiously after eating. His fever subsided in the evening and then he developed epigastric pain. He has not been going to work since the past few days and is at home taking rest since the pain is so severe. No one else in the family had similar complaints.

PAST HISTORY:

No similar complaints the past

Not a known case of Hypertension, diabetes 

PERSONAL HISTORY :

Diet :mixed

Appetite : decreased 

Bowel and bladder :regular

Sleep: adequate

Addictions: smoking beedi since 40 years .He smokes.                        25 beedis per day 

                     Alcohol consumption since 30 years daily                         90 ml before having dinner 


GENERAL EXAMINATION:

Pallor: present

Icterus : absent

Cyanosis: absent

Clubbing:absent

Lymphadenopathy:absent


VITALS

Temp :afebrile

BP:120/80 mmHg

Heart rate :90bpm

Resp rate :18cpm

















ABDOMINAL EXAMINATION:

Abdomen is obese
Soft 
Tenderness over epigastric and right hypochondriac region
Liver :firm to hard on palpation 
Murphy’s sign: absent
No rebound tenderness, shifting tenderness
No organomegaly
No shifting dullness
No fluid thrill
Bowel sounds heard

RESPIRATORY EXAMINATION:

Inspection 
 Chest bilaterally symmetrical, all quadrants
moves equally with respiration

Palpation
 Trachea central, chest expansion normal

Percussion
  Resonant

Auscultation
Bilateral  air entry present
Bilateral vesiculobronchial sounds heard
no added sound

CVS EXAMINATION :

Inspection 
precordial bulge
Palpation
Apical impulse in 5th intercostal space in mid clavicular line
Auscultation
 S1, S2 heard
No murmurs

CNS EXAMINATION
No focal neurological deficits

INVESTIGATIONS:






PROVISIONAL DIAGNOSIS 

liver abscess
Cholelithiasis


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