Medicine ELOG.

Hi,I am MATTUPALLI PRITISH JASPER  3 rd semester student.This is an online elog book to discuss our patient health data after taking his consent.this also reflect my patient centered online learning portfolio.

     

Cheif complaints: A 46 years old female who is a agricultural labour came with c/o SOB exertion since one week c/o abdominal distension since last week patient was apparently asymptomatic one year back and then devoloped dyspepsia for which she started using tablets on and off and was fine after taking tablets then she devolped SOB since one week which was not associated with chest pain and palpitations

HOPI: Pedal edema , cough . patient noticed a swelling in epigastric region during exertion and she also devolped abdominal distension since one week  no h/o of cough ,cold and fever  

History of past illness :

No h/o chest pain,palpitations and PND

No h/o headache 

No h/o burning micturition 

N/K/C/O HTN , DM ,TB , epilepsy ,asthma

Personal history : normal apetite

Bowels : Regular 

Micturition : normal 

Habits : Alcohol-No

Tobacco  Snuffs and chewables -No

Family history:

DM : No 

HTN :No

TB : No

Asthama : No

Any personal or hereditary diseases:No

Physical examination: 

Pallor : No 

No pallor  :No

Cyanosis :No

Oedema of feet : No

Temp : 99 degree F

Pulse ;86/min

Bp : 120/80 mm hg

Clubbing of fingers

Systematic examination:

Abdomen:

Shape of abdomen : Distended 

Tenderness : yes

Palpable mass : yes in epigastric region 

Liver : not palpable 

Spleen : not palpable 

Respiratory system:

No disponea no wheeze and position  of trachea is central  nd breath sounds are vesicular 

CVS : No thrills and no cardiac murmurs 

CNS : level of consciousness is alert and speech  is normal

Investigation : Hemogram, CUE HbsAg rapid,blood 

Sugar random, serum electrolytes ultra sounds at abdomen were taken

Diagnosis: Acid peptic disease with denova detected type 2 DM with epigastric hernia further treatment proceeded with surgery 

Treatment:

Inj:HAI with regular interval

Inj:NPH with regular interval

Inj  : PAN 40 mg 

Inj : opineuron amp

Tab : Ultracet 1/2 tab / SOS

 

 

 

 

Q1 what is the anatomical location of the patients problem ?

What is an epigastric hernia?

An epigastric hernia is a lump in the midline between your belly button and sternum (breastbone) which can cause pain.

Your abdominal cavity contains your intestines and other structures. These are protected by your abdominal wall, which is made up of four layers.

In an epigastric hernia, fat pushes out through a weakness in the wall of your abdomen between your belly button and sternum and forms a lump. The most common symptom is pain caused by the fat being pinched by your abdominal wall.

Peptic ulcer disease is characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin. It extends into the muscularis propria layer of the gastric epithelium. It usually occurs in the stomach and proximal duodenum. It may involve the lower esophagus, distal duodenum, or jejunum. This activity reviews the cause, pathophysiology, and presentation of peptic ulcer disease and highlights the role of the interprofessional team in its management.

Q2.why is the patient having this problem?

Causes and risk factors

An epigastric hernia is usually present from birth. It forms as the result of a weakness in the abdominal wall muscles or incomplete closure of abdominal tissue during development.

Some factors that may cause or exacerbate epigastric hernias include:

obesity

pregnancy

coughing fits

heavy lifting

physical labor

Causes of acid peptic disease include: 

Helicobacter pylori: H.pylori is responsible for around 60%-90% of all gastric and duodenal ulcers. 

NSAIDs: Prostaglandins protect the mucus lining of the stomach. Non steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac and naproxen prevent the production of these prostaglandins by blocking cyclo-oxygenase enzyme leading to ulceration and bleeding. 

Smoking, alcohol and tobacco: Cigarettes, alcohol and tobacco cause an instant and intense acid production which acts as though gasoline is poured over a raging fire! 

Blood group O: People with blood group "O" are reported to have higher risks for the development of stomach ulcers as there is an increased formation of antibodies against the Helicobacter bacteria, which causes an inflammatory reaction and ulceration.

Heredity: Patients suffering from peptic ulcer diseases usually have a family history of the disease, particularly the development of duodenal ulcer which may occur below the age of 20.

Steroids/Other medicines: Drugs like corticosteroids, anticoagulants like warfarin (Coumadin), niacin, some chemotherapy drugs, and spironolactone can aggravate or cause ulcers.

Diet: Low fiber diet, caffeinated drinks and fatty foods are linked to peptic ulcer

3. What are we doing about it ?

Pharmacological: Inj : hai

Inj : nap

Inj:opineuron

Tab : ultracet

 Non pharmacologicAl :  Ultra sounds abdomen , CUE , sugar levels ,, serum electrolytes

Q : What did you learn from the individual patient events that you experienced through their histories, 

     what did you learn from our PGs in terms of analysing the history and clinical examination

      techniques as well as findings? 

Ans : At first the patient came to opd with burpings so much before and after meals and she is having abdominal pain and unable to sleep and weakness 

So by thz way the patient had general examination and then some lab tests were written to see what is abnormal and ultra sounds at abdomen were also done that shows the impression of grade 2 fatty liver and epigastric omentum so having epigastric hernia through thz I came to know that whatever the patients have informed the symptoms the tests related to that problem were done and followed up  with symptomatic treatment .Tq