A 32 yr old male...

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Cheif complaints :

A 32 yr old male patient came to opd with cheif complaints of abdominal pain since 1day

HOPI

Patient was apparently asymptomatic 1 day back, then he developed diffuse abdominal pain which increased after food intake , non radiating pain, not relieved on medication.
No H/o Fever
No H/o vomiting
No H/o decreased urine output
No Abdominal rigidity
No H/o burning micturition 
No H/o constipation
No regurgitation 
No edema

PAST HISTORY
 Not a known case of HTN, DM, CVA, TB, ASTHMA, Epilepsy.
No similar compliants in the past.

FAMILY HISTORY
Not significant 

PERSONAL HISTORY
Diet - normal
Appetite Normal
Bowel movements - Regular
- Consumes alcohol 
- Smoker

GENERAL EXAMINATION 

Patient is examined in a well lit room.
Moderately built and nourished.

Icterus is present(sclera).
Clubbing is present.
No signs of pallor, cyanosis and lymphadenopathy.


VITALS
Temp - afebrile
Pulse rate - 87 bpm
Resp. rate - 16cpm
BP - 130/90 mm Hg
Spo2 - 98% at RA

SYSTEMIC EXAMINATION
CVS
S1 and S2 heard
No murmurs

Examination of abdomen
Shape - obese
No Tenderness
No palpable mass
No free fluid
Bowel sounds are heard
AG - 84 cm


CNS
Conscious, coherent and co-operative
Speech is normal 
No meningeal signs


- Reflexes 

             Biceps   Triceps   Supinator   Knee    Ankle
Right      ++            ++          ++                 ++       ++
Left        ++            ++          ++                 ++        ++

- No cerebellar signs

Investigations

Serology
HBsAg - negative
HIV     - negative




ECG REPORT

PROVISIONAL DIAGNOSIS
- ? Alcoholic liver disease

Treatment
              1. Inj Thiamine 100mg IV/OD in100ml NS
                 2. Tab PAN 40mg Po/OD
                 3. Tab Udiliv 300mg PO/BD
                 4.Tab. Viboliv 500mg PO/OD
                 5. SYP SUCRALFATE 15 ml PO/BD
                 6.Tab DOLO 650mg SOS.
7. Syp Lactulose 15ml PO/BD


























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