Case of epigastric pain

 A 28 yr old male came to the opd with the following cheif complaints

Cough since 5 days 

Epigastric pain since 3 days

HISTORY OF PRESENTING ILLNESS

The patient was apparently asymptomatic 5 days back.He developed cough since 5 days which was dry at the begginong and later it became productive.

Since 3 days he developed pain in the epigastric region which was insidious in onset and gradually progressive in nature that aggaravated while coughing.

Also has on and off episodes of fever.

PAST HISTORY

N/K/C/O DM, HTN, ASTHMA,TB,EPILEPSY

PERSONAL HISTORY 

Diet - Mixed

Appetite- decreased 

Bowel and bladder movements-passing urine regularly but did not pass stool  for 2 days

Sleep-adequate

Addictions:  consuming alcohol since 10 yrs initially occassionally but from 6 years started consuming daily ( 1 quarter)


GENERAL EXAMINATION

Patient is conscious coherent cooperative, well oriented to time ,place, person

moderatly built and moderately nourished 

 Pallor- mild 

icterus- absent

cyanosis- absent

clubbing- absent

Lymphadenopathy - absent

Edema- absent





VITALS 

 Bp - 100/70 mm hg

PR - 84 bpm

RR -20 com

GRBS - 130 mg/ dl

SYSTEMIC EXAMINATION

•CVS: S1, S2 heard

RS: BAE present

CNS: intact

PAE:

▪INSPECTION inspection- shape - schapoid and symmetrical

umbilicus- inverted and central in position
no visible scars, dilated veins


▪PALPATION- local rise of temperature in epigastric right hypochondriac, right lumbar, umbilicus area   tenderness in epigastric and  right hypochondrium , 
▪Hepatomegaly present, spleen not palpable
▪ no shifting dullness present
▪no palpable mass
▪Bowel sounds-heard







Day 2


29/09/22



PROVISIONAL DIAGNOSIS

? AMOEBIC LIVER ABSCESS














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