Case of abdominal pain

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Date of admission : 28 November 2021

A  42 year old female who is home maker came to the OPD with the chief complaints of : 

Abdominal pain since 3 days

Chest pain since 3 days

Shortness of breath since 1 day


 History of present illness : 

The patient was apparently asymptomatic 3 years ago

Normal routine of the patient 3 years ago : 

The patient used to wake up by 5 AM daily, carried out all the household work, ate some rice at around 10 and then used to go the farm to do some field work. Later she used to return at around 5 and then have some rice at 7/8 PM and sleep by 9/10 PM

3 years back as usually when she used to go to work, she started experiencing abdominal pain and chest pain which was dull in nature. 

This worsened and she was brought to our hospital when it was diagnosed as renal calculi. She received 3 day treatment and was discharged.

After discharge, she took herbal medication along with toddy. 

2 years back she stopped going to the work and her appetite was lost. She used to have little rice or chapattis whenever she felt like eating.

3 months back, she started experiencing the same abdominal pain and chest pain along with body pains that worsened on 28th November. She experienced shortness of breath that was present while sitting as well. 

She had history of vomitings (4 episodes) on the dame day that was non bilious, non blood tinged, non projectile, content was food, and this happened as soon as she ate meals.

She had frequent urination (once in every 2 hours) with pricking type of pain.

She has blurred vision since 6 months and her right eye was injured 3 months back.

She has constipation since 3 days


History of past illness :

The patient is not a known case of diabetes, epilepsy, tuberculosis, asthma, hypertension

She underwent hysterectomy 15 years back


Personal history : 

- The patient has loss of appetite

- She takes mixed diet

- No sleep disturbances

- She smokes (chutta) occasionally


Family history :

- There are no similar complaints in the family members


Treatment history :

- She is not a known case of drug allergy.


General examination :

- Patient is conscious, coherent, cooperative at the time of joining

- Pallor present

- No icterus

- No cyanosis

- No clubbing of fingers and toes

- No lymphadenopathy

- Bilateral pedal edema is absent














Vitals : temperature - Afebrile

             Pulse rate - 77 bpm

              Respiratory rate - 18 cycles per minute

              BP - 140/80 mm Hg

              GRBS - 136 mg/dl



Systemic examination : 


CVS

Inspection - chest wall is bilaterally symmetrical

- No precordial bulge 

- No visible pulsations, engorged veins, scars, sinuses

Palpation - JVP is normal

Auscultation - S1 and S2 heard



RESPIRATORY SYSTEM

- Position of trachea is central 

- Bilateral air entry is normal

- Normal vesicular breath sounds heard

- No added sounds


PER ABDOMEN 

- abdomen is non tender

- bowel and bladder sounds heard

- no palpable mass or free fluid present


CNS

- Patient is conscious

- Speech is present

- Reflexes are normal






Investigations : 








Final diagnosis : right renal calculi (ultrasound)


Treatment : 

IVF 45% NS 75 ml/hr
Syp Duphalac 10 ml PO BD (for constipation)
Tab Buscopan 1 tab PO sos (relieves stomach cramps)
Tab Pantop 40 mg PO OD
Soap water enema
Proctolysis enema
Monitoring vitals


Blurring of vision may be due to macular degeneration, glaucoma, cataract, diabetic retinopathy 

https://www.aafp.org/afp/1999/0701/p99.html

What would be the reason for her chest pain?

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