Tuesday, January 17, 2023

50 year old with abdominal pain

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CASE:
This is a case of 50 yr old male farmer came to Opd with chief c/o abdominal pain since december 4th 2022.

HOPI :
Patient was apparently asymptomatic 2 months back.Then he developed abdominal pain after consumption of food on 4th december 2022 in epigastric region and left iliac region.The pain is squeezing type,non radiating,increasing after consumption of food,lasts for about 20 to 30 minutes and relieves on its own,associated with abdominal bloating.
No h/o belching
No h/o regurgitation,
No h/o vomiting,
No h/o loss of apettite,
no h/o diarrhoea or constipation.
No h/o fever,
no h/o blood in stools,
no h/o SOB.
No h/o burning micturition

PAST HISTORY:
No similar complaints in the past.Not a known case of Htn,DM2,TB,Asthma,epilepsy,CVA,CAD.

PERSONAL HISTORY:
Mixed diet
Sleep and apettite normal
Bowel and bladder regular 
Addictions:- known smoker since 20 yrs 
                      smokes 8 to 10 cigarettes/                             day 
                      Occasional drinker 
                      Chews betel nut and khaini 3                         times/day 
No allergies 

FAMILY HISTORY:
Not significant

GENERAL EXAMINATION:

-  Patient was examined after taking his consent 
-  Patient is conscious , coherent , cooperative , well oriented to time , place and person 
-  He is moderately built and nourished 
-  No signs of pallor , icterus , cyanosis , clubbing , oedema , lymphadenopathy 

His vitals: 

Temperature : afebrile
BP : 120/80 mm HG 
Pulse rate : 78 / min 
Resp.rate : 16 cpm
Grbs:103 mg/dl

Systemic Examination:

GIT examination:-
Inspection
Oral cavity:-No dental caries,Staining of teeth seen
Abdomen:- 
Scaphoid shaped,
Umbilicus centrally placed and inverted,
No visible scars and sinuses,
No visible dilated veins,
No visible peristaltic movements or pulsations.
All quadrants move equally with respiration

Palpation:-
Done on supine position
No local rise of temparature 
No tenderness/rigidity /guarding
No hepatomegaly 
No sleenomegaly 
No other palpable mass felt 


Percussion:-
Tympanic note heard

Auscultation:-
Bowel sounds:- 8/ minute

Respiratory system Examination:-
Bilaterally symmetrical chest,
Chest movements with respiration are equal on both sides
Normal vesicular breath sounds heard

CVS examination:-
S1 S2 heart sounds heard

CNS examination:-
No focal neurological deficits

Investigations:-

USG abdomen:
Hemogram:-

Diagnosis:-
Solitary liver abscess(37mm×23mm heteroechoic solid lesion in segment 4B of liver)