A 37 Year old with chief complaints of abdominal pain.

 A 38 yr old male with chief complaints of abdominal pain. 

CASE

A 38 year old male came to OPD with chief complaints of abdominal pain since 4days.


HOPI

Patient  was apparently asymptomatic  4 days ago, then he developed epigastric pain insidious in onset ,continuous, stabbing pain,radiating to back,aggrevated on eating food,relived on bending forward

associated with vomitings(10episodes per day which is non-bilious, non-projectile,non blood tinged,content-food material).

H/O constipation  since 4 days.

H/O bloating  since 4 days.

PAST HISTORY 

No similar complaints  in the past. 

Not a known case of diabetes mellitus, hypertension,  thyroid,  epilepsy. 

No history of previous surgeries. 

PERSONAL HISTORY 

DIET : mixed

APPETITE : decreased 

SLEEP : adequate 

BOWEL : constipation 

MICTURITION :no urine output 

FAMILY HISTORY 

Not relevant 

GENERAL EXAMINATION 

PALLOR : Absent

ICTERUS : Absent 

CYANOSIS : absent

CLUBBING : Absent

LYMPHADENOPATHY : Absent

EDEMA : Absent

VITALS

TEMPERATURE  : Afebrile

B. P : 160/140 mm of Hg

SPO2: 99at room air

Respiratory rate : 22 cycles per minute. 

Heart rate-78bpm

SYSTEMIC EXAMINATION per abdomen 

Inspection:

Shape of abdomen : distended

Umblicus-central,inverted

No visible pulsations,no dilated veins,noscars,no sinuses

Palpation:

No local rise of temperature

Tenderness present over the left hypochondrium and epigastric

No organomegalyy

Percussion:tympanic note  heard all over the areas

Ascultation:

Bowel sounds are heard

C. V. S

S1 S2  are heard, no murmers


RESPIRATORY SYSTEM


RESPIRATORY SYSTEM- 

Patient examined in sitting position

Inspection:-

Upper respiratory tract - oral cavity, nose & oropharynx appears normal. 

Chest appears Bilaterally symmetrical & elliptical in shape

Respiratory movements appear equal on both sides and it's Abdominothoracic type. 

Trachea central in position & Nipples are in 4th Intercoastal space

No signs of volume loss

No dilated veins, scars, sinuses, visible pulsations. 


Palpation:-

All inspiratory findings confirmed

Trachea central in position

Apical impulse in left 5th ICS, 1cm medial to mid clavicular line                

Respiratory movement's equal on both sides

Percussion:-

                                       Right                     left

Supraclavicular- Resonant (R)                 (R) 


Infraclavicular-              (R)                        (R) 


Mammary-                     (R)                      Dull


Axillary-                          (R)                        (R) 


Infra axillary-               (R)                    (R) 


Suprascapular-             (R)                        (R) 


Interscapular-               (R)                        (R) 


Infrascapular-             (R)                       (R) 


Auscultation:-


                                      Right                     Left


Supraclavicular- Normal vesicular        (NVBS)

                        Breath sounds (NVBS) 


Infraclavicular-          (NVBS)                 (NVBS)


Mammary-                 (NVBS)                 (NVBS)


Axillary-                      (NVBS)                 (NVBS)


Infra axillary-     (NVBS)               (NVBS)

                                                          


Suprascapular-          (NVBS)                (NVBS)


Interscapular-            (NVBS)                (NVBS)


Infrascapular-         (NVBS)        (NVBS)

CNS

HIGHER MENTAL FUNCTIONS- 

Normal

Memory intact

CRANIAL NERVES :Normal

SENSORY EXAMINATION

Normal sensations felt in all dermatomes

MOTOR EXAMINATION

Normal tone in upper and lower limb

Normal power in upper and lower limb

Normal gait

REFLEXES

Normal, brisk reflexes elicited- biceps, triceps, knee and ankle reflexes elicited

CEREBELLAR FUNCTION

Normal function

No meningeal signs were elicited














Provisional diagnosis:

Acute necrotising pancreatitis. 

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