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A 35 yr old male pt.with abdomen pain

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Case History and Clinical Findings C/O PAIN ABDOMEN SINCE 10 DAYS WITH LOSS OF APETTITE,DISTENSION OF ABDOMEN SINCE 6 DAYS ,PEDAL EDEMA SINCE 5 DAYS ,YELLOWISH DISCOLORATION OF URINE SINCE 8 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK THEN HE DEVELOPED PAIN ABDOMEN WHICH IS DRAGGING TYPE,DIFFUSE PAIN ALL OVER THE ABDOMEN.PEDAL EDEMA SINCE 5 DAYS WHICH IS PITTING TYPE BELOW KNEES OF BOTH LIMBS.H/O LOSS OF APETITE,DECREASED URINARY OUTPUT N/K/C/O HYPERTENSION, ASTHMA,EPILEPSY,CAD,CVA. K/C/O DM SINCE 6 MONTHS ON METFORMIN,CHRONIC ALCHOLIC SINCE 15 YEARS. GENERAL EXAMINATION , VITALS; BP;110/70 MM/HG PR;64 BPM RR;16 CPM SPO2; 98% GRBS;67 MG% SYSTEMIC EXAMINATION ; CARDIOVASCULAR EXAMINATION ; S1S2 HEARD,NO THRILLS,MURMERS RESPIRATORY SYSTEM; NO DYSPNOEA,WHEEZE,VESICULAR BREATH SOUNDS HEARD P/A; SOFT ,NON TENDER,ABDOMEN DISTENDED,ENGORGED VEINS + ,SHIFTING DULLNESS + CENTRAL NERVOUS SYSTEM; NO ABNORMALITIES DETECTED PATIENT WAS ADMITTED WITH THE ABOVE MENTIONE COMPLAINTS AND NECE
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A32 yr old male pt.with metabolic syndrome

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Case History and Clinical Findings C/o of giddiness since 3 months last episode on October 16, 2022 one episode per day one episode last 10 to 20 secondsc/o of vomiting in the early morning only water no food particles after passage of stools in morning since three months today no episodeC/o of chest pain diffuse type (on/off) (diffuse type ) since 2-3 monthscomplaints of pain in epigastric region since 2 to 3 months only on pressingC/o of increased frequency of urine since two years more in morningC/o of decreased appetite since three monthshistory of past illness:History of renal calculi in right kidney 5 years back history of renal calculi in left kidney 4 years back relieved on medicationHistory of jaundice two times at the age of 4 years not a known case of diabetes mellitus hypertension, CVA,CAD, epilepsy, TB ,asthmaPERSONAL HISTORY :-Diet : mixedapetite:- decreased since three monthssleep ; adequatehabbits :- dinrks beer monthly once, smoking 3-4 cigarettes per daygeneral examin
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A 42 YR old male with ABDOMINAL DISTENSION

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Case History and Clinical Findings C/O ABDOMINAL DISTENTION SINCE 1 MONTH C/O PEDAL EDEMA SINCE 1 MONTH PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH BACK THEN DEVELOPED FEVER LOW GRADE , ON AND OFF NOT ASSOCIATED WITH CHILLS AND RIGORS RELIEVED WITH MEDICATION , LASTED FOR 3 DAYS , THEN DEVELOPED ABDOMINAL DISTENSION , INSIDIOUS ONSET AND GRADUALLY PROGRESSED TO PRESENT SIZE PATIENT ALSO COMPLAINS OF PEDAL EDEMA SINCE 1 MONTH IT WAS INSIDIOUS IN ONSET AND EXTENDED TILL MID-THIGH PITTING TYPE H/O SOB,DECREASED URINE OUTPUT H/O COUGH SINCE 4 DAYS , PAIN ABDOMEN H/O CONSTIPATION SINCE 4 DAYS H/O YELLOWISH DISCOLORATION OF THE EYES SINCE ONE MONTH N/H/O BURNING MICTURITION , VOMITING , LOOSE STOOLS N/H/O HAIR LOSS, LOSS OF APPETITE , MELENA PAST ILLNESS: K/C/O ALCOHOLIC LIVER DISEASE N/K/C/O HTN,DM2,EPILEPSY,CVA,CAD,THYROID DISORDERS , TB, ASTHMA TREATMENT HISTORY 6 ROUNDS OF ASCITIC FLUID TAPPING PERSONAL HISTORY OCCUPATION : AUTO DRIVER APPETITE : NORMAL DIET : MIXED BOWELS : CONSTIPATION
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A 38 yr old male with vomitings

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Case History and Clinical Findings CHEIF COMPLAINTS- PATIENT CAME TO CASUALITY WITH C/O 10-15 EPISODES OF VOMITINGS SINCE 1 DAY HISTORY OF PRESENTING ILLNESS- PATIENT WAS APPARENTLY ASSYMPTOMATIC 10 MONTHS BACK ,THEN HE DEVELOPED YELLOWISH DISCOLOURATION OF EYES,URINE AND ABDOMINAL DISTENSION FOR WHICH HE WENT TO HOSPITAL AND WAS DIAGNOSED WITH JAUNDICE FOR WHICH HE IS EVALUATED AND UPPER GI ENDOSCOPY WAS DONE ON 12/7/22-IMPRESSION - LOW GRADE OESOPHAGEAL VARICES,MILD PHG SINCE THRN HE IS HAVING SIMILAR EPISODES OF JAUNDICE ONCE IN A WHILE AND USG WAS DONE MULTIPLE TIMES USG IMPRESSION ON 6/12/22-MODERATE HEPATOSPLENOMEGALY,GALL BLADEER SLUDGE,NO EVIDANCE OF CHOLEDOCHOLITHIASIS,B/L MINIMAL PLEURAL EFFUSION[RT>LT],MINIMAL ASCITIES VISUALIZED. ON 14/12/22 USG IMPRESSION -MODERATE HEPATOSPLENOMEGALY WITH FATTY LIVER,ALTERED ECHO TEXTURE TO RULE OUT CLD CHANGES,MILD INTRA HEPATIC BILIARY RETICULAR DILATATION IN LEFT LOBE OF LIVER,GB SLUDGE ,MILD SPLENOMEGALY,MILD IHBRD NOTED IN THE LEFT
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A 62 yr old male pt.with abdominal distension

