2nd degree Paralytic lieus

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SCENARIO:

A 50 year old female presented to the OPD with SOB and constipation.

COMPLAINTS AND DURATION

  • Constipation since 3 days
  • Pain in abdomen
  • Shortness of breath
  • Nausea and vomiting since 3 days
  • Pain in chest since 2 years 

HISTORY OF PRESENT ILLNESS

Patient apparently asymptomatic 2 months ago, developed shortness of breath, pain in abdomen(right side tenderness and right hypochondriac pain) and constipation.This was followed by 4 episodes of vomiting

HISTORY OF PAST ILLNESS

  • Not a K/C/O HTN, DM, asthma, epilepsy
  • Renal caliculi treated conservatively 2 years ago

TREATMENT HISTORY

No significant treatment history

PERSONAL HISTORY

  • Appetite - Normal
  • Bowels- Constipated
  • Micturition -Normal
  • No known allergies
  • No addictions

FAMILY HISTORY

  • No significant family history

MENSTRUAL HISTORY

  • Hysterectomy done 15 years ago for fibroid bodies

PHYSICAL EXAMINATION

A.                GENERAL

  • Pallor - Yes
  • Icterus - No 
  • Cyanosis - No
  • Clubbing of finger/toes - No
  • Lymphadenopathy - No
  • Oedema - No
  • Temperature - afebrile 
  • Pulse rate 70 b/min
  • Respiration rate - 17/min
  • BP 1400/80 mmHg 

SYSTEMIC EXAMINATION 

B.     CARDIOVASCULAR SYSTEM

  • Thrills - No 
  • Cardiac sounds - S1 , S2 positive

C.     RESPIRATORY SYSTEM 

  • Dysponea - No 
  • Wheeze - No
  • Position of trachea - Central 
  • Breath sounds - Vesicular  

D.    ABDOMEN

  • Shape of abdomen - Scaphoid
  • Tenderness present 
  • Palpable mass absent 
  • Liver and spleen non palpable 
  • Bowel sounds - Sluggish

E.     CENTRAL NERVOUS SYSTEM 

  • Level of consciousness 

1.     Alert

2.     Stuporous 

  • Signs of meningeal irritation

1.     Neck stiffness - no

2.     Kerning’s sign - no

  • Cranial nerves - normal 
  • Motor system - normal
  • Sensory system - normal 
  • Glasgow system - normal 
  • Cerebral signs

1.     Finger nose coordination - Yes

2.     Knee Heel In-coordination - Yes

F.MUSCULO SKELETAL SYSTEM - normal 

G. SKIN - normal 

H. EXAMINATION OF BREAST - normal

I. EXAMINATION OF ENT - normal

J.EXAMINATION OF TEETH AND ORAL CAVITY - normal

K. EXAMINATION OF HEAD AND NECK  - normal


INVESTIGATIONS






 

TREATMENT

  • IV fluids
  • Soap water enema 
  • Buscopan SOS 
  • Pan D
  • Duphalac  

 

PROVISIONAL DIAGNOSIS/ DIAGNOSIS 

  • Constipation with 2nd degree paralytic ulcer

 

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