Medicine E log
Medicine case presentation
16.07.2020
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Case Discussion
A 21 year old female came with chief complaints of
- left side chest pain since yesterday
- Shortness of breath on bending since yesterday
HOPI
She was apparently asymptomatic 2 years back, then she developed loose stools multiple episodes for 2 days associated with pain abdomen squeezing type, No h/o vomitings. H/o fall on day 2 of loose stools admitted for 2 days. She fell on stones and sustained injuries over anterior chest wall and left arm and there was no bleed no abrasion.
Left sided chest pain since 1 year intermittently in retrosternal and left infraclavicular region which lasts for 10-15 mins spasm and got relieved with pins and needle sensation radiating to apical region, aggravates on taking deep breaths. 3rd episode associated with SOB. No h/o cough and pedal edema.
H/o loose stools mostly twice 20-25 episodes per day since 2 years small volume, non foul smelling, no mucus, associated with diffuse pain abdomen which was squeezing type and relieved with passing stools, tenesmus present , no dark coloured stools, no bleeding PR. No H/o Fever and vomitings
Last episode was 12 days back associated with pain abdomen.
Chest pain (4th episode)
She went to work in a cotton field, on day 2, she suddenly felt chest pain at reterosternal region, stopped working for 5 min and stood still, then she started ploughing she had chest pain pricking and dragging type radiating to apical region sudden in onset and SOB on bending forward sudden onset then suddenly sat down associated with giddiness then patient was unaware, attenders gave h/o LOC for 30 mins n no postictal confusion, took her to PHC treatment was given with IVF.
H/o similar complaints 2 months back.
No h/o tongue bite, bowel and bladder incontinence, involuntary movements.
Past history
Not a k/c/o DM, HTN, Asthma, Epilepsy, CHD and CKD
Drug history :
Not allergic to any known drug.
Personal history :
Diet : mixed
Appetite : Normal
Sleep : adequate
Bowel : regular
Bladder : irregular
-no addictions
Family history:
Not significant
General Examination :
Patient is conscious,coherent and cooperative. Moderately nourished and well built.
Temperature : Afebrile
Pulse rate : 88bpm
BP : 120/90 mm hg
RR : 16 cycles per min
SPO2 : 99%
GRBS : 121 mg/dl
Signs of pallor and icterus present.
No signs of cyanosis, clubbing, kilonychia, generalised lymphadenopathy and pedal edema.
Systemic Examination
Per Abdomen
Inspection :
Shape - scaphoid
Umbilicus - central
All quadrants moving equal on respiration
No scars, sinuses, dilated veins.
Palpation :
Soft, no tenderness, no local rise of temperature
Liver - not palpable
Spleen - not palpable
Percussion :
Liver dullness present at 5th right ICS
Auscultation :
Bowel sounds are heard
CVS :
Cardiac sounds : S1 S2 heard
No murmurs heard
Respiratory system :
Normal vesicular breath sounds heard
Bilateral air entry present
On palpation there was tenderness present over left 2nd rib.
Dyspnoea- no
Wheeze- no
Position of trachea- central
Breath sounds- vesicular
No Adventitious sounds heard.
CNS :
Patient is conscious, coherent, cooperative well oriented to time place and person.
Speech - normal
No signs of meningeal irritation
Higher mental functions- normal
cranial nerves- intact
motor system- normal
sensory system - normal
Reflexes :
Right Left
Biceps +2 +2
Triceps +2 +2
Supinator +2 +2
Knee +2 +2
Ankle +2 +2
Plantar Flexor Flexor
Based on the above findings, following investigations were sent :
Hemogram
serum electrolytes
Serum creatinine
CUE
HbsAg
Anti HCV antibodies
HIV
Widal test
ECG
Chest X-ray
USG
Stool culture and sensitivity
Stool for ova cyst
Diagnosis:
Irritable bowel syndrome with diarrhoea predominant with tietz syndrome.
Treatment :
Inj Ceftriaxone 1gm/IV/BD
Tab. PCM 650mg/Po/sos
Strict fever charting 4th hrly temperature charting
PR/BP monitoring
Tab. Pan 40mg/od
Advice at discharge :
Inj Ceftriaxone 1gm/IV/BD
Tab. PCM 650mg/Po/sos
Tab. Pan 40mg/od
Tab. Albendazole 400mg/po/od
Tab. Naproxen 250mg/Po/bd
InFebruary 2017, my immune system was not functioning correctly and my primarycare physician did a N.A.E.T. Treatment with Laser Acupuncture andAuricular Acupuncture to try to desensitize my body from the differentallergies and allergies to the metals. This procedure began to make me drained and very fatigued. He recommended that I have a GI Stool testdone as I was having GI issues in February 2017, to check for parasites,pathogens, bacterial flora, and fungi/yeasts. The results showed that I had a Bacterial Pathogen called Salmonella,high amounts of normal bacterial flora, called Enterococcus spp. andEscherichia spp., 2 parasites called Dientamoeba fragilis and Endolimax nana, and2 types of fungi/yeasts called Candida spp. and Geotrichum spp. The doctor recommended that I take Dr Itua Herbal Medicine to get rid of the Candida as that was the main concern at thetime and I did purchase Dr Itua Herbal Medicine and after taking it all as instructed I was totally cured so is a urged form of heart to believe in herbal medicines but yes indeed natural remedies should be recognize around the globe because is the only healing that has no side effect on each every healing, I will recommend anyone here with health challenge to contact Dr Itua Herbal Center on E-Mail drituaherbalcenter@gmail.com he capable of all kind of disease like Cancer,Hiv,Herpes,Kidney disease,Parkinson,ALS,Copd. with a complete cure without coming back.
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