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Case History and Clinical Findings C/O ABDOMINAL DISTENSION HOPI:PATIENT WAS APPARENTLY ASYMTOMATIC 2 MONTHS BACK THEN DEVELOPED ABDOMINAL DISTENSION WHICH IS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE ASSOCIATED WITH LOW GRADE FEVER , PEDAL EDEMA NO H/O VOMITINGS , DARK COLORED STOOLS CONSTIPATION +, NO H/O ABDOMINAL PAIN BURNING MICTURATION . DECRASED URINE OUTPUT NO H/O OF BREATHLESSNESS , CHEST PAIN , COUGH COLD , PALPITATIONS , PND ,ORTHOPNEA H/O LOSS OF APPETITE , GENERALISED WEAKNESS +,NO H/O MALENA NOT A K/C/O DM ,HTN , ASTHMA , CKD ,CVA , THYROID DISORDERS , EPILEPSY GENERAL EXAMINATION : PATIENT IS C/C/C PR 88BPM BP 110 /80 MMHG RR 18 CPM GRBS -107 MG /DL ABDOMINAL GIRTH 87 CMS WEIGHT 53 KGS INPUT/OUTPUT-300/400 ML SYSTEMIC EXAMINATION CVS ; S1S2+ ,NO MUMURS RESPIRATORY ; BAE +, NVBS CNS : NFND PER ABDOMEN : DISTENDED , NON TENDER , SHIFTING DULLNESS +, NO ORGANOMEGALY FLUID THRILL + PSYCHIATRIC REFERAL WAS DONE : IMPRESSION : ALCOHOL DEPENDENCE SYNDROME ( CURRENTLY IN WITHDRAW
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A 60 YR old male pt. with decreased urine output

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Case History and Clinical Findings PATIENT CAME WITH C/O ABDOMINAL DISTENSION ,DECREASED URINE OUTPUT , SWELLING OF B/L LOWER LIMBS SINCE 4 MONTHS. C/O SOB ON EXERTION -GRADE 3 ON MMRC. C/O DECREASED APPETITE SINCE 2 MONTHS. C/O CONSTIPATION SINCE 1 MONTH ,PASSING STOOLS ON EVERY 3RD DAY. C/O BURNING MICTURITION SINCE 1 MONTH C/O FEVER SINCE 10DAYS C/O COUGH WITH EXPECTORATION SINCE 4 -5 DAYS ASSOCIATED WITH WHITIS MUCOID SPUTUM NOT BLOOD TINGED. HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC NORMAL 4 MONTHS BACK . HE THEN DEVELOPED ABDOMINAL DISTENSION WHICH IS INCIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE ,ASSOCIATED WITH PAIN ABDOMEN WHICH IS OF SQUEEZING TYPE IN UMBLICAL REGION ,AGGRAVATED ON TAKING FOODS .THERE IS SWELLING OF B/L LOWER LIMBS WHICH IS PITTING TYPE ,EXTENDING UPTO THE KNEE WITH NO AGGRAVTING OR RELIEVING FACTORS. FEVER IS LOW GRADE ,INTERMITTENT ASSOCIATED WITH CHILLS,RIGOR AND RELIEVED BY MEDICATION. NO H/O VOMITINGS,CHESTPAIN,PALPITATIONS,GIDDINESS,SEWATING . PAST HISTO
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A 21 YR OLD MALE WITH SOB SINCE 15 DAYS

Case History and Clinical Findings C/O FEVER,COUGH,SOB SINCE 15 DAYS C/O ABDOMINAL PAIN SINCE 3 DAYS HISTORY OF PRESENTING ILLNESS : PATIENT WAS APPARENTLY ALRIGHT 15 DAYS BACK,THEN HE HAD FEVER WHICH IS INSIDIOUS IN ONSET,GRADUALLY PROGRESSIVE ,HIGH GRADE, ASSOCIATED WITH CHILLS AND RIGORS.EVENING RISE OF TEMPERATURE PRESENT. C/O COUGH WITH SPUTUM SINCE 15 DAYS,GREENISH COLOURED SPUTUM,COPIOUS AMOUNT. SHORTNESS OF BREATH SINCE 15 DAYS ,GRADE 2 ,RELIEVED BY TAKING REST . NO ORTHOPNEA,NO PND. DIFFUSE ABDOMINAL PAIN WHICH IS SQUEEZING TYPE OF PAIN . NO H/O VOMITING,LOOSE STOOLS. BURNING MICTURITION + LOSS OF APPETITE + H/O WEIGHT LOSS PRESENT 10-15 KGS IN 1 MONTH. PAST HISTORY : N/K/C/O DM,HTN,EPILEPSY,THYROID DISORDERS,TB,ASTHMA HISTORY OF TONSILLECTOMY 10 YEARS AGO PERSONAL HISTORY : DIET : MIXED APPETITE : DECREASED SINCE 15 DAYS SLEEP : NORMAL BOWEL AND BLADDER : REGULAR ( BURNING MICTURITION +) NO ALLERGIES FAMILY HISTORY :INSIGNIFICANT GENERAL EXAMINATION : PATIENT IS CONSCIOUS , C
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