35 year old with pain abdomen

 

CHIEF COMPLAINTS :


35 year old female who is a wig maker survived with 3 kids resident of nakrekal came to casuality with complaints of pain abdomen since Friday & vomiting’s since Friday, dyspepsia since 10 days 


HOPI & PAST HISTORY : 


Married at the age of 17 years , non consanguineous. 

1st child at 18 years - death of the first child at 24years due to varicella zoster. 

2nd child at age of 21 years - gave  birth to female child , now married 

3rd child at the age of 23 years -gave birth to female child , now married 

4th child at the age of 24years - gave birth to male child currently 10th class . 


HOPI & PAST H/O:

Patient was apparently asymptomatic 7 years back met with an RTA ,auto vs lorry sustained injury to her head , no loss of consciousness, no history of headache , no history of vomitings , was incidentally diagnosed with type -2 DM on irregular medication since then. 



DAILY ROUTINE : 


Wakes up at 5:30 am in the morning , gets ready for work and goes for work and comes back by 11:00 am and does house hold work , and sits at a kirana shop or play with her grand daughter . 

Earns around 4000/- month approx . 


Now, presenting with complaints of pain abdomen diffuse in type ,squeezing type of pain , associated with vomitings 2-3 episodes non bilious , non projectile , non foul smelling , non blood tinged . 

Didn’t pass flatus since 2 days 

Passing stools small amount. 

History of bloating , belching since 5 years using antacids . 

Passage of hard stools since 2 months ( Bristol stool chart - type 1 ) 


At presentation: 

Patient is consicous , coherent and Co-operative 

Febrile to touch 99.1 F 

Bp: 110/80mmhg 

Pulse :119 bpm regular normal volume 

CVS : s1 s2 no murmur 

Rs : fine crepts in left infra axillary and infra scapular area 

CNS : HMF intact 

Spo2: 92% RA 


Pallor + Icterus - , cyanosis - , clubbing - , lymphadenopathy - , pedal Edema + 



Personal history : mixed diet, appetite reduced

Regukar bowel and bladder movements

NON SMOKER AND NON ALCOHOLIC


Family history : mother is hypertensive, expired due to cva after bedridden for 6 months .


Drug history : NONE 

Cvs: apex beat 5th ics , mid clavicular line 
no thrill or heave


RS: Inspection : chest elliptical, bilateral  symmetrical
 
no trachea deviation

movements appear normal 
 
inspection : inspectory findings present

percussion: resonant note heard in all areas 

auscultation: normal breath sounds heard in all areas 



P/A: no organomegaly , breath sounds + , Tenderness + in left iliac region .

CNS : HMF intact 


DIAGNOSIS:  PAIN ABDOMEN UNDER EVALUATION WITH TYPE II  DIABETES













RYLES TUBE CONTENT - 200ML IN 18 HRS


 FINAL DIAGNOSIS:  ? INTESTINAL OBSTRUCTION 



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