CASE PRESENTATION

ALAMURI KHADHAR BASHA 3rd YEAR 1ST SEM

GENERAL DATA

Patients Name: Gil juanico Sex: M

Religion: Roman Catholic teachar Address: Davao city Date Admitted: Jan.3,2014 Reliability: 80%

Age: 54 y.o.
Occupation: Elementry school Status: Single Date of birth: Jun.15,1959

CHIEF COMPLAINT
*PROLONGED BODY WEAKNESS & ABDOMINAL PAIN *

HISTORY OF PRESENT ILLNESS

Patient felt severe abdominal pain in the LUQ,pain score of 7-8/10. Pain was radiating back to left flank and over symphysis pubis,burning type quite near the epigastric area,where he feels/locate it significantly. Aggrevated at night and with empty stomach, relived by having some semi solid foods. Consulted a clinic,where he was diagnosed to have UTI & managed with antibiotics (cant recall). Patient stated it was his starting day of unproper diet or indigestion.

18 Days PTA,on Dec.16

PARTINENT (+) =Abdominal pain,constipation PARTINENT (-) =Fever,cough,vomiting, Haematemesis

 4 Days PTA,on Dec.3

Patient felt severe pain,over the anal region,pain score of 8/10. Aggrevated by walking or doing some activities & relived by resting. Consulted in DMSF OPD,diagnosed to have internal hemorrhids & prescribed to have policresulin + cinchocaine hcl,some pain killers (cant recall). Patient stated his unproper diet was continuing so,he balanced with soft diet.

Patient stated that he was not able to tolerate his unproper diet,which he mentioned it as prolonged body weakness. So,he admitted DMSF hospt. Stating his chief complaint as prolonged body weakness with abdominal pain and previously diagnosed UTI. Laboratory tests CBC(showed dec.hemoglobin and inc.glucose) ,following endoscopy was done upon admission.

ODA, Jan.3

PAST MEDICAL HISTORY

Yr 2006 at age 45yrs Annual school. check up. Of unknown age Immunizations -> -> -> HYPERTENSION (10) at ARTHRITIS. Cant recall.
CURRENT REGIMEN:
Diclofenac 50mg bid/day Neobloc 50mg bid/day Metoprolol 100mg bid/day Luserten ??? Polocerculin + cinchocine hcl

PERSONAL AND SOCIAL HISTORY

Occational drinker (kind in parties) Somking none Description of life style: works from 8am 5pm,busy schedule & after reaching home relaxes himself to relive the stress Diet-fruits,bread,fish,vegetables.1cup rice/meal

Allergies - none

FAMILY HISTORY

HYPERTENSION

Mother(66) father.(79)

(-) diabetes mellitus,tb,jaundice,stroke,heart disease.

PHYSICAL EXAMINATION
VITAL SIGNS: BP 140/70, HR 72, Temp 36.8,RR 24. GEN APP: middle-aged MALE breathing spontaneously, answers yes or no to questions. HEENT: R pupil reactive 4mm 2 mm. L pupil sluggish and minimally reactive. No oral lesions. Tongue normal. No carotid bruits, JVD, thyromegaly or LAD. LUNGS:symmetrical ,no crackles heard. HEART: No gallops, murmurs, rubs, heaves or thrills. ABDOMEN: Hypoactive bowel sounds. burning, moderate to severe tender ness. EXTREMITIES: No c/c. No edema. SKIN: No rashes, echymoses or needle tracks. NEUROLOGIC: As described above. She is moving all extremities. RECTAL:No rectal exam done ,has hemorrhoids,tenderness.

REVIEW OF SYSTEMS
General: (+) changes in weight, (-) sweats, (+) weakness, (-) fatigue

Skin: (-) itchiness, (-) color changes, (-) pigmentation, (-) rashes, (-) photosensitivity, changes in hairs and nails
Eye: (-) blurring of vision, (-) redness, (-) itchiness, (-) pain, (-) increased lacrimation Ear: (-) deafness, tinnitus, discharge Nose: (-) epistaxis, (-) nasal discharge, obstruction, (-) postnasal drip Mouth and throat: (-) bleeding gums, sores, fissures, tongue abnormalities, dental caries, (-)sore throat, lump sensation Pulmonary: (-) hemoptysis

Cardiac: (-) easy fatigability, orthopnea, nocturnal dyspnea, syncope, edema GI: (-) retching, hematemesis, melena, hematochezia, belching, (+)dysphagia, indigestion, food intolerance, flatulence, (+)abdominal pain, constipation, hemorrhoids, (-) diarrhea, (-) vomiting GU: (-) urinary frequency, urgency, hesitancy, nocturia Musculoskeletal: (+) joint stiffness, pain,(-) swelling, cramps, muscle pain, weakness, wasting Endocrine: (-) heat-cold intolerance, polyuria, polydipsia Hematopoietic: (-) abnormal bleeding, (-) bruising Neurologic: (-) headache, seizure, mental status changes, head trauma

DIFFERENTIAL DIAGNOSIS
Chronic gastritis

Gastric ulcer
Pancriatitis Stomach cancer

CHRONIC GASTRITIS
Upper abdominal discomfort RULE IN

Nausea,vomiti ng

RULE OUT

GASTRIC ULCER
Epigastric pain,burning or aching pain Pain reffered to back,weight loss Pain worsen at night & while eating

RULE IN

Nausea,vomiting, bloating,belching

RULE OUT

PANCRIATITIS
LUQ abdominal pain,radiating back,pain worsen during intake of meal
RULE IN

Vomiting,naus ea,fever,jaundic e

RULE OUT

STOMACH CANCER
Stomach pain,sense of fullness,loss of appetite,weight loss,trouble to swallow
RULE IN

Nausea,vomitin g,tarry black stools,jaundice

RULE OUT

IMPRESSION
GASTRIC ULCER

DIAGNOSTICS
Physical examination Endoscopy Upper gastrointestinal (UGI) series
H.PYLORI INFX:
Non invasive ->

-serology
breath test Invasive -> -Rapid urease test -Carbon labeled urea

Stool occult blood test

SALIENT FEATURES - HISTORY

Epigastric pain,burning or aching pain
Pain reffered to back

Pain worsen at night & while eating

Sense of fullness,loss of appetite,weight loss,trouble to swallow Use of pain killers and arthritis hx medications

MANAGEMENT

ANTIBIOTICS -metrodinazole , amoxicillin , clarithromycin -to eradicate h.pylori -surgical intervention PROTON PUMP INHIBITORS -clansoprazole , omeprazole

Proton pump inhibitors (or "PPI"s) are g aroup of drugs whose main action is pronounced and long-lasting reduction of gastric acid production.

Bismuth salts -suppress or eradicate h.pylori Smoking reduction and rest Dietary modification Surgical procedure -vagotomy -Billroth I and Billroth II

VAGOTOMY (BILLROTH I)
A vagotomy is a surgical procedure that is performed only in humans. It is resection(removal of, or at least severing) of part of the vagus nerve.

ANTRECTOMY
is the resection, or surgical removal, of a part of the stomach known as the antrum. The antrum is the lower third of the stomach that lies between the body of the stomach and the pyloric canal, which empties into the first part of the small intestine.

GASTROJEJUNOSTOMY (BILLROTH II)

A procedure in which the duodenum is excised or bypassed and the stomach is end to end anastomosed to jejunum

FOLLOW UP CHECK UP